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observed in that one remaining case. Second, in hospitals "cerebro-spinal fever very rarely spreads";
the Advisory Committee refer to one case, that of a nurse at Exeter, "the only case of the kind alluded
to in these reports." A similar single case was reported in London. Here, again, in view of the size
of the nurse population of the country, no significance, qua direct case to case infection, can attach
to these two occurrences.
Thirdly, the Committee call attention to the very remarkable findings of Drs. Eastwood and
Scott, concerning the prevalence of the meningococcus in the throats of non-contacts in London, during
the spring and early summer months of 1915 ; the former found 10 per cent., the latter 13 per cent.,
of carriers among those examined. These percentages closely correspond with findings among more
or less close contacts, and the results support the hypothesis suggested by the Advisory Committee
(p. 39), viz., that the proportion infected in the case of contacts represents "the proportion of carriers
already present among the population, where the case had arisen." This simple hypothesis is one
which it seems difficult to reconcile with the views hitherto commonly held concerning the causal significance
of the meningococcus. The difficulty is, moreover, emphasized by reason of the fact that from
the Advisory Committee's and other reports it is clear that question has arisen as regards acceptance
of criteria, formerly regarded as reliable for purposes of bacteriological diagnosis ; thus, it seems that
" scattered Gram positive cocci (may occur) amongst the Gram negative majority"; again certain
anomalies are encountered in connection with fermentative reactions; and, finally, it is necessary to
realise, as regards failure of growth at 23 deg. C., that" this test, put forward as of diagnostic value,has, in
the experience of most of the reporters, proved an unreliable one." Nevertheless the writers of the
Advisory report say " it appears to us that the meningococcus is shown to be a good enough species in
the natural history sense," though to this statement they add the words " as species go amongst
bacteria"; they further safeguard themselves, moreover, by saying " we recognise that the difficult
question of specificity amongst bacteria is one as to which we may eventually be compelled to reconsider
our opinions."
Influenza and cerebro-sfinal fever.—Detailed enquiry was made concerning this subject last
year. Occasional references are made in the Army and Navy reports to the same question. Thus
the Navy report, written by Surgeon-General Rolleston, contains the following notes:—
"Catarrhal affections—catarrh, influenza, tonsillitis, and sore throat—were numerous
during the early months of 1915, and their prevalence roughly coincided with the outbreak of
cerebro-spinal fever . . .
"In some barracks and establishments the maximal incidence of cerebro-spinal fever
occurred in the month fluring which catarrhal affections were most numerous.
"In conclusion, there appears to be a relation between the incidence of catarrhal affections
on the one hand, and of cerebro-spinal fever cases on the other."
The same question is incidentally noticed also by the Special Advisory Committee appointed to
report upon cerebro-spinal fever in the Military Forces. The Army bacteriologists approached the
subject from the points of view marked out by two specific inquiries in a questionnaire, the first being
—Is catarrh apparently a predisposing factor? The second—Is naso-pharyngeal catarrh common
among carriers ? Neither of these questions goes directly to the root of the matter so far as influenza
is concerned. Moreover, the second has more particularly aroused the interest of the reporters, and
thus overshadowed the first. The answers to the second question are summarised on pp. 43-45 of the
Committee's report. Two observers' notes are especially interesting. Professor Hutchens (Newcastle)
"concludes that there is no connection between catarrh and cerebro-spinal fever, except that
the epidemic coincided with a period of the year when catarrh is prevalent"; and Lieut. Bullock
(Woolwich) writes in the same sense, and it is added that "as practically everyone had catarrh at some
time during the epidemic period, not much importance can be attached to its concurrence with cerebrospinal
fever." The fact, that nearly everyone had catarrh at some time during the epidemic period,
does not, however, preclude the possibility of study being made as to the chance that such catarrh
should immediately precede or actually accompany an attack of cerebro-spinal fever. In last year's
Annual Report, indeed, the attempt was made to learn whether the concurrence of influenza and cerebrospinal
fever was more frequent than mere chance coincidence would account for. The answer, it will
be remembered, was in the affirmative.
The only direct light thrown by the army reporters on the relation between "influenza" and
cerebro-spinal fever is that shed in their discussion (on p. 54) of the " influence of recent illness." They
quote two cases, one of influenza and one of tonsillitis, preceding cerebro-spinal fever, and, thereupon,
remark: "These cases are open to the criticism that the supposed influenza and tonsillitis may have
been slight or casual cerebro-spinal fever." They then add: "The question of the relationship between
cerebro-spinal fever and influenza, tonsillitis and catarrhs, is discussed by more than one of the
reporters." One of them thinks it "possible that some cases diagnosed as influenza and tonsillitis
were really mild forms of cerebro-spinal fever." Again, it is stated that "it is probable that abortive
cases of cerebro-spinal fever occur in which signs of meningitis are ill-marked or absent and which quickly
recover; such cases would easily be passed over as influenza." These suggestions, however, are not
followed up by the Advisory Committee; indeed, they proceed to refer to two cases which occurred
after inoculation against typhoid fever, and three cases which followed vaccination against smallpox,
sequences of events which the Committee relegate to the category of casual coincidences.
Two other important reports may be cited in which reference to the same subject is made. Thus
Dr. Bruce Low says :—
"In not a few outbreaks, however, though some of the persons attacked have developed
the marked features of the disease, many others have suffered concurrently from a mild form of