Review of cerebro-spinal fever based on personal observations and deductions; along with appendix of case-sheets and records

Abstract

In this Review of Cerebro- spinal Fever I have endeavoured throughout to confine myself as much as possible to my own observations, and deductions therefrom, of cases which came directly or indirectly, under my care during twelve months tour of duty as Pathologist and Bacteriologist for the Ripon Military Hospital and Reserve Training Centre.With the object in view of writing this treatise at a subsequent date in such a form that it might be helpful to my colleagues, particularly in the diagnosis and treatment of cerebro-spinal fever, I took notes of my various cases as they occurred; but it was not until rather too late that I thought it might be even more interesting to include the.case sheets of the actual cases, and so I was unable to collect. all of these for copying. 'I would point out at this stage, that in the first place I have entered up the cases in this volume :in the order of'their occurrence; and secondly that the cases are in no way chosen.During the twelve months I was performing the above mentioned duty I came in contact with every case of cerebro-spinal fever that was admitted to the Hospital; but it was not until the February, March, and April of 1917, when we had an epidemic of 49 cases, that I was asked to take full control of the cerebro-spinal wards. Up to that time I came in contact with the cases to do lumbar punctures from a diagnostic point of view, and only occasionally from a treatment point of view, although, through the courtesy of the medical officers in charge, I was given the opportunity of making notes with regard to the clinical features etc. presented. It will therefore be interesting to compare the first few cases in my résumé with the latter ones, because it was from these earlier cases that I made deductions which helped me in the diagnosis and treatment of my subsequent cases; and likewise to compare my own earlier cases with my later ones because from the earlier ones I obtained deductions which provided me with the necessary indications for observing the clinical features and treatment procedure more closely, with the object in view of improving; treatment, and with the result, I am pleased to state, that the death rate verb, rapidly began to come down. During the first quarter of the above mentioned twelve months, we had 9 cases of cerebro-spinal . fever admitted of whom 5 died and four recovered; and of these four,only two were free from sequelae, i being blind through optic neuritis and irido-choroiditis, and the other deaf and slightly mentally deranged. I regret that I was unable to obtain the case sheets of all of these cases. During the second quarter (the Summer of 1915) we had no cases. During the following quarter we had ten cases, of whom I obtained several case sheets, and of which cases seven resulted in death. During the following quarter, the months of February, March, and. April, when I had full charge both clinically and bacteriologically, I had 49 cases of which 37 were bacteriologically proved positive cases of cerebro- spinal fever, and of which only five died. Of the five deaths three were cases of fulminant type,and in one case the fatal result came within two hours after admission ; another was a recurrent case; and the fifth died as the result of broncho-pneumonia as a complication. Thus it will be seen that the death rate was con - siderably reduced in the last quarter which markedly improved state of affairs was due to early diagnosis, early lumbar puncture, close observation of clinical features during treatment, and the religious carrying out of the treatment as laid down in my review, all of which facts I feel sure will be borne out by the subsequent detailed accounts of the cases themselves and my records. I would here include a few lines from the annual report of the cerebrospinal specialist for the area in which.. I was stationed: -"The mortality rate improvement was most evident among the Ripon cases. The mortality here was over 50% during the first 7 months, whereas during the past 5 months it was reduced to 18.7%. I feel sure that the improved figure is due in a great measure to the energy and determination with which Captain Adams, the Pathologist at the Ripon Military Hospital.tackled the cases. Previous to February the treatment was carried out under conditions of divided responsibility, but later when Captain Adams had sole control treatment became more persistent and continuous ,"With reference to this report I would mention that the 18.7% of the 5 months mentioned was improved during the abovementioned three months to an 8.2% death rate.The only two subsequent cases I have had since,and which are written up in this work,were very severe cases and of great interest. Both of these cases recovered.In conclusion, it is my ardent desire to explain that,although this work shows difference of opinion on many points, I have not written it with the object in view of its being accepted as a direct contradiction of any one of these points of difference, but merely as my close observation in every section of study of the disease, with the object in view of presenting my findings for comparison with those of others in order that we might ultimately perfect the literature at present in our hands, and thus be of material assistance to the medical world as a whole, and through them to all sufferers from this previously considered almost fatal disease.