View report page

7
logical examination which has not included character 5 ; and others again in which both characters
4 and 5 have been disregarded, no cultural tests at all having been applied. It would seem, therefore,
that cases which would have been identified as cerebrospinal fever by one bacteriologist would not
have been included by another.
The position of the bacteriologist would appear to be this. The meningococcus is not
a substance which can be exactly tested for, as a poison is, by certain delicate but definite chemical
tests, but is rather to be considered as a plant which is examined and grown and observed in various
ways ; its recognition in some cases is simple, in others is doubtful or difficult; and recognition then turns
on the general behaviour of the plant, as estimated by the acumen and experience of the observer. In
such delicate and highly skilled diagnosis as this much would seem to turn on the personal equation of
the bacteriologist. It does not seem possible to lay down an exact standard to which each suspected
meningococcus can be fitted.
I should like now to note some possible objections which may be raised to the considerations
which have been advanced. Criticism is apt to take this form. If you are going to take all this time
and trouble, such as waiting for a post-mortem examination, or making a long bacteriological enquiry,
before identifying the various cases as they arise, it will place the recognition of the disease outside
the power of all but a few specialists, and may greatly delay the adoption of preventive measures. I
should reply, if this be so, it cannot be helped and we must put up with it. We must face the facts as
they are and endeavour to ascertain the truth to which they lead. If we do not at once understand them
we can at least refrain from constructing unnecessary hypotheses; it is better to confess ignorance than to
embrace error. But I do not see what harm is done by delay in the final identification of cases. There
has been in London, recently, no evidence of infection, and if such arose, there is ample means for the
notification and isolation of suspected cases. On the other hand, by careful2 enquiry, there is the opportunity
of advancing knowledge of the natural history of the disease, and the placing of it on record for the
benefit of the public and of medical knowledge. It seems to me not only a waste of time, but actually harmful,
to generalise from cases of secondary suppurative and tuberculous meningitis (if such they be), and
record their behaviour as that of another disease, viz., cerebrospinal fever. What importance, for
instance, would be attached to the records of an investigation into the natural history of primroses, let
us say, when there was reason to suspect that a large number of the specimens were, in point of
fact, not primroses at all, but were buttercups and daisies ? I submit that articles on cerebro-spinal
fever, and accounts of epidemics, would gain much in value if the reader could be referred to a
detailed analysis of the cases upon which such accounts are based, and to the methods by which the
cases are identified.
The foregoing notes have no pretensions to completeness, nor have I any theory to press, or position
to take up, in regard to the disease. I am in a state of ignorance about it. What I do feel is that
further enquiry is needed, and that there is oneway, and only one, in which the obscurity of the disease
is likely to be dispelled and knowledge advanced ; and that is by a collective and extended investigation
of cases as they occur, and by gathering together the various scraps of evidence obtainable.
I have indicated above some of the points which occurred to me as being worthy of note in
future enquiry. The principal requirement, however, is the adoption and general use of a definition
which would facilitate the ready and accurate classification of the varieties of meningitis.
W. Mc C. Wanklyn.
Public Health Department.
8, St. Martin's Place, W.C.
October, 1908.