The President's Address. By G. S. Woodhead. 221 



time after it had been described as a separate disease, it was often 

 mistaken for the old jail fever, at that time not differentiated into 

 typhus and typhoid. I was much interested to note that Sir 

 William Osier has recorded his conviction that it was an entirely 

 new disease at the time when it was first described, and that it 

 could scarcely have come under the ken of our great English 

 physicians ; but, as I had occasion to point out the other evening, 

 although T have the greatest respect for the powers of observation 

 of the physicians of the seventeenth and eighteenth centuries, I 

 think we ought to remember that their opportunities of making 

 careful observations in jails, barracks and ships, where the patients 

 died like flies from jail or typhus fever, must have been extremely 

 limited. It must be recognized that epidemic cerebro-spinal 

 meningitis, if present, would in all probability, under the 

 conditions prevailing in the places where it was most likely to be 

 met with — the foul jails of the pre-Howard days — assume the 

 fulminating type and carry the patients off in a few hours before 

 accurate observations of any kind could be made. I am the more 

 convinced of this when I find that practically the only sign by 

 which it would then be possible to distinguish the epidemic cerebro- 

 spinal meningitis from typhus or typhoid is, according to Sir 

 William Osier, not to be relied upon, for he says * : " Both types 

 of typhoid present symptoms which closely simulate cerebro- 

 spinal meningitis. On several occasions, at the Montreal General 

 Hospital, cases have been sent into the wards with a diagnosis of 

 cerebro-spinal fever. These cases showed high fever, delirium, 

 retraction of the neck " (the distinguishing symptom above 

 referred to), " spasm, and tremor of the muscles, and, had not the 

 post-mortem examination revealed typhoid lesions and only 

 cerebro-spinal congestion, the diagnosis would not have been 

 corrected. I am sure that many cases sent into the Health 

 Officers as cerebro-spinal fever are instances of the cerebro- 

 spinal form of typhoid." Moreover, I cannot but believe that 

 cerebro-spinal fever was present in crowded, badly ventilated, 

 badly sewered jails, barracks, hulks, and even houses, long before 

 it was recognized and differentiated from a group that at that 

 time contained what are now known to be two distinct diseases, 

 typhus and typhoid fevers, and probably the third, epidemic cerebro- 

 spinal meningitis. It is important to remember this, as, from a 

 study of former epidemics and from what I have seen of the disease, 

 it is a condition associated, specially, with the herding together of 

 people in badly ventilated quarters. What are the chief general 

 points of interest of this malady ? It appears to be as variable 

 in type as almost any known disease, and in some instances it 

 may be that it assumes such a mild form that it is not recog- 



* " Principles and Practice of Medicine," 1st ed., p. 187. 



June 16th, 191-5 k 



