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52
the meshes of the pia mater and beneath the arachnoid.
Kernig's sign "and the tache cerebrale | are also present."
The disease appears at times in an anomalous form, giving
rise to difficulty in diagnosis. Further, the symptoms may vary
from the mildest to the most severe ("fulminant" variety)—in
the latter death ensuing rapidly.
The germ that is generally regarded as the specific cause of
cerebro-spinal fever is known as the diplococcus meningitidis
intracellularis of Weichselbaum, and is to be found in the cerebrospinal
fluid, which can be withdrawn from the lower part of the
spinal canal by lumbar puncture.
In all the cases notified in the Borough of Lambeth,precautionary
measures have been taken as to disinfection, the rooms being
also stripped of their wall papers and thoroughly cleansed. In
no single instance has the disease spread amongst the inmates of
a house wherein the disease has first appeared. Systematic
enquiries have been made in each case, and the results tabulated
under the following headings agreed upon by the medical officers
of the different Metropolitan Districts in consultation with the
County Medical Officer of Health :—
District—name—-address—occupation—date of beginning of
present illness with symptoms in their order of development, e.g.,
character of onset, vomiting, headache, delirium, coma, tache
cerebrale and evidence of muscular rigidity, retraction of head,
Kernig's sign—recent illnesses of patient, including discharges from
ear or nose, enlarged glands, etc.—whether away from London
*To obtain this sign the patient is placed so that the hip-joint is semiflexed,
and while the hip-joint is retained in this position, the knee-joint is
extended passively. A contraction of the ham-strings 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—such streak appearing earlier (within
30 seconds), lasting longer (8, 10, or 15 minutes), and being broader and of
deeper colour than in healthy persons.