REVIEWS 345 



based on some forty military cases from the Eastern Command under the obser- 

 vation of the authors at Cambridge. So much has been learned during the last 

 decade as to the nature and epidemiology of this once mysterious malady that 

 there was real need for an authoritative work embodying recent researches, and 

 the writers are to be congratulated upon the thorough way in which they have 

 dealt with the subject, upon its literary presentation, and upon their admirable 

 coloured illustrations. 



After an historical summary, the clinical features of cerebro-spinal fever are fully 

 and accurately described, and it is at once apparent that the descriptions are 

 drawn from actual experience. The substantial identity of posterior basic 

 meningitis in infants with the epidemic disease is assumed. Diagnosis occupies 

 a whole chapter, special stress being laid on Kernig's sign and on the importance 

 of lumbar puncture. In the chapter on treatment the authors pin their faith on 

 persistent drainage of the spinal theca by lumbar puncture, a method of proved 

 value which in their hands gave better results than any other. We think, however^ 

 that they underestimate the value of serum treatment, though it is true that every 

 one found it disappointing in the 191 5 epidemic. We know from American 

 experience, and from the results obtained by Robb at Belfast with Flexner's serum, 

 that a marked reduction in the death rate has at times followed its use by the 

 intrathecal route. It would seem that we had not at our command in 191 5 any 

 serum sufficiently potent against the particular strains of meningococcus then 

 prevalent — a defect now largely remedied, if we may judge from the improved 

 results already recorded in 1916. The writers' unfavourable verdict may thus 

 demand reconsideration. 



It is perhaps invidious to point out any one chapter in the book as the best, but 

 if we had to make such a choice we should name that on the pathology of the 

 disease, on account of its admirable presentation of the structural arrangements of 

 the meninges and the physiological effects which follow their disturbance by 

 inflammatory changes. Of the two paths by which the meningococcus has been 

 believed to gain access from the nasopharynx to the meninges, the authors are 

 inclined to favour the direct route by the olfactory nerves as more probable than 

 that by the blood. There is an excellent account of the cerebro-spinal fluid and 

 its changes in epidemic meningitis. 



The spread of the disease by the healthy carrier is accepted as the chief 

 mechanism of an epidemic, and the whole carrier question is fully discussed in the 

 chapter on epidemiology. Little is said, or can, indeed, be said, as to the con- 

 ditions which determine the occurrence of the disease itself in the carrier. 



The final chapter is devoted to bacteriology. It contains a clear account, not 

 only of the meningococcus, but of the allied organisms with which it may be con- 

 founded. Cultural tests are fully considered, but we note the omission of any 

 reference to the value of egg-medium : in sealed tubes of this medium it will live 

 for at least three months— far longer than in the starch-agar stabs recommended 

 by the authors. 



In discussing the difficult question of the subspecies of the meningococcus the 

 serological results at present available are duly considered, including those 

 obtained by Gordon in last year's epidemic. The authors are wise in regarding 

 this matter as at present unsettled, though we think they underestimate the value 

 of agglutination tests in diagnosis. 



The book is so free from misprints that it is only kind to mention the few 

 which we have noted. On p. 92, line 21, "dura mater" is printed where " pia 

 mater" is evidently intended. "Cornflower" is a misprint for "cornflour" on 



