EPIDEMIC CEREBROSPINAL MENINGITIS 1475 



From this date onwards till about 1 884 the whole ground of the history has 

 been reviewed by Hirsch in the third volume of his classical * Handbook of 

 Geographical and Historical Pathology,' in which he divides the epidemics of 

 cerebro-spinal meningitis in Europe and America into four cycles, viz. : — 



(1) 1805-1830, Europe and North America. 



(2) 1 837- 1 850, Europe, North America, and Algiers. 



(3) 1 854- 1 875, Europe, North America, Africa (parts). Western Asia, and 

 South America. 



(4) 1 876- 1 884, small epidemics in former areas, to which may be added: — 



(5) 1885 to present time. Recognition of the disease in the tropics, West 

 Indies, Fiji, Anglo-Egyptian Sudan, West Africa, Western Australia, Mexico. 

 Severe epidemics in America and Europe — i.e., this is the period of the first 

 pandemic. 



It will thus be seen that the area in which the disease is recognized has 

 gradually extended, and that this has been quicker of late years, probably 

 due to increased facilities for travel which has introduced it by the agency 

 of carriers into lands in which it probably did not previously exist, as, for 

 example, Fiji, the result being that at the present time it appears to be diffused 

 all over the world and to occur as localized epidemics in different places in 

 different years. 



In the study of these epidemics certain important features were brought 

 out — viz., the influences of over- exertion, starvation, overcrowding, and bad 

 ventilation, which account for the prevalence of the disease among soldiers 

 and poor people and for its increase in different countries in periods of bad 

 weather — e.g., during the winter and spring in cold climates and during the 

 Haboub seasons of the hot Anglo -Egyptian Sudan, or to a less extent the cold 

 weather of the Sudan, when the people huddle together into crowded, ill- 

 ventilated huts and houses. 



The historical portions with which we are mainly interested are those 

 concerned first withits occurrence in the tropics, and secondly with its aetiology. 



Occurrence in the Tropics. — The first record we have been able to find of 

 the disease in a subtropical land is the occurrence of an epidemic in 1840- 1847 

 in Algiers, in which country it has, from time to time, been reported. It is 

 also said to have occurred in 1840 in Brazil and in Monte Video in South 

 America . 



In 1 872 it was reported in Asia from Smyrna and in 1 874-75 in Persia, accord- 

 ing to Bruce Low in his paper on epidemic cerebro-spinal meningitis published 

 in 1899. 



It is believed to have been present in Central America and in the West 

 Indies prior to 1884, but without trustworthy information. 



Corney has given an excellent account of the invasion of Fiji by the disease. 

 It would appear that the first cases were noted in 1876 in an immigrant 

 labourer's depot at Levuka, and from that time onwards it was probably 

 diagnosed as tetanus, sunstroke, or meningitis, until it assumed epidemic form 

 in 1885, which he believed was due to the contagion being spread from man to 

 man — a very advanced idea at that time. 



Cerebro-spinal meningitis was reported from the West Coast of Africa by 

 the Williams in 1900, and from then onwards from time to time. In 1905 

 there was a severe epidemic in Northern Nigeria, which was reported upon by 

 Twomey and Davidson, and in 1906-08 in the northern territories of the Gold 

 Coast, where it was ably investigated by Horn. In Northern Nigeria it was 

 said that cattle were attacked, and in the Lorha district of the northern 

 territories of the Gold Coast the natives are said to have noted a great mor- 

 tality among fowls prior to the epidemic of the disease. According to Bargy 

 and Horn, the disease was marked at this time in French West Africa to the 

 west of the Black Volta. 



In 1909 it was reported as being present in 1907 in the northern districts of 

 Togoland by Jaffe, when it was known to cause 300 deaths. Jaff6 obtained 

 the true diplococcus of Weichselbaum from his cases. 



Epidemic cerebro-spinal meningitis has been recorded in British East Africa 



