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notice which has been taken of the recent indentification of a case in
the neighbourhood of London, and of several cases, four of which
terminated fatally, at Irthlingborough in Northamptonshire.
Cerebro-spinal fever is not a rare occurrence in the United
Kingdom. In the course of the last forty years this malady is
known to have been prevalent in a considerable number of different
localities in England and Wales, several of these loci.1 outbreaks
having taken place in recent years. In some instances they have
formed the subject of investigation by a medical Inspector of the
Local Government Board, whose report has usually been made
public. Occurrences of cerebro-spinal fever have also been observed
in Scotland and in Ireland. There is indeed, as will appear later
reason for belief that this disease is even less uncommon in this
country than the foregoing particulars would seem to indicate.
The late Mr. Netten Radcliffe defined cerebro-spinal fever as
"an acute, epidemic disease, characterised by profound
disturbance of the central nervous system, indicated at the
onset chiefly by shivering, intense headache or vertigo or both,
and persistent vomiting: subquently by delirium, often violent,
alternating with somnolence or a state of apathy or stuper: an
acutely painful condition with "spasm—sometimes tetanoid—of
certain groups of muscles, especially the posterior muscles of
the neck, occasioning retraction of the head; and an increased
sensitiveness of the surface of the body. Throughout the
disease there is marked depression of the vital powers; not
unfrequently collapse : and in its course an eruption of vesicles,
petechial, or purpuric spots, or mottling of the skin, is apt to
occur. If the disease tend to recovery, the symptoms gradually
subside without any critical phenomena, and convalescence is
protracted: if to a fatal termination, death is almost invariably
preceded by coma. After death the enveloping membranes of
the brain and spinal cord are found in a morbid state, of which
the most notable signs are engorgement of the blood vessels,
usually excessive, and an effusion of sero-purulent matter into
the meshes of the pia mater and beneath the arachnoid."