Review of a Cerebro-Spinal Fever Epidemic Amongst Troops in France

Brown, James (1940) Review of a Cerebro-Spinal Fever Epidemic Amongst Troops in France. PhD thesis, University of Glasgow.

Abstract

(1) Study was made of oases occurring in an epidemic of cerebro-spinal fever amongst Troops, numbering 29,000, stationed on Lines of Communication in Prance. (2) This epidemic lasted from January until June, 1940, the maximum number of cases per month occurring during March. (3) Forty-four cerebro-spinal fever, 14 Carrier and 4 chronic meningococcal septicaemia cases were observed and treated by chemotherapy. (4) Incidence of cerebro-spinal fever was 1.5 cases per 1,000 men. (5) 66% cases occurred amongst men between 20 and 29 years of age. (6) Carrier rate during the first half of this epidemic was 17% but over the entire epidemic period was only 9.2% of contacts. (7) It was established that no individual had contracted cerebro-spinal fever shortly following contact with an existing case. Such a mechanism, therefore, could not have been responsible for promulgation of this epidemic. (8) Existence of ambulant and remission cases of cerebrospinal fever was demonstrated. (9) With two exceptions, all positive cultures from cerebro-spinal fluid of these cases yielded Group I meningococci. These exceptional cases gave Group II meningococci. (10) Combined serum and chemotherapy, applied in the first 10 cases of this series, was discarded in favour of intensive chemotherapy alone. (11) Toxic manifestations, following Sulphapyridine treatment, of a mild nature only, were observed. (12) Repeated lumbar puncture was unnecessary in 64% cases treated. (13) Rapidity of recovery and remarkable freedom from permanent sequelae, obtained by sulphapyridine treatment of these cases, was outstanding. (14) Sequelae occurred in 9 cases, 7 being of nerve origin, only one leading to possible permanent disability. (15) Of 10 cases treated by serum and sulphapyridine 4 developed sequelae, 1 possibly permanent. Of 34 cases, treated by intensive sulphapyridine alone, 5 developed sequelae. (16) The nature of these sequelae and their relatively late onset was considered due to a toxic neuritis or to a concomitant, local, neurotropic virus myelitis rather than to direct infection of or haemorrhage into nerve trunks. (17) Mortality amongst these 44 cases of cerebro-spinal fever was NIL. (18) Four cases of chronic meningococcal septicaemia and 14 Carriers were successfully treated by chemotherapy. (19) Response of chronic meningococcal septicaemia to sulphapyridine treatment was dramatic and satisfactory. (20) Chemotherapy provided an effective method of dealing with cerebro-spinal fever Carriers. (21) From 44 cerebro-spinal fever cases, 8 gave a chronic meningococcal septicaemia history prolonged over many weeks immediately preceding the onset of meningitis. (22) Cerebro-spinal fever preceded by chronic meningococcal septicaemia or by frequent remissions was the predominant form of disease encountered towards the end of this epidemic. (23) Relation of remission and chronic meningococcal septicaemia cases to spread of cerebro-spinal fever, during this epidemic, was considered of greater importance than hitherto recognised. (24) Existence of atypic and low-grade manifestations of meningococcal infection was observed in the late stages of this epidemic. (25) It was considered that such cases might be responsible for maintenance, amongst adults, of this disease until a future epidemic of cerebro-spinal fever might develop.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Keywords: Medicine, Epidemiology, Military history
• Date of Award: 1940
• Depositing User: Enlighten Team
• Unique ID: glathesis:1940-79588
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 04 Mar 2020 16:45
• Last Modified: 04 Mar 2020 16:45
• URI: https://theses.gla.ac.uk/id/eprint/79588