1482 



COSMOPOLITAN FEVERS 



soamin, or hexamine, sixty-four deaths and forty-one recoveries, while symp- 

 tomatic treatment gave ten deaths and four recoveries. 



In 19 1 6 Chalmers and O'Farrell, studying an outbreak of cerebro-spinal 

 meningitis in the Anglo-Egyptian Sudan, came to the following con- 

 clusions : — 



1. The important causal agent is Neisseria intracellularis (Weichselbaum, 

 1887), and only once has Diplococcus crassus von Lingelsheim, 1906, been 

 found acting in this capacity, and so far no other organism. 



2. Only man has been found to be the host of Neisseria intracellularis, and 

 he acts in this capacity as the true carrier of the germ, and as such does not^ 

 acquire the disease because of an immunity conferred by autovaccination. 



3. In order to acquire the disease, two factors at least are required, viz.: — 

 (a) Infection with Neisseria intracellularis. 



{b) Lack of capability on the part of the body to produce the necessary 

 immunity. 



The infection takes place from the nose of a carrier or a case to the nose of 

 an uninfected person, and is favoured by overcrowding and bad ventilation. 

 The lack of power to produce the necessary immunity is favoured by poor and 

 insufficient food, bad hygienic conditions, and over-exertion. 



4. In susceptible persons the germ passes into the mucous membrane of 

 the nose and of its connected cells, and multiplies therein, and then entering 

 the blood-stream forms in the early days of the disease a bacteriaemia. 

 Normally, however, it does not long remain in the blood-stream, and therefore 

 normally does not produce a prolonged septicaemia, which, when present, should 

 be considered as a complication. Apparently the organism is strongly 

 attracted to the cerebro-spinal fluid, into which it quickly passes via the 

 choroid plexus of the lateral ventricle, and perhaps other vascular structures 

 of the brain and spinal cord, and so causes the disease. 



The reason why the cocci as a rule do not pass in relays day after day from 

 the mucous membrane of the nose into the blood is because the patient is 

 either dead or the resistance is raised in a short time, but if this resistance 

 again becomes lowered it is possible that relays may again pass from the nose, 

 and in this way a relapse or recurrent attack ensues. 



5. There are various strains of Neisseria intracellularis, 3ind to be successful 

 in treatment a polyvalent serum and a polyvalent vaccine made from local strains 

 are necessary. Vaccine alone will cure many cases, but requires time to act, 

 which may not be available, and hence the value of the serum in such cases, 

 especially when followed by subsequent vaccine therapy, 



6. Prophylaxis depends upon: — 



(a) The search for, isolation of, and treatment of cases and carriers, and here 

 vaccine therapy is of use in helping to cleanse cases and carriers. 



(&) The increase of the immunity of the general population, which can prob- 

 ably be done by prophylactic vaccination in doses of 5, 50, and 100 millions, 

 but further experience is required of this when given on a large scale. There 

 is little doubt that a negative phase is produced, at all events at times, in the 

 first stages of this vaccination, and this may possibly be aggravated by fear, 

 poor or insufficient food, and bad hygiene. It also appeared to them that vaccine 

 prophylaxis ought to be tried on a large scale, as it causes no general or local 

 symptoms if the germs are killed at 50° C, and the vaccine is aseptic and 

 isotonic with the fluids of the body, and if the site of injection is the subcutane- 

 ous tissue just below the angle of the scapula, which in their opinion is the best 

 place for prophylactic and other subcutaneous injections. 



7. There are a great many questions with regard to epidemic cerebro-spinal 

 meningitis, which are at present unsolved, and one of the most important 

 appears to be the question as to whether any animal or animals act as hosts 

 of the germ. 



In 191 7 the Medical Research Committee of the National Health Insurance 

 issued a report on bacteriological studies, and in 191 8 upon serum treatment 

 in connection with the disease. 



-ffitiology. — The causal agent in the large proportion of cases is Neisseria 

 intracellularis (common name: meningococcus) or one of its immediate allies. 



