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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.
Kernig's sign* and the tâche cérèbrale† 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
intracellulars of Weichselbaum, and is to be found in the
cerebro-spinal fluid, which can be withdrawn from the lower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.
In London, during 1908, 12 deaths were registered from
cerebro-spinal fever, and 85 cases of the disease were notified.
*To obtain this sign the patient is placed so that the 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—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.
d 2