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CEREBROSPINAL MENINGITIS. 
 
 Report to the State Board of Health upon an Epidemic in Monroe 
 
 and Lenawee Counties, Michigan; and a Study of some 
 
 other facts relative to the Cause of the Disease. 
 
 By HENRY B. BAKER, M. D., 
 
 Secretary of the Board, and Member of Committee ox Epidemic, Endemic, 
 
 and Contagious Diseases. 
 
 Reprinted from the Second Annual Report of the State Board of Health of the 
 State of Michigan, for the Year ending Sept. 30, 1874. 
 
 Printed eor the Author bt W. S. Georqe & Co., Lansing, 1875. 
 
 
 
~* 
 
CEREBROSPINAL MENINGITIS. 
 
 -Report to the State Board of Health upon an Epidemic in Monroe 
 and Lenawee Counties, Michigan; and a Study of some 
 other facts relative to the Cause of the Disease, 
 
 By HEISTRY B. BAKER, M. D., 
 
 Secretary of the Board, and Member op Committee on Epidemic, Endemic^ 
 
 and Contagious Diseases. 
 
 
 
 
 ': 
 
^ 
 
 Mi 
 
 Entered according to act of Congress, in the year 1875, by 
 
 HENRY B. BAKER, 
 
 In the office of the Librarian of Congress, at Washington, D. C. 
 
CEREBRO-SPINAL MENINGITIS 
 
 REPORT. 
 
 To the President and 3Iembers of ifw State Board of Health of Michigan : 
 
 Gentlemen — Omitting details of circumstances which ]ead to this report, 
 with which you are already familiar, by the general direction of the board I 
 reached Blissfield in Lenawee county on the 22d of June, having selected that 
 place as a starting point in order to avail myself of the assistance of Dr. H. 0. 
 Wyman, who had kindly volunteered to assist in obtaining a history of the 
 epidemic. Dr. Wyman proved himself an energetic and enthusiastic worker in 
 the cause of public health. I wish to acknowledge my indebtedness to him for 
 valuable assistance. 
 
 In presenting the facts ascertained with reference to this epidemic, many of 
 them are stated simply as facts supposed to have some bearing upon this sub- 
 ject, while as regards others I have thought that I could not do better than to 
 briefly go over that part of the subject to which it seems to me each particular 
 item presented is more or less closely related, and thus to indicate my own 
 view of at least one of the relations which the item of evidence collected bears 
 to the subject, and the conclusion to which the combined evidence tends. I 
 have also collected, from the literature of the medical profession, numerous 
 isolated facts relative to anatomy, physiology, pathology, and therapeutics, and 
 have endeavored to group them in a way to render them of more practical 
 value to humanity in connection with the study of this disease. 
 
 More or less evidence has been collected concerning 88 cases of unusual 
 sickness : 33 cases having occurred at or near the village of Dundee, 40 cases 
 at or near the village of Petersburg, 2 cases at or near the village of Deerfield, 
 5 cases at or near the village of Blissfield, 2 cases in the township of Raisin- 
 ville, and 6 cases in or near the city of Monroe. 
 
 Monroe, Raisinville, Dundee, and Petersburg are all in Monroe county ; 
 Deerfield and Blissfield are in Lenawee county. All these places have indirect, 
 Monroe, Petersburg, and Deerfield have direct railway cornmunicaton each 
 with the other. The city of Monroe and the four villages named above are all 
 situated on the banks of the River Raisin, which also runs through the town- 
 ship of Raisinville. The river is not a large one ; it is not a navigable stream. 
 The water in the river is not clear ; in fact, at that time it was quite turbid. 
 There is a mill-dam at each village, and a slight odor sometimes arises from 
 the water, especially as it pours over the dam. At Petersburg complaint was 
 made that a "flood-wood" very near the village was the cause of a bad odor 
 
118 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 in its immediate vicinity; and at this and other places I was more than once 
 referred to the river and the dams as the cause of the epidemic from which 
 they had just suffered. 
 
 Analysis of water taken from the River Raisin at Deerfield, Sept. 8, 1874, by 
 Prof. R. C. Kedzie of this board resulted as follows : In each imperial gallon, 
 20.3 grains of solid matter, of which 9.8 grains was organic matter containing 
 nitrogen. 
 
