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INFLUENZAL MENINGITIS.

As everybody knows, the construction of thePanama Canal was vastly facilitated by theexcellence of the medical service which had chargeof the health of all the workers. This servicesucceeded in cutting down infectious disorders,with malaria at their head, to an extremely lowpoint, and has kept a record of the most interest-ing cases or types of disease with which ithas had to deal during the years of its activity.Between 1908 and 1913 60 cases of meningitis weretreated at Colon Hospital; 7 of these were influenzal,and’ 5 are described and discussed in a paperby Dr. R. B. Hill and Dr. R. J. Pickard.! Influenzal

meningitis, due to the bacillus ifluenzae, is a

very fatal disease; 7 out of 63 recorded ca,ses

and 1 out of the 7 cases treated at Colon haverecovered. Its pathological anatomy is very variable.In some the dura mater is mainly involved, inothers the pia-arachnoid ; thick yellow-green pusmay be seen, or a merely serous exudate. Thebrain may be chiefly involved, or the spinal cord, orboth together; the involvement of these organs maybe either general or localised in irregular patches.The influenza bacillus may always be recoveredfrom the cerebro-spinal fluid, which is increasedin amount in these cases, and often from the

circulating blood as well. It is thought thatthe infection of the meninges and blood arisesfrom a previous influenzal infection of the respira-tory tract. The symptoms of influenzal meningitisare also very variable. The onset, occasionally ful.minating, is usually gradual, with bronchitis, head-ache, low irregular fever, malaise, and in childrendiarrhoea. There may be irregular fever and rigorssimulating malaria; the spleen may be enlargedand rose-spots may appear, so that enteric feveris closely imitated. Characteristic meningiticsymptoms are habitually seen-rigidity of themuscles of the back and neck, Kernig’s and Babinski’s signs, ocular palsies, and photophobia ;the pulse, usually rapid in infants, in whom the disease is common, is generally slow in adults with influenzal meningitis. Herpes is rare ; the hydro-cephalic cry is frequently noted, convulsions may l

occur, and vomiting. The urine shows a diazoreaction, or febrile albuminuria. The blood exhibits la moderate leucocytosis, usually under 15,000, unlesssome complication is present; in the blood, as in (the cerebro-spinal fluid, the leucocytosis is poly- morphonuclear. Dr. Hill and Dr. Pickard point out ;that the prognosis in influenzal meningitis is bad; but that as the pathological lesion may be small and very localised in the disease, it is probable that morefrequent lumbar puncture and more careful bacterio- logical examination of the cerebro-spinal fluid in obscure cases of cerebral irritation would prove that influenzal infections of the brain are commoner fthan they are thought to be. Treatment of the t

condition is unsatisfactory. Urotropin seems to be 1of doubtful value. Frequent lumbar punctureto relieve pressure would seem to be more

promising and should always be tried. Specifictherapy by vaccine or antiserum should have a Ifuture before it; Wollstein, for example, has pre- Ipared an antiserum with high opsonin contentthat cured experimental influenzal meningitis in

J

monkeys, but no case of the employment of this e

serum in human beings has yet been recorded. ga

1 R. B. Hill, M.D., and R. J. Pickard, M.D., Proceedings of the Medical Association, Isthmian Canal Zone, 1912-13, Mount Hope, C.Z.,1914, vol. v., Part ii., p.100.

THE PREVENTION OF CONSUMPTION : PROFESSORDENYS’S ADDRESS.

AT the sixteenth annual meeting of the membersof the National Association for the Preventionof Consumption, which was held on Thursday,July 15th, at the office of the association, ProfessorDenys, of the University of Louvain, delivered aninteresting little summary of the present position.He pointed out that until comparatively recentlytuberculosis was universally regarded as a con-

stitutional disease, but that Koch’s discoveries hadput the matter at once upon a new basis. Thepeccant microbe having been identified, furtherresearches into its qualities had revealed certainvery important facts-namely, that it multipliesonly in the tissues of living beings, and thatit requires many special conditions for its

propagation, for it will not bear competition withother microbes or withstand the influence oflight or the process of desiccation. Thesefacts, Professor Denys showed, reduced the propa-gation of tuberculosis to two main sources-thesputum of infected human beings and the milk ofinfected cattle-and in both directions care andorganisation were known to effect their successfulinfluence. He concluded by indicating that in orderto rid the world of tuberculosis no extrememeasures are required, and this is especially im-portant where a movement has to be quite generalin its working and dependent for its activities onthe good-will of the population. The preventionof consumption, he said, "is only a question ofgood-will, knowledge, and understanding. On good-will we may count, especially under the stimulus ofexample and persuasion. With regard to know-ledge, much has already been done in the way ofeducating public opinion, but much still remainsto be done. New ideas, opposed to familiar habits,require much time to penetrate into the practiceof the people. No opportunity should be lost ofreminding them that tuberculosis is a contagious.disease, but that, by adopting simple precautions,they have every chance of escaping infection. Infact, it would be a good thing if these simpleprecautions of cleanliness were to be universallyadopted. In my opinion the newspapers mightplay an important part in this campaign. Theymight publish from time to time the results of someof the many medical inquiries which prove in so.

convincing a manner that some careless con-

sumptive has infected his comrades in the work-shop, or that a tuberculous cow has been the sourceof a series of cases of infantile tuberculosis." Pro-fessor Denys makes insufficient allowance for thelimitations of journalism. A certain number ofsuch cases are published in newspapers, bothmedical and lay. but the risks of incurring actions:or libel prevent the comments being of a nature

bring home surely to the public mind the care-essness and callousness of many of its members.

MUNICIPAL CONTROL OF THE MILK-SUPPLY.

THE professor of hygiene at the University ofParma, Dr. E. Bertarelli, has recently occupiedhimself with the problem of preventing diseasedisseminated by impure milk, and asks what can beeffected in this respect, due consideration beinggiven to the economic conditions and mentalattitude of the public towards it/ Large com-munities that have studied the question and

1 Il Morgagni, June, 1915.