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Island, so that only 1 hour 40 minutes elapsed between material leaving donors and reaching volunteers.
Ten volunteers each received six c.c. of material. "None of them took sick."
Experiment IV.—Material transferred directly from nose to nose and throat to throat. "We
used ninteeen volunteers for this experiment, and it was during the time of the outbreak when we had
a choice of many donors (first, second and third day of disease). None of these volunteers took sick
in any way."
Experiment V.—Injections of blood. Ten c.c. of citrated blood injected into each of the ten
volunteers. "None of them took sick in any way."
Experiment VI. was "designed to imitate the natural way in which influenza spreads,
at least the way in which we believe influenza spreads—and I have no doubt it does—by human
contact." Ten volunteers were brought into a ward having thirty beds, all filled with influenza.
The volunteers sat down alongside the bed of the patient and talked to him for five minutes.
At the end of the five minutes the patient breathed out as hard as he could, while the volunteer,
muzzle to muzzle (in accordance with his instructions, about two inches between the two),
received his expired breath and at the same time was breathing in as the patient breathed out.
This they repeated five times, and after this "the patient coughed directly into the face of the volunteer,
face to face, five different times." After "talking and chatting and shaking hands with him for
five minutes, and receiving his breath five times and then his cough five times directly in his face, he
moved to the next patient whom we had selected, and repeated this, and so on, until the volunteer had
had that sort of contact with the different cases of influenza in different stages of the disease, mostly
fresh cases, none of them more than three days old." "They were watched carefully for seven
days, and none of them took sick in any way."
The above experiments were carried out during 1918. At the end of the year the work was for
the time suspended. In February and March, 1919, further experiments were undertaken, but the
epidemic was now on the wane and there was difficulty in finding donors. Here at last some positive
results were obtained, but they were deemed to be " ordinary cases of sore throat only."
The cautious conclusion drawn by Dr. Rosenau from these experiments is that "We must be
very careful not to draw very positive conclusions from negative results of this kind. Our
volunteers may not have been susceptible. They may have been immune. They had been exposed as
all the rest of the people had been exposed to the disease, although they gave no clinical history of
attack." Readers of the account will no doubt think the experiments show the volunteers were protected
by previous exposure to influenza.
Col. Dorgan's report on cerebro-spinal fever.
In the Lancet of July 19th, 1919, there appeared a report on cerebro-spinal fever by Col.
Dorgan. Reference has been made in these reports, and elsewhere, on various occasions, to the
investigations into the epidemic at X Garrison made by Col. Dorgan and his coadjutors in 1916, for I
had the advantage of discussing the whole question with him in that year, and we were able to compare
notes on the strikingly similar behaviour of the epidemic in X Garrison and in the London civilian
population. Col. Dorgan's report, though submitted to the Army authorities, was not published at the
time, but the article, ultimately released for publication in the middle of 1919, gives the full story of X
Garrison and summarises the author's more recent conclusions. He gives, in a more complete manner
than had been done by anyone else, facts which indicate the prime importance of unrecognised cases in
the spread of infection, and at the same time he demonstrates in a more detailed and conclusive manner
than had previously been done on the great scale, the failure of the method of segregating healthy
carriers of meningococci. He describes on the one hand the "mutation in the type of resulting
infection," as exhibited in family attacks; and on the other he intimates that "cases produce carriers
but not carriers cases." He points out, moreover, that no statistics have been produced "to show a
difference in the percentage of carriers among contacts and non-contact carrier groups." Speaking
with the knowledge gained in X Garrison and elsewhere, he commeDts upon the "central laboratory
finding" that "It requires at least six weeks' hard work before even a trained bacteriologist, with considerable
serological experience can sufficiently master the technique to obtain consistently satisfactory
results. Similarly, when he goes on a holiday, even for a week, it requires at least another week's work
before the necessary unconscious manipulative dexterity returns." Those of us who were troubled and
alarmed by this statement, when it originally appeared two years ago, should be greatly comforted
now to find that Colonel Dorgan's carefully considered and expressed view is that "if the technique
is so far above the ordinary well-trained bacteriologist it loses much of its practical value." It is
gratifying, moreover, to find that Col. Dorgan does not subscribe to the doctrine that "each outburst
of cerebro-spinal fever is due to two, three or four distinct organisms being simultaneously let loose to
produce infection." Indeed, he says "This seems so unlikely that it causes us again to hesitate before
accepting the view that four specifically distinct organisms are concerned in epidemics of cerebro-spinal
fever."
Colonel Dorgan's condemnation of the method of isolation of carriers is quite decided and definite.
He, moreover, criticises the "inhaling-room treatment, which offers valuable help at any point where
isolation breaks down," remarking that it "would seem to be a tactical measure which serves to focus
the attention on a healthy carrier, and covers the retirement from the former position which had become
untenable."
In his remarks on prophylaxis he insists that primary importance should be attached to ventilation
and overcrowding. He is able to conclude his paper with quotations from the "Medical Supplement"
of July, 1918, showing that the main contentions of his report of 1916 had in the course of two
years become widely accepted.
Cerebro-spinal fever
The progressive decline in the incidence of cerebro-spinal fever since the epidemic wave in 1915.
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