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respects seems to exclude the probability of radium havinga selective action on cancer tissues, it is well to moderatethe hopes as to the possible therapeutic value of radium.We entirely approve of the attitude adopted by the Fund

towards a cancer census, for the data on which such a

census would be founded are untrustworthy, and we are in-terested to see that the French Association for the Inves-

tigation of Cancer has come to the same conclusion. TheFund has been much assisted by the willingness with whichDr. J. TATHAM has placed the resources of the General

Register Office at its disposal with a view to promote theattainment of greater utility and accuracy in the statisticsof cancer, but there is necessity for great completenessof the data of mortality before any useful comparisons can be made between the figures of different countries.

With the question of affiliation with the International

Society for Cancer Research the Imperial Cancer ResearchFund has also dealt wisely. The International Society is anassociation founded in Berlin, and it is intended to forward

the holding of international congresses at which the factsand problems connected with cancer may be discussed. It

was mentioned in the last annual report of the ImperialCancer Research Fund that it had been decided not to jointhis society, even though the offer was made that the first

international congress should be held in London. ESorts have been made to persuade the Fund to reconsider its

refusal-indeed, His Majesty the KING was presented witha petition by the International Society asking that as patronof the Imperial Cancer Research Fund he would have

this decision of non-participation altered-but the policyof the Fund remains constant. It is somewhat. importantthat the attitude of the Fund should be understood, for

those unacquainted with the facts may hastily conclude thatit results from some want of willingness to cooperate withother countries. In the first place the Fund has alwaysdone its utmost to assist other workers, both in this and in

foreign countries LU uui.s euu. lu has suppned illaburiul

many laboratories both at home and abroad-in fact, to

more than 30 different laboratories in foreign countries ;and a large number of foreigners have been received intothe laboratories of the Fund in London. The staff of the

Fund is already doing its utmost to assist international

workers in the investigation of malignant disease. Dr.

E. F. BASHFORD, the director of the laboratory of theFund, and his committee are, however, agreed that

the time has not yet come for an international con-

gress on cancer. The facts requiring a congress for the

unanimous recognition of their importance have still to be dis-covered, and much more good at present can be done by active

cooperation in the distribution of material than by anycongress. Inasmuch as the Imperial Cancer Research Fundis representative, by its executive and other committees, ofsome of the most important public bodies of this country,any congress held in London under such auspices would excite great anticipations on the part of the generalpublic, which would not be fulfilled by the results. A

premature congress can only do harm ; but when the timeis ripe, no society will be more anxious to cooperatewith other nations than the Imperial Cancer Research

Fund.

An Outbreak of Cerebro-spinalMeningitis.

ONE of the curious features of infective diseases is their

tendency to periods of waxing and waning intensity, thecauses of which are at present singularly obscure. In the

case of the rarer epidemics the periods of prevalence afford

special opportunities for the study of the nature of the

maladies, and it is important that the occasions offered

should be utilised to the full. A disease which in recent

years has presented signs of increased activity, both in this

country and in other parts of the world, is cerebro-spinalmeningitis, and our knowledge of this affection has distinctlyincreased as a result of the studies to which it has been sub-

jected by many observers. A recent contribution of consider-able interest has been made by Dr. DAVID J. MORGAN in a

pamphlet embodying an account of an outbreak of I I spottedfever" which occurred in Swansea during 1908.1 Dr. MORGANraises several points worthy of more extended investigation.The whole number of cases with which he deals amounted to

63, and short clinical notes are given of all of them. The male

patients outnumbered the female, as is usual in this affec.

tion, by 37 to 26 cases. Rather less than half of the whole

number presented the peculiar rash from which the appella-tion "spotted fever arises; but it must be borne in mind

that typhus fever is also known by this name, and

that the two maladies were not distinctly separated onefrom the other in days gone by. Hence it would be

better, we think, to abandon this term for cerebro-spinalmeningitis, the term being really more suitable for typhusfever, where the form of exanthem is much more constant.

It is generally supposed that infection in cerebro-spinalmeningitis is carried by the air and that the germs are

inhaled by patients, the throat, nose, and tonsils being the

portals of entrance. Dr. MORGAN’S observations do not bear

out this supposition. Indeed, he found that cases of apparentdirect infection were rare, only three instances occurring inwhich more than one member of a household suffered. The

distribution would seem to be more like that of enteric

fever than of immediately contagious diseases, such as scarletfever or measles, and Dr. MORGAN suggests the alimentarycanal as the portal of entry, supporting his view on the

severity of the abdominal symptoms encountered, on theoccurrence of necrotic areas in the liver, and on the con-

stant enlargement of the abdominal lymphatic glands seenafter death.

The resemblance presented by certain cases of cerebro-

spinal meningitis to enteric fever and the difficulties in

diagnosis which may result are perhaps not generally recog-nised. Dr. MORGAN even finds that the serum of these

patients may agglutinate typhoid bacilli in a dilution of

1 in 50, a phenomenon which would be looked uponas a positive reaction to Widal’s test. Three cases out

of five tested did so in his experience, and a fourth

gave a positive reaction in rather less dilution. He suggests,indeed, that cases of cerebro-spinal meningitis have, on the

1 An Account of an Outbreak of Spotted Fever (Epidemic Cerebrospinal Meningitis) which occurred in Swansea during 1908. By David J.Morgan, M.A., M.D., B.C.Cantab., D.P.H.Lond., F.C.S., Medical Officerof Health of Swansea, &c. Swansea: South Wales Post NewspaperCo., Ltd., High-street. 1909.

