View report page

6'2
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; subsequently by delirium, often violent, alternating
with somnolent or a state of apathy or stupor; 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 tends to
recovery, the symptoms gradually subside without any critical
phenomena, and convalescence is protracted; if to a fatal termination
death is almost invaribly 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 seropurulent
matter into the meshes of the pia mater and beneath
the arachnoid."
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,
110 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 whatwould 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 sore-throat; and by the occurrence of cerebro-spinal fever
in Irihlingborough 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 absent, 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
* 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. In cases of meningitis this appears earlier (within 30 seconds),
lasts longer (8, 10, or 15 minutes), and is broader and of deeper colour than in healthy
persons.