Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 9 (7).djvu/6

196 Cerebro-spinal fever is much more prevalent in the United States of America and Canada than in this country, and undoubtedly one of the most important factors that contributed to its prevalence in an epidemic form in the British Isles was the concentration of troops at various centres in this country, and more especially the arrival of the Canadian troops—this was undoubtedly an important factor in the subsequent prevalence of the disease.

To most members of our profession, prior to 1914-15, this disease was only known by name.

Cerebro-spinal fever may be defined as a specific disease due to infection of the organism by the Diplococcus meningitidis of, occuiring both in epidemic and in sporadic form, and most often showing itself as a meningitis involving the whole cerebro-spinal axis.

The first authentic account of an epidemic is that which occurred in Geneva in 1805. Glimpses of the disease, in this epidemic form, are met with in the literature of the Middle Ages.

The epidemic in Geneva does not appear to have been widespread, as only thirty-three persons died of the disease.

The interest lies in the contemporary records: the clinical symptoms were accurately described by, as well as the post-mortem appearances by.

writes: "The initial symptom was a sudden failure of strength; the expression was anxious; the pulse was feeble, sometimes threadlike, in a few cases hard and bounding". There was violent headache—in the main, frontal.

"The headache was followed by the vomiting of green matter, by stiffness of the spine, and, in infants, by convulsions.

"The body shewed livid patches after death—occasionally, during life."

well describes the post-mortem appearances: "The vessels of the meninges," he says, "were notably congested; a gelatinous humour covering the brain was markedly tinged with blood. There was fluid in the ventricles. The choroid plexus was of a deep-red colour.