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illness with nasal catarrh, tonsillitis or influenza-like symptoms. As a result, certain French
authorities at one time sought to prove that epidemic cercbro-spinal meningitis was closely
related to influenza. Some observes recognise as cerebro-spinal fever only those cases in which
the characteristic symptoms are present, while others regard the concurrent catarrhal illness
as due to the same infection, and therefore to be regarded as a milder manifestation of the same
disease. Again, there has been suspicion that cases regarded locally as cerebro-spinal fever
were really instances of epidemic poliomyelitis and vice versa."
And finally, Captains Foster and Gaskell, in their comprehensive report on cerebro-spinal fever
in the Eastern Command, observe: "The diagnosis of early cases of cerebro-spinal fever from influenza
presents some difficulty"; and they then consider the points of resemblance and the problem of diagnosis
in the early stages of illness. They conclude that: "Mild cases of cerebro-spinal fever may be unrecognised
and classed as influenza, but no proof exists that the former disease is ever so slightly marked as
not to develop at least some of the diagnostic signs."
Turning now to the particulars with regard to notified cases, which have been carefully compiled by
the London medical officers of health, and of which an analysis has already been made for 1914, and
the early part of 1915, it is possible by use of the completed returns for 1915 to carry the matter further.
It will be remembered that out of 462 cases concerning which information was published in last year's
report, 37 gave a history of recent influenza, and 27 had suffered from this complaint within 7 days
of the onset of symptoms of cerebro-spinal fever. It was pointed out that chance alone would have
led to the expectation than two or three only of the 462 persons would have so suffered. It was added
that: "This latter number (27), compared with the 'expected,' is so large as to afford strong ground
for the belief that some relationship exists between the two diseases. This presumption is materially
strengthened when regard is paid to the large number of cases of cerebro-spinal fever giving a history
of contact with sufferers from influenza."
The material now available enables an analysis to be given of the results obtained in four periods:
—(a) The non-epidemic year 1914; (b) the epidemic period January to May, 1915; (c) the rest of the
year 1915 in which the disease was less prevalent; (d) the period of slight recrudescence extending
from Januarv to April, 1916.

It will be seen from this table that, dealing with cases of influenza within seven days of onset of
cerebro-spinal fever, there were :—
(a) In the first non-epidemic period—no cases.
(b) In the second epidemic period there were 27 cases, while chance would warrant an
expectation of only two or three such cases.
(c) In the period of declining epidemic prevalence there was only one case, and this might
perhaps be looked upon as a mere chance coincidence.
(d) In the period of slight recrudescence there were five cases, a number in excess of that
which might have been anticipated as a mere chance result.
It will be further seen that the numbers of cases with a history of contact with persons suffering
from influenza is far higher (23) in the period January May, 1915, than in the other periods. The
percentages of such cases to the total number of cases in the four periods are 16 per cent., 5 per cent.,
1 per cent., and 2 per cent. respectively.
In opposition to the conclusions relating to the association of influenza and cerebro-spinal fever,
it has been suggested that the concurrence of epidemics of influenza and cerebro-spinal fever is merely
fortuitous, and critics account for the histories of preliminary influenza leading up to declared cerebrospinal
fever, by the fact that in its early stages the latter disease may closely simulate the former. But
the critics have still to explain the frequent association in epidemic prevalences of the two symptom
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