 All along the river in this vicinity there are many bayous and flat places 
 which are under water when the water is high, and dry when it is low. Oppo- 
 site such places one frequently experiences the peculiar pungent odor some- 
 times given off by aquariums and ferneries containing ferns, mosses, etc., and 
 occasionally this is united with an odor like that from a drained mill-pond in 
 process of drying up. 
 
 The prevailing diseases of this locality are usually the intermittent and re- 
 mittent fevers. 
 
 EFFOKT TO TKACE THE SPREAD OF THE DISEASE. 
 
 I was told that cerebro-spinal meningitis had not prevailed just in this local- 
 ity for several years, at least not to any great extent. I find, however, on ex- 
 amining the returns of deaths, made by the supervisors, that in 1868 there 
 were in the township of London, which adjoins Dundee, four deaths attributed 
 to "spotted fever." Three of these deaths occurred in one family. In 
 1871 there was one death, and in 1873 one death in the same town- 
 ship. These were all the deaths returned from Monroe county from this dis- 
 ease in 1867, 1868, 1860, 1870, or 1871. For the year 1872, however, ten 
 deaths were returned, but none of them occurred in either Dundee or Peters- 
 burg. For the year 1873, eight deaths from this disease were returned from 
 Monroe county, one having occurred in Dundee and one in Summerfield, in 
 which township the village of Petersburg is situated. Dr. Paquette told me of 
 another death near Petersburg in the fall of 1873, which at the time was 
 thought to be a case of poisoning. He now thinks it was this disease. The 
 patient was a lady, and the body was buried in the village cemetery. Dr. 
 Jackson gave me notes of one case at Dundee, January 1, lb74, which died on 
 the third day. 
 
 This epidemic began about the same time at Dundee that it did at Peters- 
 burg. The first case at Petersburg occurred March 3, 1874, and the patient 
 was still sick when I was there, June 23. The first case, during the epidemic, 
 at Dundee, occurred March 7, — four days later than the one at Petersburg. 
 The patient was convalescent on the 54th day after the attack. The last case 
 at Dundee was attacked May 4. Most of the cases at Dundee occurred during 
 March and April, while most of the cases at Petersburg were in April and 
 May. Those at Deerfield were in May. The cases of unusual sickness at 
 Blissfield occurred in May and June. 
 
 IS THE DISEASE COMMUNICABLE? 
 
 From the preceding statement of cases of the disease in that vicinity pre- 
 vious to this epidemic, it will be seen that there appears to have been abundant 
 opportunity for the disease to have spread either by contagion or infection, if 
 it is ever possible for it to spread in such manner. 
 
 The physicians in the villages visited were unanimous in saying that they 
 saw no conclusive evidence of its being contagious. I collected some evidence 
 
CEREBROSPINAL MENINGITIS. 119 
 
 which might be construed in a way to show that it was communicable in some 
 manner, but which was nearly as well explained by the fact of persons having 
 been placed under similar conditions. In relation to this subject, John Netten 
 Ekdeliflfe, in his essay on '• Epidemic Cerebrospinal Meningitis/' in J. Russel 
 Bey n olds' ; " System of Medicine/' says: 
 
 * The great majority of observers have come to the conclusion that the dis- 
 ease is incommunicable from the sick to the well. Among the minority who 
 hesitate to accept this deduction without reservation are Professor Hirscb, Pro- 
 fessor Stokes, and Mr. J. Simon. The facts which suggest the possibility of 
 the active cause of the disease being portable in some way are of the following 
 character: ( a ) A child was seized with epidemic cerebro-spinal meningitis and 
 died. A second child of the same family was attacked with the malady a few 
 days later. The day following the attack of this child, the mother, who slept 
 in the same bed with it, sickened of the disease. 1 
 
