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and surprising a " supreme calcium moment," that there come the latest illuminating
glimpses of encephalitis lethargica. Thus, in the Journal of the American Medical
Association of March 1st, 1924, there is the statement: " This peculiar malady seems
to change its symptoms from year to year. In 1919 and 1920 the predominating
symptoms were drowsiness, ophthalmoplegia, pupillary and bladder changes and
headaches. In 1921 they were profound toxaemia, cranial nerve palsies, delirium,
headaches and neuralgic pains in the limbs." In 1923, at least in Minnesota, there
seemed to be an entirely new set of symptoms. " In one group of cases myoclonic
twitches of the face, limbs or trunk predominated, and in another group of cases
mental confusion with headaches." Again, (March 22nd, 1924, p. 957), there is
an account of " Nephritis in Epidemic Encephalitis," by A. E. Bennett, M.D.,
Philadelphia. He describes the occurrence of nephritis, not infrequently complicating
acute cases of epidemic encephalitis in the Philadelphia General Hospital.
He points out that the differential diagnosis from myoclonic uraemia is in some
cases exceedingly difficult. " The same bacterial cause of the infection in the central
nervous system probably produces the kidney lesions. In seeking etiologic factors
in the past medical history of chronic nephritides, it is suggested that inquiry be
made for past encephalitic disease the same as we question our patients as to
antecedent scarlatinal infection." In the same Journal (Oct., 20. 1923) there is
an account by Dr. E. L. Hunt of the recent epidemic in New York. He discusses
the relationship of the disease with influenza and the question of contagiousness.
Dr. Bassoe, in the discussion on Dr. Hunt's paper, suggested that the virus of
encephalitis may he dormant for long intervals in the brain or elsewhere.
Surely we may recognise here the protean influenza, now not merely in mufti,
but changing from one civilian garb to another under our eyes, and demonstrating
unmistakably that the more it changes the more it is the same thing. In reporting
upon the influenza of 1918 (Appendix to Ann. Rep. for 1918), it was urged, following
Creighton, that the Hippocratic method should be applied in examining diseases
of the influenzal group; that account should be " taken of gradations, modifications,
affinities, being careless of symmetry, of definitions or clear.cut nosological ideas,
or the dividing lines of a classification." It is, in fact, the problem of the " idols
of the den "examined by Francis Bacon, and referred to by Sir William Jenner,
in the opening sentences of his Gulstonian Lectures on the Acute Specific Diseases,
when he asks, "Are we to fasten on the differences of things to the neglect of their
agreements," or " to perceive the agreements and pass by unheeded the differences "
—" to divide where nature has drawn no fine " or " to generalise where nature has
bestowed no unity " ? It would at least seem well in dealing with diseases of the
influenzal group to rely upon the clue that : " It is by prominences above the plane
of the ordinary that reason feels her way, if at all, in her search for the true, and
that the proper question in cases such as this is not so much what has occurred, as
what has occurred that has never (or as we in our ignorance may suppose has never)
occurred before! "
Difficulties such as those under consideration are perhaps not readily susceptible
of treatment by ordinary statistical methods. As one of the writers, in the classical
report of the Ministry of Health, on the Pandemic of Influenza 1918.19, observes
(p. 133): " The laws of the fluctuations in sampling the Influenza bag may be very
unlike those of the time honoured and static universe of counters," which provides
the statistician with his " simple formula." In the case of Influenza the subject of
study is a variable, and yet, as already noted, " plus 5a change plus c'est la meme
chose," i.e., the same thing, epidemiologically speaking, though perchance not quite
the same thing from a mathematical and statistical point of view. The difficulty may
be well illustrated by taking one special " pathognomonic symptom "—e.g., sweating.
Compare the epidemic of 1485 with modern Influenzas. The former was
styled the " sweating sickness." At a recent discussion on Horse Influenza at the
Royal Society of Medicine, the question was asked whether it is a fact that in this