157

strength of this peculiarity, been called enteric fever at

various times, and quotes published instances apparentlyillustrating this source of error. It is of considerable im-

portance that further light should be thrown on the fre-

quency with which this serum reaction does actually occur,and we sincerely hope that those who have the opportunityof studying cases of cerebro-spinal meningitis will pay

attention to this point and record their experiences. Apartfrom this, and from the gravity of the abdominal symptoms,in a certain proportion of cases there should not be

any great difficulty in distinguishing the two affections.

In cerebro-spinal meningitis the onset is invariably sudden,as is well brought out by Dr. MORGAN’S report, and

the pain in the head is excruciating in character,not the dull frontal headache of enteric fever. Stiffness in

the neck and retraction of the head are noted in over 90 percent. of the cases of cerebro-spinal meningitis, and

actual opisthotonos was recorded in 73 per cent. of

patients. A further assistance in diagnosis is afforded bythe occurrence of Kernig’s sign-the stiffness of the muscles

at the back of the thigh rendering it impossible to extend the

leg when the thigh is flexed to a right angle with the trunk.

Lastly, the examination of the fluid obtained by lumbar

puncture will almost always lead to a correct diagnosis. It

varies, it is true, considerably in different cases, from a

thick creamy pus to almost clear straw-coloured fluid, butthe meningococcus is usually to be found without difficulty.An interesting question with regard to treatment is raised

by Dr. MORGAN, who was struck by the extraordinarydivergence in the rate of mortality among cases treated

respectively at home and in the isolation hospital at

Swansea. Whereas 93 per cent. of the former cases died,in the hospital the death-rate was only 44 per cent. He

attributes this remarkable difference to the fact that cases

in the hospital were treated by lumbar puncture as a routine

measure, whereas when home treatment was carried out

members of the patient’s family often objected to this pro-cedure. No serum was used as a remedy throughout the

epidemic, and Dr. MORGAN is inclined to attribute the

amount of success which has been claimed for serum-

therapeutics in this disease to the fact that the use of this

remedy necessitates a preliminary lumbar puncture, to

which, and not to the serum, the patients’ recovery is

due. At present we must conclude that there is

not sufficient evidence available to decide as to the value

of serum in cerebro-spinal meningitis. The remedy hasnot been very long introduced into practice and several

brands of serum are prepared, the comparative efficacy ofwhich has not been determined. We are therefore not pre-

pared to admit that Dr. MORGAN’S experience by itself canbe allowed to counterbalance such reports as have been

made by others in this respect. Nevertheless, he makesout a good case for careful investigation as to the amount ofgood which is to be attributed to the serum and to the merewithdrawal of spinal fluid respectively. So far as we are

aware, no harm has ever been traced to the injection ofserum, so that there is no reason to feel reluctant to make

trial of it. As the withdrawal of the spinal fluid will pre-sumably be followed by the exudation of a fresh supplyto take its place, it would be of interest to compare the

bacteriolytic and opsonising values of the fluid withdrawn withthose of the serum supplied for treatment. If this were done

in a fair number of instances, some theoretical inferences

might be drawn as to the probable value of serum as a local

dressing for the spinal cord and brain, since it is as a local

application that it has been found useful, authors beingapparently agreed that ordinary subcutaneous injection is notof any value in this affection. Be this as it may, we con-

gratulate Dr. MORGAN on the careful observation which hehas made of the epidemic which came under his notice, and

hope that his report will be widely studied in order that the

points which he has raised may be investigated by others,and that advances may result in the diagnosis and treatmentof one of the most fatal diseases which afflict Europeannations.

The Food of the Soldier-FOR some time past a War Office committee has been con-

sidering the various questions concerning the health of thesoldier produced physiologically by his food, training, andclothing, and as this committee is composed not only of

military officials of great experience, such as Surgeon-General Sir ALFRED KEOGH, Director-General of the ArmyMedical Service, Surgeon-General Sir T. J. GALLWEY,Colonel S. P. ROLT, inspector of gymnasia, and others, butalso of scientific men such as Sir F. TREVES and Dr. J. S.

i

HALDANE, its conclusions deserve careful consideration at

the hands of all interested in the well-being of the army.The third report of this committee has recently been issued,dealing with the oft-discussed question of the soldier’s food.The report itself is short, consisting only of a dozen pages,but it is accompanied by six appendices, of which the firstfour contain details as to the analysis and packing of variousbrands of tinned meats supplied to the army by MajorW. W. 0. BEVERIDGE, R.A.M.C., assisted by Captain H. B.

FAWCUS, tG.A.IV1.U., and Major U. N. F. FOWLER, K. A. M. U.

The fifth appendix by Major BEVERIDGE deals with the

composition of emergency rations ; and the sixth gives auseful statement of the various rations supplied to foreignarmies, compiled by Lieutenant-Colonel W. G. MACPHERSON,R. A. M. C.

The report itself deals chiefly with the quantity, nature,and variety of the soldier’s food under ordinary conditions-that is, his peace ration-and the arrangements that exist forhis messing. From time to time various criticisms have been

passed on the amount and kind of food supplied to our

troops, generally more or less unfavourable. These comments

have sometimes been the outcome of zeal for the soldier’s

welfare rather than of knowledge as to what is actually donefor him, or, indeed, as to what work he himself has to do.It has often been supposed that he is much underfed, the

assumption being that what is called the "ration"—i.e., a

pound of bread and three-quarters of a pound of meat-is all the food that he is provided with under ordinaryconditions in barracks in this country. In addition to

this, however, he has a "messing allowance" of 3d. a

day, which is expended by the commanding officer of the

regiment or unit, to the best advantage, in the purchase of

vegetables, cheese, materials for puddings, and the like, as