 <4 ( b ) 1. On the 8th of February, 1865, a youth, aged 20 years, was attacked 
 with the characteristic symptoms of epidemic cerebro-spinal meningitis. He 
 was nursed by a woman from another village. The youth died, and after his 
 death the woman returned home. She soon sickened, and she died of the epi- 
 demic disease on the 26th February. There had been but one case pre- 
 yiously in the village. To the interment of the woman, the funeral obsequies, 
 as customary in the district, being performed with the coffin open, came a 
 family from another locality. After the return home of this family, a child 
 three months old, sickened immediately of meningitis, and died within twenty- 
 four hours. Then a man who had accompanied the family to the interment 
 was attacked with the disease, and died on the 2d of March. Lastly, a girl 
 in the same locality who had also been at the funeral, was seized, and died 
 on the 7th March. 2. At another village, two children of one family, aged 
 three and a half and one and a half years respectively, died of the epidemic, — 
 one on the 27th January, the other on the 7th February. The clothes of 
 the deceased were taken to a neighboring village, and came into the pos- 
 session of a girl aged five years. She soon sickened of the epidemic, and died 
 on the 14th February. 2 " 
 
 "It is obvious that contagiousness of a like character to that of small-pox, 
 scarlet fever, or typhus, is not possessed by the malady under consideration. 
 The question is: Does epidemic meningitis, like typhoid fever or cholera, pos- 
 sess a peculiar contagiousness of its own, a property of communicability pecu- 
 liar to itself? This has yet to be solved." 
 
 PREVIOUS CASES N"OT FAR DISTANT. 
 
 In addition to the cases already mentioned, I was told that cases of the dis- 
 ease occurred the preceding fall in Milan, eleven miles from Dundee. There 
 is direct railway communication between Milan and Dundee. Three or four 
 rivers run through the township and afterwards empty into the river Raisin, 
 but below Dundee and all the other places named, except Raisinville and 
 Monroe. Oases were also reported as having occurred at Manchester, in Wash- 
 tenaw county. Since then I have visited Manchester, and found that the dis- 
 ease prevailed there in the preceding August, 1873. There is direct railway 
 communication between Manchester and Blisstield, and communication with 
 the other places by changing cars. Manchester is situated on the river R tisin, 
 
 1 Profeesor Stoke? ? The Medical Press and Circn ar, June i9, 1867, p. 532. 
 >Hirecii, Transicuoua of tn« Epidemiological Society, vol. 2, p. 873. 
 
120 STATE BOARD OF HEALTH-REPORT OF SECRETARY. 
 
 nearer its source than any of tbe places yet named. Cases have been reported 
 as having occurred previous to that time in Jackson county, at different places 
 along this same river Raisin still nearer its source, and in the city of Jackson, 
 which has direct railway communication with Manchester and Bh'sstield. In 
 the returns of deaths for the year 1873, the supervisor of tbe township of Nor- 
 yh]] reports one death from this disease on the 13th of April, 1873. The vil- 
 lage of Morvell is on the bank of the river Raisin, above Manchester. Deaths 
 are also reported from this disease in Napoleon, in the spring of 1873. 
 
 As it is possible that undue importance may be attached to the fact that cases 
 of this disease occurred along this river, and were traced backwards in order 
 of time as the stream was ascended toward its source, it may be well to state 
 that during the spring of 1873, this disease prevailed in various localities 
 throughout the State. The returns of deaths for that year have not yet been 
 compiled in a way to show how extensively, but an examination of the returns 
 for Branch county reveals the fact that 32 deaths are returned from ''cerebro- 
 spinal meningitis," " spinal i'ever" etc. According to the proportion of deaths 
 to cases in Petersburg, Dundee, and Blissh'eld, those 32 deaths represent about 
 one hundred cases of the disease in Branch county during the year 1873. The 
 returns for Ingham county include 15 deaths, which may, probably, be 
 attributed to this disease, some of them appearing, however, as deaths from 
 "spinal fever." For Allegan county the returns show 98 deaths during the 
 year 1873, from specified causes such as may be supposed to be this disease, 
 modified by different circumstances, such as age, sex, inter-current disease, etc. 
 Following back, it appears from the returns of deaths from Allegan county, 
 for the year 1872, that there were in that year 12 deaths from this disease. In 
 1871 there were 5 deaths. For 1870, and for 1869, no deaths were returned 
 from that county from that cause; but one death is returned as having 
 occurred in October, 1868. 
 
 At different times in the past, this disease has prevailed more or less exten- 
 sively at several places within this State. But any attempt to trace it now is 
 attended with very great difficulty, for the reason that the attention of phys- 
 icians, and of the people, was at that time almost entirely directed to efforts in 
 the direction of cure, and no permanent provision had then been made, either 
 for studying the cause of the disease, or recording the coincident facts and 
 results that it might afterward be studied. 
 
