Memorandum on cerebro-spinal fever / Ministry of Health.

  • Great Britain. Ministry of Health.
Date:
1940
Catalogue details

Licence: Public Domain Mark

Credit: Memorandum on cerebro-spinal fever / Ministry of Health. Source: Wellcome Collection.

    4/10 (page 4)
    of the meningococcus with that isolated from a patient, to show that a particular person has probably introduced the disease. In residential schools and similar limited communities, the occurrence of a case of cerebro-spinal fever may justify the bacteriological examination of swabs from the nasopharynx of those persons who have occupied beds adjacent to that of the patient, or who have otherwise been in close contact with him and the segregation of those found to be infected with a strain of meningococcus identical with that of the patient. It is prudent not to permit close association of children with any person who within three weeks has been living in a community in which the disease was present, until the person has given a negative nasopharyngeal swab. Naval, Military and Air Force contacts will, of course, be dealt with as laid down by the Medical Departments of the Navy, Army and Air Force respectively. The isolation in hospital of civilian contacts or known “ carriers ’’ should not be attempted. They should be instructed to sleep alone, to avoid crowded assemblies and close contact particularly with children and young persons. To this end they.should be in the open air as much as possible. Local treatment of the nasopharynx is probably useless. Treatment of “‘ carriers ’’ with sulphanila- mide or sulphapyridine has been tried but in the present state of knowledge mass treatment of contacts by these drugs for this purpose should not be attempted. As a rule, “ carriers ”’ become free spontaneously in the course of two to three weeks simply with fresh air and exercise. Diagnosis. The incubation period is indefinite, but usually from three to five days. The maximum period may be as long as nine to ten days and in some fulminating cases as short as 24 hours. Suddenness is one of the usual characteristics of the onset but is not invariable. Before its confirmation by lumbar puncture the diagnosis is mainly determined by five symptoms; intense headache, vomiting, pyrexia (usually moderate and associated with a comparatively slow pulse), stiffness of the neck muscles, and Kernig’s sign. | , The patient appears to be more seriously ill than his moderate temperature and slow pulse would indicate; cerebration is usually slow or otherwise abnormal; stupor, delirium or coma may be present early in the disease. The vomiting is almost invariably associated with constipation. Stiffness of the neck muscles is an early sign, whilst retraction of the head comes later; forward flexion of the neck is more painful than _ rotation; Kernig’s sign is pronounced and there is usually little difficulty in distinguishing this definite sign of meningeal irritation from its slight counterfeit which can sometimes be elicited in influenza or measles.