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An interesting example of the difficulties recently arising is the following:
In a note upon " Two cases of acute polioencephalitis," Dr. Poole, Medical Officer
of Health of the Thornton Rural District (Lancet, January 24th, 1925), describes
the perplexity experienced in deciding to which of four groups of notifiable infectious
disease these two cases should be allotted. Dr. Poole says he had to turn from
one to another of these groups, each of which "was presumably a separate entity."
In an article on the subject of Dr. Poole's cases, the Lancet hints at a possibility
that at some future time "a synthetic, as opposed to an analytic approach to the
encephalitis problem may be rendered possible."
A remarkable instance which may be compared with these experiences, during
1924 and early 1925, is afforded by the "New Disease," in Japan, "first reported
unofficially as cerebro-spinal meningitis, again as encephalitis lethargica, and still
later as an hitherto unindentified disease." The first cases occurred in July, and
by September "the disease spread over nearly the whole of Japan." . . . The
symptoms of the disease resembled those of encephalitis lethargica, but the usual
eye symptoms were absent." A later statement (Jl. Amer. Med. Assocn., 7th March,
1925, p. 764), gives the chief symptoms as "headache, faintness, dizziness, vomiting
and aching of the limbs and trunk, coming on after a sudden elevation of temperature.
At the same time there is a loss of consciousness which may lead to frenzy."
Another interesting case is that of the severe outbreak of poliomyelitis which
occurred in Iceland and resulted in 65 deaths between January and August of last
year. A still more recent instance is the outbreak of July-November 1924, in
Queensland, referred to in the Ministry of Health returns for the week ended
March, 18th, 1925. Similar questions are raised by Dr. A. J. Brock (Lancet, December
28th, 1924) who asks: "whether it is not the case that poliomyelitis and
encephalitis are less distinct in nature than their names would suggest—that they
tend in fact to run into one another, as also into the influenzas presenting
cerebral and spinal complications, and so eventually into ordinary influenzas."
Nowadays, not merely from an epidemiological but also from the clinical and
pathological points of view, there is discernible a disposition to study the relations
of epidemic encephalitis to other epidemic diseases affecting the nervous system.
Dr. Farquhar Buzzard, in opening a recent discussion on encephalitis lethargica
at the Medical Society of London, observed: "There are no real characteristic or
physical signs by which the disease can be recognised, and as any function of the
brain may be disturbed there may be a whole series of clinical manifestations."
Dr. D. E. Core (Lancet, 25th April, 1925) speaking in a similar sense at Manchester,
said: "The idea of establishing a diagnostic scheme based upon symptoms was in
his mind untenable." Dr. J. L. Halliday (Lancet, 11th April, 1925) comments
upon difficulties which have arisen as regards diagnosis, owing to the fact that the
newspapers have laid quite unjustifiably exaggerated stress on particular symptoms.
He refers to the case of an anxious mother who brought up a baby a few months old
for the reason as she avowed that it was " sleeping and seeing double."
The need for
consideration
of the
epidemiological
aspects of
the problem.
In fact an appeal must now be made to epidemiology, and the time has come
when an influence or virus must be invoked in explanation of the phenomena—a virus
primarily attacking with special severity, now one and now another portion of the
cerebro-spinal system, but capable also, at other times and on other occasions, of
working mischief in other systems (gastro-intestinal or pulmonary) of the human body.
The idea that such a virus or influence is at work is at once grasped when the great
epidemics are studied, for the truth cannot fail to be recognised in connection with
"posting prevalences," which sweep across the civilised world at intervals of twenty
or thirty years; the mark of the blow directed at the cerebro-spinal nervous system
is perhaps quite as unmistakeably set upon the "trailers," those lesser epidemics
showing like ripples upon the ocean waves of the pandemic prevalences; and as is
now becoming apparent, even in the sporadic cases of illness occurring in the troughs
of the great waves it is possible to guess at the nature of the "influence" at work.