 Mortality statistics have only been collected in Michigan since 1867. The 
 first statistical evidence of this disease in Michigan, was in the second Regis- 
 tration Report, for the nine months ending December 31, 1868, in which tire 
 reported 7 deaths from " spotted fever." For the year 1869, there were 
 reported 5 deaths; for 1870,9; and for 1871, 18 deaths. During the year 
 1872, the number of deaths from this disease appears to have been much 
 increased, and in 1873 very greatly increased, as indicated by the returns from 
 the three counties before referred to, — Branch 32, Ingham 15, and Allegan 98 
 deaths. The deaths during the year 1874, will not be enumerated until the 
 spring of 1875, but it seems probable that in 1874, there were in the State a 
 less number of deaths from the disease under consideration than occurred dur- 
 ing the year 1873. In Lansing, several deaths from this disease occurred in 
 the spring of 1873, while the disease did not prevail there in 1874. In view of 
 these facts, we have, among other questions, to consider why the disease pre- 
 vailed so extensively at Petersburg and Dundee in 1874, and did not in 1873, 
 when some other localities within the State were suffering most severely. 
 
CEREBROSPINAL MENINGITIS. 121 
 
 PREVALENCE OF THE DISEASE OUTSIDE OP THIS STATE. 
 
 In a report to the New York City Board of Health, Dr. Moreau Morris, City 
 Sanitary Inspector, says: "During the early part of January, 1872, reports 
 of a 'new form of disease' began to reach the Bureau of Sanitary Inspection. 
 Some called it * spotted fever,' others ' epidemic meningitis,' a 'fever resembling 
 typhoid,' and l typhoid complicated with acute meningitis.'" "Isolated cases 
 had occurred during previous years." "Deaths had been recorded from 
 'cerebrospinal meningitis,' in 1886, 18; in 1867,32; in 1868,34; in 1869, 
 42; in 1870, 32; in 1871,48." From January 1 to November 1,1872,761 
 deaths from this disease were reported to the Health Department of New York 
 city. 
 
 From a report to the State Board of Health of Massachusetts, in 1873, by 
 J. Baxter Upham, M. D., it appears that the first reliable record of this disease 
 as an epidemic in that State was of 9 fatal cases in the town of Medfield in 
 March, 1806. "It prevailed quite extensively in 1810." Between the years 
 1806 and 1816 it appeared at intervals at various points within the State. 
 From that time little was heard of the disease until March, 1849. "It 
 appeared again, to a limited extent, in April, 1857." Below is a statement of 
 cases reported in 1866 to the Medical Society of that State : 
 
 In 1857 there were . .-__ — - 3 cases 
 
 " 1858 " " 27 " 
 
 " 1859 " " _ .__. 3 " 
 
 " 1860 " " .. ... _-_ _._ ... " 
 
 " 1861 " " „ __ 5 |« 
 
 " 1862 " " .... _-.._.. 5 ," 
 
 " 1863 " " _- 7 " 
 
 " 3864 " " .„. 8S ;" 
 
 « 1865 " " .... 116 " 
 
 " years not designated there were „- «_-- 2Q " 
 
 Total ......_ 280 " 
 
 In 1866 the record was not complete, but included 7 cases. From that time 
 until 1872 no proper record could be found, as regards the State, but in the 
 •city of Boston there were returned, in 1867, 7 deaths; in 1868, 8 deaths; in 
 1869,7 deaths; in 1870, 5 deaths, and in 1871, 3 deaths. In 1872 it appears 
 for the first time in the State nosological records under its true name." In 
 that year 175 deaths were returned from this cause, the cases being scattered 
 throughout the State. In the epidemic of 1873 there were reported 517 cases 
 of the disease, and the mortality is stated to have been " a little less than 44 
 per cent" — (about 227 deaths?) At this rate of mortality the 175 deaths in 
 1872 would represent about 397 cases of the disease. 
 
