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infrequently developed disturbances of moral behaviour, and in these considerations
justification may perhaps be found for the view that "this disease is not new." It
may be added that in Sydenham's "New Disease" of 1685, the mischief affected the
brain in many instances; Willis associated his influenzal prevalences with outbreaks
"infestuous to the brain and nervous stock"; Sir George Savage in our own day
has told how increase in insanity followed upon the influenza of the nineties; even
in the English Sweats of four centuries ago we read how sufferers beat their heads
against walls or threw themselves into the water. All those who accept without
question the fact that the primary attack in influenza is upon the cerebro-spinal
nervous system, and who hold that an epidemic must be judged by its epidemiological
characters, as well as by the symptoms exhibited in individual cases, will
regard these recurrences of particular associations, described again and again
during the last five centuries, and yet once more in the present century, as
illustrations of the truth that there is an abiding unity of influenza among all
its seeming diversities.
Difficulties
experienced
in distinguishing
epidemic
encephalitis
from other
epidemic
diseases
affecting the
central nervous
system.
It must be realised, however, that it is not merely the association of encephalitis
lethargica with influenza that is now seen to be in question, but its relationship
also to poliomyelitis, polioencephalitis and cerebro-spinal meningitis, in fact to the
Heine-Medin disease group of Continental writers. Dr. McNalty, who has contributed
so largely to knowledge of all these diseases, made a careful analysis of the differences
between encephalitis lethargica and poliomyelitis. His eighteen points of distinction
amount in substance to this, that there are two allied phases of epidemic disease
affecting the central nervous system, which can be more or less differentiated
from one another by the fact, that in the one the stress of the mischief is apt to
fall mainly upon the anterior horns of the grey matter of the spinal cord, while in
the other the neighbourhood of the roots of certain cranial nerves in the mesencephalon
is more particularly affected, thus offering greater opportunity for variety
of symptoms. Shortly prior to, instead of as now following after, the pandemic wave
of influenza of 1918, similar points of distinction between cerebro-spinal fever and
poliomyelitis were made by medical officers of the Local Government Board and
of local authorities. The first doubts arose in connection with a prevalence near
Melton Mowbray in 1910, and in the following year cases investigated by Col. Reece
in Devon and Cornwall excited considerable interest. The same difficulties were
experienced in London, and this more particularly at the time when a "new disease"
appeared in Mid-Herts and later again when cerebro-spinal fever was prevalent in
Glasgow and Belfast. It was possible, already in 1912, to give Col. Reece the assurance
that records relating to cases of cerebro-spinal fever and poliomyelitis in London
"could be differentiated from one another readily, inasmuch as one set was on blue
forms and the other set on white forms." . . . All this was before difficulties
of diagnosis were enhanced by the advent of encephalitis lethargica.
Some authorities have demurred even to including epidemic hiccough as a
variant of encephalitis lethargica. Dr. Cadham of Winnipeg, however, from study
of three recent epidemics of hiccough in that city (1919, 1922 and 1924) definitely
concludes that there is widespread in the community "a disease suggestive of an
infection of the central nervous system, with symptoms varying from those of a
mild acute neuritis to those of epidemic encephalitis and including hiccough." Dr.
Hall is almost persuaded to accept epidemic hiccough as a variety of epidemic encephalitis
; he refers to " the simultaneous appearance of the two, the not infrequent
occurrence of both in the same household, and the actual development of one from
the other." He cannot agree, however, that epidemic encephalitis must be regarded
as a form of Heine-Medin disease, but he is disposed to consider the possibility of
some relationship between epidemic encephalitis and influenza; indeed he says:
when further experience has accumulated the exact relations in which these diseases
stand to each other will be found to be more intimate than is now generally
realised."