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Cerebrospinal Fever.
Reports of the prevalence of cerebro-spinal fever in Glasgow and Belfast indicated the need
for watchfulness over any cases of this disease which might occur in London. There had been no
special manifestation of this disease in London, the number of deaths attributed to this cause in London
having been in 1902, 4 ; 1903, 6 ; 1904, 6 ; 1905, 5 ; and 1906, 4. It appeared desirable, however,
that, in anticipation of possible increase of the number of deaths in London attributed to this disease,
and to the further possibility that an increase in the number of cases might occur without immediately
manifesting itself in the death returns, that the disease should be notified and suspected cases
should, as far as possible, be studied. Hence on the 12th February, 1907, the Public Health Committee
presented the following report to the Council:—
We have had under consideration the prevalence of cerebro-spinal fever in Glasgow and Belfast, and have
received from the medical officer a report on the subject. It does not appear, from the returns issued by the RegistrarGeneral,
that there has been any increase of deaths in London under the headings which might be thought of as
possibly including cases of this disease. Moreover, the medical officer has inquired at the principal general hospitals
and children's hospitals in London, with a view to learning whether there is reason for thinking that cases of this
disease in its epidemic form are occurring in London, and the information we have received from these sources is
altogether reassuring. We are, none the less, of opinion that systematic inquiry should be made, for some time to
come, into cases of disease which raise question as to cerebro-spinal fever, and, for this purpose, we shall submit to
the Council on 26th February, 1907, the earliest possible date, a recommendation that, for a period of six months,
cases of cerebro-spinal fever shall be notified in London. We are not at the present proposing to extend to this disease
any other provisions of the Public Health (London) Act, 1891, to allow the precedent of notification of chickenpox,
concerning which the Council has in the past made similar orders at times of prevalence of small-pox. In our
report to be presented later we shall deal with the question of providing facilities for the diagnosis of the disease.
On the 26th February the Council made an Order requiring cases of cerebro-spinal fever (epidemic
cerebro-spinal meningitis) to be notified for a period of six months, and Dr. Wanklyn was instructed
to proceed to Glasgow with a view to learning any lessons which the experience of that city might
teach in respect of this disease.
Later, question arose as to whether the term epidemic cerebro-spinal meningitis included cases
of posterior basal meningitis, and the Council sought the advice of the President of the Royal College
of Physicians, Sir Richard Douglas Powell, Bart., who appointed a Committee to advise on this matter,
the Committee consisting of Sir Thomas Barlow, Bart., M.D., Dr. F. E. Batten, Dr. W. H. Hamer, Dr.
Rolleston and Dr. G. F. Still.
The recommendation of this committee and the action taken thereon is shown in the following
report which the Public Health Committee presented to the Council on the 18th of June:—
In connection with the notification of the disease, a question was raised whether the term " cerebro-spinal
fever" includes, for the purposes of notification, cases of posterior basal meningitis. On this point we deemed it
necessary to consult the President (Sir Richard Powell, Baronet) of the Royal College of Physicians, who appointed a
committee to advise on the question, and that committee has reported as follows—
" We find clinically that, although as regards symptomatology and duration there are some differences
which might separate the most marked cases of cerebro-spinal fever (epidemic cerebro-spinal meningitis) and
posterior basal meningitis from one another, nevertheless intermediate cases occur in which such differentiation
is impracticable.
It cannot (at present) be maintained by experts with absolute certainty that there is any demonstrable
difference in the bacteriology of the two diseases. The organism which is commonly associated with each
disease is microscopically the same (meningococcus, micrococcus intracellularis, diplococcus intracellularis
meningitidis), such variations as may be met with being dependent on minor differences in cultural characters.
It is noteworthy that, so far as has been ascertained at present, both diseases tend to occur during the
earlier months of the year, and that, although the occurrence of the disease in both instances is epidemic, in
neither has it the characteristics of a spreading malady.
The committee recommend—
(i.) That, inasmuch as the season in which the disease is liable to be prevalent will not recur for seven to
nine months, the order of notification at present issued should continue in force for a period of two years, in
order to cover two possible epidemic periods.
(ii.) That, in the order of notification distributed to practitioners, it should be stated that for notification
purposes the disease at present known as posterior basal meningitis is included under the term cerebro-spinal
fever.
(iii.) That, after notification, further details of the cases should be obtained (a) in hospitals through the
courtesy of the medical officers in charge, (b) in private by a special officer available to investigate the case
bacteriologically or otherwise if desired, in association with the practitioner in charge."
We are confident that the Council will value highly the advice so courteously given by the President of the
Royal College of Physicians and his colleagues who composed the committee.
The operation of the notification order now in force will continue until 12th September, 1907 ; but we shall
shortly submit a recommendation to give effect to recommendation (i.), and, if and when such extended order be made,
we shall cause medical practitioners in the county to be informed that, for the purposes of notification, the disease
at present known as posterior basal meningitis is included under the term cerebro-spinal fever, but that the term
cerebro-spinal fever is not to be interpreted to include cases of meningitis due to tubercle, syphilis, middle-ear disease
or injury.
As regards recommendation (iii.), we are in communication with the medical officers in charge of the London
hospitals with a view to their co-operating with the Council in furnishing details of the cases under their care. The
metropolitan medical officers of health already co-operate with the Council in obtaining particulars of cases of the
fever occurring in London, and we propose that the services of Dr. Wanklyn, the assistant medical officer of health,
should be available with a view to the investigation of cases in association with medical practitioners in London,
should they so desire. In this connection we desire to express our appreciation of the opportunities courteously afforded
by Dr. Chalmers, the medical officer of health of Glasgow, to Dr. Wanklyn, who, acting under our authority, recently
visited Glasgow with a view to studying the course of the outbreak of cerebro-spinal fever in that city.
We are making arrangements as regards the bacteriological investigation suggested by the committee, the
Council having on 26th February, 1907 (p. 460), sanctioned expenditure not exceeding £200 in respect of precautionary
measures against the spread of the disease.
On the 9th July the Council made an Order extending the period of notification of cerebro-spinal
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