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Europe. Interest in this malady has been farther stimulated by the public
notice which has been taken of the recent identification of a case in the
neighbourhood of London, and of several cases, four of which terminated fatally,
at Irthlingborough in Northamptonshire.
Cerebro-spinal fever is not of [rare occurrence in the United Kingdom. In the
course of the last forty years this malady is known to have been prevalent in a
considerable number of different localities in England and Wales, several of these
local outbreaks having taken place in recent years. In some instances they have
formed the subject of investigation by a medical Inspector of the Local Government
Board, whose report has usually been made public. Occurrences of cerebro-spinal
fever have also been observed in Scotland and in Ireland. There is, indeed, as will
appear later, reason for belief that this disease is even less uncommon in this
country than the foregoing particulars would seem to indicate.
The late Mr. Netten Radcliffe defined cerebro-spinal fever as
"an acute, epidemic disease, characterised by profound disturbance of the
central nervous system, indicated at the onset chiefly by shivering, intense
headache or vertigo, or both, and persistent vomiting: subsequently by delirium,
often violent, alternating with somnolence or a state of apathy or stupor: an
acutely painful condition with spasm— sometimes tetanoid— of certain groups of
muscles, especially the posterior muscles of the neck, occasioning retraction of
the head; and an increased sensitiveness of the surface of the body.
Throughout the disease there is marked depression of the vital powers; not
unfrequently collapse: and in its course an eruption of vesicles, petechial or
purpuric spots, or mottling of the skin, is apt to occur. If the disease tend to
recovery, the symptoms gradually subside without any critical phenomena, and
convalescence is protracted: if to a fatal termination, death is almost invariably
preceded by coma. After death the enveloping membranes of the brain and
spinal cord are found in a morbid state, of which the most notable signs are
engorgement of the blood vessels, usually excessive, and an effusion of seropurulent
matter into the meshes of the pia mater and beneath the arachnoid."
To the clinical manifestations of the disease, indicated in this definition, may be
added the presence of Kernig's sign* and of tache cérébrale.†
Local prevalence of a malady distinguished by the foregoing features would, no
doubt, attract attention and would, it may be presumed, lead to early recognition of
its true nature. But, while these features are characteristic of cerebro-spinal fever
of typical and severe sort, experience has taught us that this fever may and does
appear in milder or in anomalous forms which render identification difficult, and which
lead to its being mistaken for other ailments of more common occurrence in this
country. Illustration of this is afforded by certain localised outbreaks of cerebrospinal
fever in the eastern counties in 1890, where this disease was generally
mistaken for sunstroke or for enteric fever, or was looked upon as a new form of
illness; by the prevalence of what would seem to have been cerebro-spinal fever in
Northamptonshire in 1890-91, where the malady was for the most part diagnosed
* To obtain this sign, the patient is placed so that the hip-joint is semi-flexed, and while the hip-joint is
retained in this position, the knee-joint is extended passively. A contraction of the hamstrings then sets in,
which causes resistance to the extension.
† A congested streak produced by drawing the finger-nail gently over the patient's thigh, abdomen, or
face. In cases of meningitis this appears earlier (within 30 seconds), lasts longer (8, 10, or 15 minutes), and
is broader and of deeper colour than in healthy persons.