 This disease has prevailed in different parts of the civilized world since 
 1805, and it may be for a long period of time previous to this centur}\ I shall 
 make no elaborate attempt to give a history of the disease. It is not at all prob- 
 able that it would be possible for any person to give a complete history, for the 
 reason that it not infrequently happens that it is called by some other name. 
 "It was not recognized as a distinct affection until the beginning of the pres- 
 ent century."* "While Paumier describes something very much like ifc 
 
 ♦Stille, 
 
122 
 
 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 at Paris in 1568, the first clearly recognized occurrence of it was at Geneva in 
 1805 ; after which it was traced in a number of different localities on the Con- 
 tinent in 1806-7, 1811, 1813-14-15-16, and 1823. At Geneva, "the characters 
 described were: Sudden attack in the night, vomiting of green matter, atro- 
 cious cephalalgia, spinal rigidity, difficulty of deglutition, convulsions, noc- 
 turnal exacerbations, petechia?, death occurring after from twelve hours to five 
 days of illness. At Grenoble, in 1814, one variety was observed with tetanus, 
 and another without tetanus. In the department of Landes, 1837, there was 
 also remarked, in certaiu cases, exaltation of the tegumentary sensibility. The 
 disease attacked persons of all ages, and both sexes, although the smallest 
 number of cases occurred in females."* 
 
 In another part of this report, in connection with the subject of "Food as a 
 cause of this disease," reference is made to various other epidemics of cerebro- 
 spinal meningitis, most of which occurred in foreign countries. Also, in con- 
 nection with 4 * An effort to trace the cause of some previous epidemics," refer- 
 ence is made to some others which have occurred in this country. 
 
 2 ABLE I. — Exhibiting for each Case of Cerebro- Spinal Meningitis reported as having occurred 
 in Lenawee and Monroe counties during the epidemic of 1874, the Residence, Date of Attach ; 
 Sex, Age, Bag of Death after Attack, and Day of Convalescence after Attack. 
 
 Residence of Patient at or 
 Near 
 
 Date op 
 Attack. 
 
 Sex. 
 
 Age in 
 Years. 
 
 Day of 
 
 Death 
 alter 
 
 Attack. 
 
 Day of 
 Con va- 
 le pce'ce 
 
 alter 
 Attack. 
 
 54th 
 17th 
 
 21st 
 10th 
 
 28th 
 
 ~8t"h 
 
 24t"h 
 
 19 th 
 
 24th 
 31st 
 31st 
 28th 
 14th 
 
 ~9t"h 
 3d 
 26th 
 16th 
 39th 
 32d 
 56th 
 
 Dundee ._ 
 
 January 1st.. 
 
 March 3d 
 
 March 7th... 
 March 8th.. _ 
 March 13th.. 
 March 16th.. 
 March 18th.. 
 March 20th. _ 
 March 20th.. 
 March 22d... 
 March 2Ed... 
 March 23d... 
 March 24th.. 
 March 25th. . 
 March 25th.. 
 March 26th.. 
 March 26th.. 
 March 29th- . 
 March 29th. . 
 March 30th .. 
 March 31st... 
 
 April 1st 
 
 April 1st 
 
 At.ril 2d 
 
 April 2d 
 
 April 3d 
 
 April 4th 
 
 April 4th 
 
 April 41 ii 
 
 April 6th 
 
 April 7th..... 
 April 7th 
 
 Male 
 
 Male 
 
 Female 
 
 Male 
 
 Male 
 
 Male 
 
 Male. .. .... 
 
 Male 
 
 Female.. ... 
 
 Male 
 
 Male 
 
 Male 
 
 Male -. 
 
 Male 
 
 Male. 
 
 Male 
 
 Male 
 
 Male ... 
 
 Female 
 
 Male 
 
 Female 
 
 Male 
 
 Female 
 
 Male 
 
 Female 
 
 Male. 
 
 Male 
 
 Male 
 
 Male 
 
 Female.. ... 
 
 Male.. 
 
 Male 
 
 6 
 13 
 
 10-12 
 21 
 
 9 
 
 7 
 14 
 15 
 19 
 
 5 
 44 
 32 
 23 
 
 2 
 17 
 
 5 
 
 4 
 18 
 17 
 
 3 
 11 
 
 3 
 
 i 
 23 
 
 5 
 27 
 
 6 
 23 
 26 
 
 8 
 
 n 
 
 3d 
 149th 
 
 "68th 
 3-24 
 
 "2d" 
 "7th 
 
 ""7th 
 
 "lOth 
 4th 
 
 "3d 
 
 "6th 
 22d 
 
 Petersburg 
 
 Dundee __ . 
 
