View report page

83
To the clinical manifestations of the disease, indicated in this
definition, may be added the presence of Kernig's sign* and of
tache cerebrate.†
Local prevalence of a malady distinguished by the foregoing
features would, no doubt, attract attention and would, it may be
presumed, lead to early recognition of its true nature. But, while
these features are characteristic of cerebro-spinal fever of typical and
severe sort, experience has taught us that this fever may and does
appear in milder or in anomalous forms which render identification
difficult, and which lead to its being mistaken for other ailments of
more common occurrence in this country. Illustration of this is
afforded by certain localised outbreaks of cerebro-spinal fever in the
eastern counties in 1890, where this disease was generally mistaken
for sunstroke or for enteric fever, or was looked upon as a new form
of illness; by the prevalence of what would seem to have been
cerebro-spinal fever in Northamptonshire in 1890-91, where the
malady was for the most part diagnosed as pneumonia or as sorethroat
; and by the occurrence of cerebro-spinal fever in Irthlingborough
in the present year, where many of the persons attacked
were regarded as suffering from influenza. In these anomalous
forms of cerebro-spinal fever, many or even most of the symptoms
associated with the recognised type of the disease may be absentj
while, in mild cases, they may be so slight or of such brief duration
as to escape notice. It is, however, for such cases that it is
necessary to be on the outlook, whether in relation with a definite
occurrence of cerebro-spinal fever in a locality; or by reason of the
prevalence in a particular neighbourhood of illness not clearly
referable to definable cause. In these circumstances, there would
be advantage in the local medical officer of health endeavouring to
secure, by arrangement with the medical men practising in his
district, information as to the existence of cases of the kind in
question.
* To obtain this sign, the patient is placed so that hip-joint is semi-flexed, and
while the hip-joint is retained in this position, the knee-joint is extended passively.
A contraction of the hamstrings then sets in which causes resistance to the extension,
† A congested streak produced by drawing the finger-nail gently over the
patient's thigh, abdomen, or face. In cases of meningitis this appears earlier
(within 30 seconds), lasts longer (8, io, or 15 minutes), and is broader and of
deeper colour than in healthy persons.