CHAPTER LVllI 



COSMOPOLITAN FEVERS 



General — Epidemic cerebro-spinal meningitis — The exanthemata — Vaccina- 

 tion — Alastrim — Vaccinia in natives -™ Vaccine rashes — Influenza — 

 References, 



GENERAL. 



At the present time many so-called tropical diseases have become cosmopolitan 

 — e.g., amoebic dysentery — while others, such as malaria, probably have 

 always been world-wide in their distribution. There are, however, some few 

 fevers which, though they really belong to cool climates, nowadays are of 

 importance in the tropics — for example, the exanthemata and influenza. 

 We think it advisable to give a brief account of these. 



EPIDEMIC CEREBRO-SPINAL MENINGITIS. 



Synonyms. — Spotted fever. French, Meningite cer6bro-spinale epidemique; 

 Italian, Meningite cerebro-spinale ; German, Epidemische Genickstarre. 



Definition. — An acute specific fever caused by Neisseria intracellularis 

 Weichselbaum, 1887 {Diplococcus intracellularis) , and allied organisms, spread 

 from man to man by aerial carriage, and characterized by a brief septicaemia, 

 leading to a cerebro-spinal meningitis, and occasionally by a more prolonged 

 and dangerous septicaemia associated with a petechial eruption. 



History. — The disease may have been known to the ancients, but to our 

 minds the phrenitis of Hippocrates and of Celsus has nothing in common with 

 cerebro-spinal meningitis. We have been unable to refer to the works of 

 Aretaeus or of Paul of Mgina., and, therefore, are unable to state whether the 

 disease which they are said by Kutscher to have described in Ital}?- resembled 

 cerebro-spinal meningitis or not, and the same remarks hold good with regard 

 to the epidemic described by Abdere de Lucien. 



On the other hand, we have carefully read Sydenham's 'Rise of a New 

 Fever,' which Arnell considers to be identical with the disease which he saw 

 in Connecticut in 1807, and which, he also says, is the same as Cullen's 'Typhus 

 Petechialis ' and the disease described in Medicus Novissimus, published at 

 the beginning of the eighteenth century. When superficially considered, 

 Sydenham's new fever does, at the first glance, read like cerebro-spinal 

 meningitis, but when the symptoms are carefully analyzed they will be 

 observed to resemble those of the enteroidea group of fevers, and therefore we 

 are convinced that Sydenham's new fever is not cerebro-spinal meningitis. 



We have been unable to peruse Vieusseux's original account of the outbreak 

 in 1805 at and around Geneva, but North's translation in 181 1 of the article 

 in the Journal de Midecine de Paris makes it quite clear that this was un- 

 doubtedly the disease in question, and the same author's verbatim account of 

 Danielson and Mann's article published in the Medical and Agricultural 

 Register of Boston, with its careful clinic and post-mortem histories, leaves no 

 doubt that these two authors were dealing with an epidemic of cerebro-spinal 

 meningitis at Medfield in March, 1806. North's valuable little book containing 

 all the early histories of the disease appeared in New York. 



1474 