 Dundee 
 
 Dundee 
 
 Petersburg „ 
 
 Ida 
 
 Dundee _ 
 
 Dundee _. 
 
 Dundee 
 
 Dundee _ 
 
 Dundee 
 
 Dundee 
 
 Dundee _ 
 
 Petersburg 
 
 Dundee _ 
 
 Dundee 
 
 Dundee 
 
 Monroe 
 
 Dundee _. 
 
 Dundee 
 
 Dundee 
 
 Dundee 
 
 Dundee 
 
 Dundee 
 
 Dundee 
 
 Dundee 
 
 Dundee 
 
 Monroe 
 
 Dundee _. 
 
 Dundee.. 
 
 Petersburg 
 
 * Dr. Henry Hartehorne, quoted from the Am. Jonr. of Med. Sci., July, 1861, p. 93. 
 
CEREBROSPINAL MENINGITIS. 
 TABLE I.— Continued. 
 
 123 
 
 .Residence or Patient, at or 
 Near 
 
 "Raisinville. . 
 
 Dundee 
 
 Raisinville.. 
 Petersburg. 
 Dundee ... 
 Petersburg . 
 Petersburg. 
 
 Dundee 
 
 Dundee 
 
 Dundee 
 
 Monroe 
 
 Petersburg. 
 Petersburg- 
 Peter -burg. 
 Petersburg. 
 
 Dundee 
 
 Petersburg. 
 Petersburg. 
 Petersburg. 
 
 Dundee 
 
 Dundee 
 
 Monroe 
 
 Petersburg . 
 
 Petersburg. 
 
 Peter-burg. 
 
 BlisnYld... 
 
 Petersburg. 
 
 F.lissfield... 
 
 Petersburg. 
 
 Petersburg. 
 
 Petersburg. 
 
 Petersburg. 
 
 Petersburg. 
 
 Petersburg 
 
 Petersburg. 
 
 Petersburg. 
 
 Deerfield... 
 
 Deer-field . . . 
 
 Petersburg. 
 
 Monroe 
 
 Petersburg. 
 Petersburg. 
 Petersburg. 
 Petersburg. 
 Petersburg. 
 
 Monroe 
 
 Petersburg. 
 Blissfield... 
 Petersburg. 
 Petersburg. 
 Petersburg. 
 Petersburg. 
 Petersburg. 
 Blisstield.°.. 
 Blisstield.. 
 Petersburg. 
 Peter-burs:. 
 
 Date of 
 
 Attack. 
 
 April 7th 
 
 April 8th 
 
 April 9th 
 
 April 10th___. 
 April 11th... . 
 April 16th.... 
 
 April 16th 
 
 April 18th.... 
 April 19th.... 
 April 20th. ... 
 Aoril20th.... 
 
 April 23d 
 
 April 28th 
 
 Apiil 29th 
 
 April 29tb 
 
 April 30th... . 
 
 May 2d 
 
 May 2d 
 
 May 2d 
 
 May 3d 
 
 May 4th 
 
 May4th. 
 
 May 5th 
 
 May 5th 
 
 May 5th 
 
 May 6th. 
 
 Mav8th. 
 
 May 10th 
 
 May 10th... 
 May 10th. _.. 
 May 12th.... 
 May 12th.... 
 May 12th. ... 
 May 12th.... 
 May 12th.... 
 May 12th. ... 
 
 May 13th 
 
 May 14th.. 
 May 18th.. 
 May 18th.. 
 May 19th.. 
 May 19th. . 
 May 19th.. 
 May 22d... 
 May 22d. . 
 
 May 27th 
 
 May 29th... 
 May 30th... 
 
 May 3lst 
 
 May 31st 
 
 June 2d 
 
 June 4th 
 
 June 9th ... 
 June 18th... 
 
 June2bd 
 
 June23d_... 
 
 Sex. 
 
 Female.. . 
 
 Ma'e 
 
 Female. .. 
 Female .. 
 
 Male 
 
 Male 
 
 Male 
 
 Female. . 
 
