CEREBOS-SPINAL MENINGITIS.

Taranaki Daily News, 7 August 1915, Page 12

CEREBOS-SPINAL MENINGITIS.

FROM THE MEDICAL POINT OF •VIEW. WITH HINTS TO THE PUBLIC. In the British Medical Journal of March 20 this year -there is an article by Dr. A. Lundi'e, Dr. D. J. Thomas and Dr. S. Fleming from which we make a few extracts that will, we hope, tie of some service to. the public in regard to this dread disease.

Experience is fallacious and judgment difficult, and we ourselves would not at-, tempt a final diagnose without .bacteriological confirmation. Any case that is hard to diagnose within two or three days is a case fo< he bacteriologist. The catarrhal stage is usually detected almost by accident. The accident of a severe case happening in a regiment causes an xamination of all the men who slept in the same room as the patient for several nights before he took ill. We use West's swab. At the laboratory the plates arc incubated for 12 to 24' hours, and the likely colonies are subcultivatcd on plates and incubated at 37deg and 23deg C. Colonics growing at 37deg and not at 23dcg and having the 'requisite appearances are taken as meningococcus, and the person from whom they are obtained is declared a carrier. We find in practice that all our carriers have catarrh. Stage 11. is that febrile condition which is undiagnosablo, unless it passes on to stage 111., which is sometimes as hard to diagnose. Occurring in an epidemic, it ought to give rise to the profoundest misgivings. The palate is often still red and spotted. These may be minute vesicles on it. The pharynx is more or loss inflamed. The voice is .often husky, and there may be a little dry, harsh'cough. There may also be nasal catarrh and profuse discharge. Herpes labialis is common. There is often more or less elevation, of temperature, but this is not of much diagnostic value. The face is very gften flushed, and there may be some conjunctival injection. There may also be a greater or less degree, of menial confusion just as this stage begins to merge into the third.

This U the septicaemia stage and no dpubt diploeoeci arc already in the blood stream.

The third or meningeal stage conies on at varying intervals. Sometimes the whole syndome is run through in a few hours, leaving the patient dead, with the practitioner wondering what hilled him. It may .set in after mysterious attacks of vomiting, lasting three days, and, there being no other symptoms, may cause the gravest suspicions of criminal administration of poison. Almost any error of diagnosis might he committed, owing to the protean aspect of the clinical picture. Some cases go on to death without any pain. At other times the headache is appalling. Rash and spots are not very common, and it would be a pity to wait for them. The disease is more widespread than is usually recognised. It probably gives fair warning of its onset by catarrhal symptoms, and often goes no furthev. In its second stage it may run a long non-malignant course, giving plenty of time to arouse suspicion, and, if correctly diagnosed, would probably be cured

'by suitable treatment. During an epidemic, Tontine examination of all sore throats would probably he of more value in stopping" the disease than the examination of a vast number of alleged contacts, most of whom are perfectly healthy, and the examination of cases in the second stage could be made a matter of consultation. In our view, the probability is that by the use of autogenous vaccines many flabby uvulas and throats would be restored to a healthy condition, and thereby preventeM from offering a safe harbor to the meningococcus. It is hard to conceive that the meningococcus ever holds undisputed possession of any mucous membrane, or ever even obtains a hold at all, unless its vitality lias already 'been lowered by some means or other.