"C.S.M."

Dominion, Volume 10, Issue 3038, 27 March 1917, Page 6

"C.S.M."

ATTACKING A CAMP MENACE < STORY OF A MEDICAL CONQUEST ("Times" Medical Correspondent.) What may be described as a "massed attack" on disease was begun in January, 1915, when the Director-General of Army Medical Services, Sir Alfred Keogh, called for the co-operation of the Research Committee against corebro-spinal fever ("spotted fever"), which had broken out in variious camps at Home. . The story of this attabk is told in a report of the Medical Research Committee just published. It is a story which adds new lustre to the scientific history of the war, to the Army Medical Department, and to the Medical Reseaich Committee. The disease had just declared itself, and, _ arguing from the standpoint of civilian experience, it' was to be feared thai ''it would take a terKblo toll'of life. Happily Sir Alfred Keogh saw tho need for instant action, and took it.-. No sooner was the presence of the/enemy reported thaii the opposing forces wore being mobilised. The committee answered the call made upon it, and tho War Office afforded every facility for action. Lieutenant* Colonel M. H. Gord'on was appointed to help Colonel Horrocks and Surgeon-' Colonel Reece, who were already- at work. The first step was to secure a base. A central laboratory was equipped ■at the R.A.M C. College and 37 district laborarories were started at points chosen, by the War Office. The central laboratory at once supplied to tfe.e district laboratories swabs for securing test specimens from suspected cases and "carriers," and spccial media for growing the bacteria—the so-calledl meningococci Moreover, .at once arrangements i<>r giving advice were put in handj l tan-commissioned offioers and men of the R.A.M.C. were put in training *. o learn how to make the media. As soon as they had learned they were -ii'sited out to thej'i'ront" at the distriot laboratories. In addition, since the ' 'front' was liable to extend at any moment, 1 a ."specially equipped travelling laboratory vas put in commission by the VVar. Office. The arrangement of this central laboratory,, the G. H. Q. of the campaign, is worth noting. Colonel Gordfin.kept himself free "for purposes of , consultation and research." "Under him Major Hine took charge of tho training of officers, tho keeping of accounts, and the manufacture of a large supply of vaccine for' use in emergency. - Mr. E. G. Murray dealt the testing of material received, like an intelligence officer, and later Lieutenant Tulloch continued this work. Other work-' ers were Captain Armstrong, Captain Dayies, and Captain Martin Flack.

Delicate Tests. The next step was to gain information about the enemy, his movements, his appearance, above all his weak points. ( Various extremely .delicato tests were. employed. It was believed that the meningococcus lias its own special habits as regards t}ie temperature at which it will grow andthe food it needs. But thanks to the so-called agglutination tests much more was found. It was established that not one but four different types of enemy were at work. The importance of this was great, for up till this time the weapons of war, had consisted of a serum inrtended to defeat only one type. The r-eason for the comparative failure of this serum and the high mortality of the';disease began to be apparent. . If it can be imagined that an army is provided with guns which will only kill Germans and is then faced by Austrians and Turks and Bulgars as well,' the position of those treating cerebroI spinal fever before thi.s discovery was made becomes plain.

The moment /this knowledge about the four types of enemy was. secured'it was sent out to all the "fronts," and instant steps were taken to identify the bodies of enemy troops engaged. Were these' Type I-or Type II or Type 111 v or Type IV. meningococci? The question' was settled without delay, and weapons of war prepared forthwith. "As soon as defined," says the report, "specimens. of eaci of'the four types of meningococcus were forwarded to those who prepare anti-meningococcus serum . for therapeutic purposes.

:. "The success.of specific serum, however, is'dependent in no small degree upon its '■ early administration, which implies early diagnosis of the disease." s

Investigation of the types now went on apace. _ In every case of this disease the germ is found not only in the .fluid surrounding the brain, but also ,in the liose of the patient. It was accepted that'the disease began when the germ was able'to pass from nose to brain. The questions thus arose—Can it be said that if a patient! has Type I in his _ nose he also has Type I in bis brain ? Again,' since infection-is direct from patient to patient, does infection follow type—i.e., does a ."carrier" with Type I. spread Type I only? It was soon "proved, that— (1) A case of cerebrospinal fever only yields a single type of meningococcus from its ceijebro-spinal fluid—i.e., that a case is always strictly one type or. another. . ■ ■ . (2) That the type found in the nose is always the same as the type in the brain. . '\ *\- ■ (3) That because the germ is always present in the nose at the, beginning of the attack, every case of the disease is an instance of a "carrier" becoming a victim to 'his own carried infection. (4) Finally, that, "type breeds true" in every case.' The types are not interchangeable. They < are .separate breeds, as white men and black men and yellow men are.-; ■ Here now was knowledge of the fo'e. On the heels of this knowledge came the weapons forged to destroy him. In th first place there is the weapon of rapid administrative handling. Whenever a case is notified, and if the case is in hospital, details are ascertained at once by telephone. If the case is in the' London area immediate "contacts" are .'segregated by. telephone pending investigation. The case is tested at once, and then aerum is administered. This "serum has now-been made so that each type can be dealt with; thus, no matter which typo may bo present, a serum is available to act npon it/ A- swab is taken from the nose for tost, and swabs are also taken from all contacts so that it may be determined who do and who do not harbour the germ. , If the case-has been in the wards for several days all the inmates of the ward and members' of tlie nursing staff are swabbed.

I An Example of Energy. ' An example of the need of examining contacts 1 is furnished by an outbreak which occurred in a large garrison in the spring of 1916. Captain Armstrong was sent down and, with "laudable energy, T< swabbed a very _ large section of tlie wliole garrison, in all 10,000 men, the vast majority of whom had not been in . contact with the cases. A provisional isolation of 410 men was made as the result of this. Captain Armstrong had to abandon the work at this point, but Captain Tulloch took it up. TTlien he arrived on the scene BIJ of the 410 had become free of organisms: All of the remaining 324 had mcningococeus-like organisms. Of these 321 actually, carried the specific njeningococcus of tho disease. In no single oase/did any man who was found to be negative either develop the disease or transmit it to others. As

showing how the disease may be trans* mitteS, tie case of Sapper :B - may ue cued. He came back from Franco on April 9, 1916, complaining of headacEfc and pains in the back and legs. Two days later ono of his children was taken ill and removed with symptoms of the disease. Next day another child was taken ill and removed to an. isolation hospital, where he died of the disease. The father was found to bo a carrier of Type 11. A sister was ' sent to bring home the ,first 'child, now recovered, from the hospital, and, later died within twenty-four hours.. This chilS also harboured Type 11. The results of this work are its real, claim to consideration. They are only being gathered, at present, but wo may epitomise them thus: —Out of 33 military cases treated in the London district alone last season by serum prepared under these methods only threo died, a result in marked contrast with ilie 40 to 60 per cent, mortality usually, found before this*,serum was avail-, able. i Cjomment is not- required. The' treatment of carriers is difficult, bub it has been found that the useof inhalation chambers charged with chloramine vapour works very well, and a large proportion of. carriers can be 1 freed from the meningococci thus in a short period. This treatment also seems' to benent, victims of post-nasal ca-. t'arrli.