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as pneumonia or as sore throat; and by the occurrence of cerebro-spinal fever in
Irthlingborongh in the present year, where many of the persons attacked were
regarded as suffering from influenza. In these anomalous forms of cerebro-spinal
fever, many or even most of the symptoms associated with the recognised type of
the disease may be absent, while, in mild cases, they may be so slight or of such
brief duration as to escape notice. It is, however, for such cases that it is necessary
to be on the outlook, whether in relation with a definite occurrence of cerebro-spinal
fever in a locality, or by reason of the prevalence in a particular neighbourhood of
illness not clearly referable to definable cause. In these circumstances, there would
be advantage in the local medical officer of health endeavouring to secure, by
arrangement with the medical men practising in his district, information as to the
existence of cases of the kind in question.
Failure to recognise cerebro-spinal fever is also apt to happen when the malady
is of the "fulminant" variety, in which death ensues rapidly. In these instances
the disease has been mistaken for typhus fever, idiopathic tetanus, or malignant
measles.
An important aid to diagnosis may be found in examination of the cerebro-spinal
fluid, withdrawn from the lower part of the spinal canal by lumbar puncture, for
the presence of the "diplococcus meningitidis intracellulars" of Weichselbaum;
a micro-organism which is now generally regarded as the specific cause of cerebrospinal
fever.
Whether cerebro-spinal fever is spread by direct infection from person to person
is matter of uncertainty; indeed, there is as yet no definite knowledge as to the
way or ways in which its transmission may take place. Since, however, the
possibility of direct personal infection cannot, on the evidence available, be
excluded, it will be wise to endeavour to secure, as far as practicable, the
isolation of the sick from the healthy. It will also be advisable to apply
suitable measures of disinfection to premises that have been occupied by the sick,
and to articles that may have been in relation with them.
In view of the fact that the presence of Weichselbaum's diplococcus has been
observed in the mucus of the nose and mouth, not only of the sick, but also of those
attending on the sick, there may be advantage in resorting to periodical ablutions
of the nasal and buccal passages of the sick and their attendants.
W. H. POWER,
Local Government Board, Medical Officer.
July, 1905.
ANTHRAX.
Two cases of this disease were reported during the year.
On the 13th May the Home Office reported that a man employed at a
wholesale skin warehouse in the City had died from Anthrax in the London
Hospital two days previously. On investigation it was ascertained that the
man, who resided at Walthamstow, was taken ill on the 8th May, and
admitted on the following day to the London Hospital, where he died
on the 11th.