the epidemiology of the meningococcus

1198

reaches the cisterna magna and then passes underthe medulla, pons, and midbrain to the cisternainterpeduncularis and chiasmatis, whence it isdistributed to the cerebral sulci, where it is absorbed.It has been shown experimentally that about three-fourths of the cerebro-spinal fluid is absorbed in thesubarachnoid spaces of the brain and the remainderin the spinal subarachnoid space. An obstructionin the cisternse under the medulla, pons, or mesen-cephalon will produce hydrocephalus just as effectu-ally as a block in the aqueduct of Sylvius. An

interesting method of demonstrating during life anobstruction in the subarachnoid space has beendevised. By lumbar puncture 30 to 60 c.cm. of fluidare removed and an equal volume of air is substituted.If there be no obstruction every part of the subarach-noid space will be visible in a radiogram ; the cerebralsulci will be seen as a network. If hydrocephalusbe present it cannot be of the communicating form.But if air is absent in the sulci an obstruction mustexist in the subarachnoid space.

LEGALISED CHILD ADOPTION.

THE Committee appointed last August by theHome Secretary to consider the desirability ofmaking legal provision in this country for the adop-tion of children has just brought in a very practicaland serviceable report.! Soon after getting to worka brief interim report was issued recommendingimmediate amendment of the law so as to secure thelegitimation of children born out of wedlock by thesubsequent marriage of their parents. An enact-ment to this effect, which has already been embodiedin a 13ill read a second time in the House of Commons,would secure the rights of one considerable group ofunfortunate children. The present report proposestwo further alterations in the law. both urgent.First, an Act to give legal recognition to the adoptionof children under the judicial sanction of countycourts, securing both for adopter and adopted childsimilar rights and duties to those obtaining betweennatural parents and their children. Such an enact-.ment would give to the adopter that protectionwhich has heretofore been so sadly lacking. Parentswho have habitually neglected a child, and left it tobe brought up by relatives or strangers, are all tooready to claim it again on reaching the wage-earningage. Such a catastrophe has occurred to manyadopters and deterred others from adopting. Thesecond recommendation is an amendment of theChildren Act, 1908, whereby so-called adoptionswhich do not receive formal legal sanction should benotified and properly supervised. Here the pro-vision would be for the protection of the child, forwhom in many cases a monetary consideration hasarisen. When these three questions have beendealt with by separate Acts the Committee recom-mends the reconsideration of the whole legislationrelating to children with a view to amendment andconsolidation. The personnel of the Committee,which has discharged so wisely and quickly its civicduties, consist,s of Sir Alfred Hopkinson (chairman),Mr. Neville Chamberlain, Hon. Lady Norman, Mrs.C. E. B. Russell, Mr. J. H. Seddon, and Mr. T. W.Sherwood. We are grateful to them, and trust thatParliament will lose no time in setting the seal upontheir labours.

THE EPIDEMIOLOGY OF THE MENINGOCOCCUS.

ONE of the most illuminating and suggestive papershitherto published on the peculiarities of themeningococcus has recently appeared under thesignatures of Prof. 0. Thomsen and Dr. FerdinandWulff of the Serum Institute in Copenhagen. Thestarting-point of their theories would seem to be the

1 Report of the Committee on Child Adoption. Cmd. 1254.H.M. Stationery Office. Price 2d.

2 Hospitalstidende, 1921, vol. lxiv., Nrs. 2 and 3.

observation that in no case has more than one typeof meningococcus been found at the same time in thenaso-pharynx of a ’’carrier." Interpreting thisobservation as a sign of mutual antagonism betweenthe different types of meningococcus, the authorsmake the interesting suggestion that, with regard tothe meningococcus at any rate, there are two totallydifferent kinds of immunity. The one is due to theantibodies present in the blood and, to a less extent,in the secretions of the naso-pharynx. The other isdue to the " carrying ’ of harmless or comparativelyharmless types of meningococcus which allow nofoothold for a virulent type. This second kind ofimmunity is, in the authors’ opinion, the chief factorwhich renders long service soldiers comparativelyunsusceptible, while recruits seem to be peculiarlysusceptible. Under the often overcrowded conditionsof military service, both avirulent and virulent typesof meningococcus are frequently to be found in thenaso-pharynx, and in the case of a recruit who joinsan old draft of soldiers, there is a race between theavirulent and virulent types. If the latter reacheshis naso-pharynx first, and if his concentration ofantibodies is low, he falls ill or, if his concentrationof antibodies is high enough to prevent serious bloodinfection, but not high enough to prevent lodgmentin the naso-pharynx, he becomes a " carrier " of thistype and is a serious danger to his fellows. Theauthors describe an epidemic of cerebro-spinal feveramong recruits lodged in barracks, one side of whichwas much more damp and dark than the other.Soon after the outbreak every soldier was examined,and the " carriers " of the virulent type A (whichappears to be totally distinct from the virulent typesidentified in this country) were isolated and theepidemic was checked. An instructive feature ofthis investigation was the discovery that, though thesoldiers were equally divided between the two sidesof the barracks, many more harboured meningococcion the dark and damp side than o’i the other, theactual figures being 22 to 9. Similar observationshave been made by Danish army surgeons in earlieryears, and the authors suggest that the explanationfor this phenomenon is to be found in the loweredresistance of the body to infection induced by dark-

*

ness and other unfavourable atmospheric influences.The authors translate their hypotheses into certainrecommendations on behalf of recruits in theirrelations with old service men who may prove to be" carriers " of the dangerous type, and it appearsfrom a note in Hospit,as.’iderade for March 2nd thatthese recommendations have already been adoptedby the Danish army authorities.

THE PNEUMOCOCCUS AND STREPTOCOCCUS

IN RELATION TO INFLUENZA.

THE current number of the FdirzburJh. MedicalJ 0 w"na contains a valuable report on this subjectmade by Dr. W. R. Logan to the Medical ResearchCouncil. The plan of investigation adopted wasto examine cases of (1) pure influenza in their earlieststage of illness, and (2) pulmonary complications inthe more advanced stages of the disease. In theearly cases where there was no sputum the materialwas obtained from the naso-pharynx by means of aswab, whilst in the later pulmonary cases sputumwas available for examination. All the cases wereobtained during the influenza epidemic in Edin-burgh from November, 1918, to February, 1919.Dr. Logan examined 44 cases of pure influenza and61 cases of pulmonary complications. From 13-6per cent. of the former and 78’1 per cent. of thelatter pneumococci were obtained, and from 100 percent. of both groups streptococci were obtained. Indifferentiating the pneumococcus from the strepto-coccus the bile solubility test was used as the finalarbiter of distinction. Thirty-four pneumococcalstrains were examined as to type on the well-known lines of work of the Rockefeller bacterio-