1476 



COSMOPOLITAN FEVERS 



since 1906, when Haran noted five cases, and has been ably described by 

 Shircore and Ross in 1913, 



In 1915 Butler drew attention to a curious feature of the disease, in that 

 there are places in East and Central Africa where it has always been endemic 

 and seldom epidemic, and he quotes Uganda in general, whilst in the high- 

 lands of British East Africa the endemic form is seldom seen, but epidemics of 

 greater or less virulence are known. He says that in one tribe alone between 

 20,000 and 40,000 deaths are attributed to this disease, a mortality which 

 sleeping sickness can hardly be said to rival. 



In India it appears to have been first reported by Vandyke Carter as occur- 

 ring in July, 1878, in Bombay, where he says that he is not aware that it had 

 been previously recognized. He does not appear to have published this 

 observation until 1882, and then only in his work ' Spirillum Fever,' p. 436, 

 when he gives not merely a clinical but a post-mortem account of one case and 

 clinical histories of three others. As he has been said not to have recognized 

 the disease, it may be well to note that he heads the paragraphs in question 

 cerebrospinal meningitis. 



In 1884 Dimmock gave a full account of an outbreak in the preceding year 

 in the Shikarpur Jail, Since then some cases have generally been reported 

 year by year, and the whole subject of epidemic cerebro-spinal meningitis in 

 India was ably reviewed by Robertson-Milne in 1906, 



In 1905 Castellani described two cases which occurred in Singhalese natives 

 in Ceylon. 



In 19 1 6 Chalmers and O'Farrell published a series of investigations upon 

 the disease as seen in the Anglo-Egyptian Sudan. 



History of the Organism. — In 1875 Klebs was the first to see cocci in the 

 cerebro-spinal fluid of cases of meningitis, and to assign to them a causal 

 function. He was followed b^'-Eberth in 1881, in which year Gaucher was the 

 first to see micrococci in the blood and urine in a patient during life and in the 

 exudate from the spinal canal after death; and in connection with these 

 findings in the blood one may invite attention to the observation of Cole in 

 191 5, who obtained films of the peripheral blood in which ten out of 2,000 

 leucocytes showed the organism, and also to Osier's statement that Gwyn in 

 1899 was the first to isolate the organism from the blood in pure culture. 

 In 1883 Ughetti also found micrococci in the exudate and in the blood, and in 

 1884 Marchiafava and Celli wrote a short work on the occurrence of micro- 

 organisms, and especially diplococci, in cerebro-spinal meningitis. They were 

 also seen in meningeal exudates by von Leyden in 1883, and byLeichstenstern 

 in 1885, and the last-mentioned observer noted that they resembled the gono- 

 coccus by being found in the leucocyte. 



In 1886 Senger also noted them in the cerebro-spinal exudate, while FrSnkel 

 with Weichselbaum, Fo^ with Bordoni, Uffreduzzi, and Lemoine described the 

 pneumococcus as the causal organism of a series of cases of cerebro-spinal 

 meningitis unassociated with pneumonia. 



In 1887 Weichselbaum published his paper ' Ueber die ^tiologie der akuten 

 Meningitis Cerebro-spinalis,' in which he described eight cases of meningitis 

 without pneumonia, two of which'were due to the pneumococcus and six were 

 caused by an organism which difEered therefrom by being generally a diplo- 

 coccus, more rarely arranged as tetrads, and resembling the gonococcus, being 

 often contained in leucocytes and being Gram-negative. He, however, 

 distinguished this organism from the gonococcus by the fact that it produces 

 in subcultures on agar-agar slopes a flat viscous growth which is greyish when 

 seen by reflected and greyish- white when examined by transmitted light. It 

 only grew at incubator temperatures, and had but a slight vitality. This 

 organism he called Diplococcus infracellularis weninKntidi';, and looked upon 

 its action as being toxic in nature, while he hesitated to regard it as the causal 

 agent of the disease. 



Although Weichselbaum's observations were confirmed by Gold»chmidt in 

 1887, and by Edler and himself in 1888, they produced comparatively little- 

 influence, and were almost unnoticed until a polemic wa.s started in 1890, which 

 raged till 1893, as to the identity of Bonom6's streptococcus of epidemic cere- 



