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much evidence of the disease in London at the present time, but
in view of its extremely fatal nature and of its epidemic character,
it is desirable that sanitary authorities in the Metropolis should be
on the alert to deal with any emergency that may arise.
Cerebro-Spinal Meningitis is an infectious disease occurring
sporadically and in epidemics, characterised by inflammation of the
membranes of the brain and spinal cord and a very variable
clinical course. The disease was first described in 1805, when a
small outbreak occurred in Geneva. Since that time various
epidemics of it have occurred, both in Europe and America. The
epidemics are localised, occurring in certain regions, and not
exhibiting the usual tendency to become widespread, which
characterises certain other forms of epidemic disease. Country
districts have been more affected than cities as a rule. Children
and young adults are most susceptible to the disease, and it has
shown a disposition to attack young soldiers concentrated in
barracks and camps. Considerable doubt exists as to its infectious
nature, or rather, as to the mode of infection and its degree of
infectiveness. There can be little doubt that it is infectious, but
there is evidence that it is not so to any very great degree; and
that it is materially influenced in this respect by environment, the
incidence of the disease being mainly confined to the more crowded
and destitute portions of towns and cities.
The real nature of the disease was first disclosed through the
isolation by Weichselbaum, of Vienna, in 1887, of an organism from
the cerebro-spinal fluid, to which he gave the name of Diplococcus
Intracellulars Meningitidis, which was invariably present in cases
of the disease. Other investigators confirmed Weichselbaum's
observations; and later researches by Von Lingelsheim, who reproduced
the disease in monkeys by injecting into the spinal canal
of the animals the meningococcus or specific organism, when
lesions identical to those found after death in man were found at
the post mortem, placed the origin of the disease beyond doubt.
Recent investigations have been carried out by Dr. Gordon on
the bacteriology of the disease, and his report has been published
by the Local Government Board, and forms a valuable contribution
to the literature of the subject. Dr. Gordon has also found the
organism in the secretions from the upper air passages ; and, in
addition to providing a readier and more accessible method of
obtaining the organism for diagnostic purposes, suggests a highly
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probable mode of entry of the disease into the system and the
means by which the disease is spread.