 Male 
 
 Male 
 
 Male 
 
 Male 
 
 Female. _ 
 
 Male 
 
 Female.. 
 Female. _ 
 
 Male 
 
 Male 
 
 Male 
 
 Male 
 
 Female .. 
 Female .. 
 Female.. 
 Female.. . 
 Female... 
 
 Male 
 
 Female. _ 
 
 Male 
 
 Female. . 
 Female. _. 
 
 Mnle 
 
 Female.. 
 Female.. 
 Female.. . 
 Female.. 
 Female. . 
 
 Male 
 
 Female.. 
 Female.- . 
 Female.. 
 Female... 
 Female.. 
 Female.. 
 Female- 
 Female. . 
 
 Male 
 
 Male 
 
 Female. _ 
 
 Male 
 
 Female.. . 
 Female.. 
 
 Male 
 
 Female.. . 
 Pern ale.. . 
 Female.. 
 Female... 
 Male 
 
 Age in 
 
 Years. 
 
 12 
 
 30 
 12 
 13 
 22 
 
 9 
 12 
 20 
 29 
 
 4 
 17 
 48 
 13 
 46 
 21 
 28 
 
 n 
 44 
 
 40 
 
 29 
 24 
 
 5 
 
 14 
 11 
 
 4 
 21 
 
 8 
 
 10 
 22 
 12 
 14 
 75 
 11 
 
 3 
 
 2 
 
 12 
 20 
 
 7 
 30 
 
 7 
 36 
 
 6 
 50 
 15 
 12 
 
 5 
 45 
 35 
 63 
 60 
 18 
 
 5 
 45 
 30 
 37 
 47 
 
 6 
 
 Day of 
 
 Death 
 
 alter 
 
 Attack. 
 
 86th 
 
 26th 
 
 "*6th 
 "~6th 
 
 * 4th 
 
 ~27th 
 "5th 
 
 2d 
 2d" 
 
 7th 
 "3-24 
 
 17th 
 4th 
 
 "4th 
 4th 
 
 5th 
 3d 
 
 Day of 
 Conva- 
 lescence 
 after 
 Attack. 
 
 ..?.. 
 
 68th 
 54th 
 15th 
 
 ~9th" 
 
 20th 
 
 79lh 
 
 9th 
 
 18th 
 
 71st 
 
 35th 
 
 4th 
 
 25th 
 4th 
 
 35th 
 
 17th 
 25th 
 
 30th 
 
 3d 
 
 37th 
 
 17th 
 
 5th 
 14th 
 14th 
 14th 
 
 10th 
 
 ~8tli 
 
 29th 
 10th 
 11th 
 10th 
 
 2d 
 
 8th 
 
 7th 
 
 2d 
 
 3d 
 
 * Sick June 24. 1874. 
 
124 
 
 STATE BOARD OF HEALTH-REPORT OF SECRETARY. 
 
 TABLE II.— Exhibiting by Sex and by Age, the number of Cases of Cerebro- Spinal Meningitis 
 in Petersburg, Dundee, DeerUeld, Blissfield, BaisinxiUe, Ida, and Monroe, during the Epi- 
 demic in Spring of 1874' 
 
 LOCALITY. 
 
 Sex. 
 
 AGES IN YEARS AND PERIODS OF YEARS. 
 
 All 
 Ages. 
 
 89 
 47 
 
 42 
 
 40 
 16 
 
 24 
 
 33 
 
 24 
 
 9 
 
 2 
 1 
 1 
 
 5 
 
 2 
 3 
 
 2 
 
 Under 
 One 
 \ear. 
 
 l 
 
 to 
 2. 
 
 2 
 
 2 
 
 2 
 
 2 
 
 2 
 to 
 6. 
 
 9 
 5 
 
 4 
 
 3 
 ~~3 
 
 6 
 5 
 1 
 
 5 
 to 
 10. 
 
 17 
 12 
 
 5 
 
 6 
 
 4 
 2 
 
 7 
 7 
 
 1 
 
 10 
 to 
 15. 
 
 15 
 
 4 
 11 
 
 11 
 3 
 
 8 
 
 1 
 
 i 
 
 15 
 to 
 
 2U. 
 
 9 
 5 
 
 4 
 
 3 
 
 1 
 2 
 
 3 
 2 
 
 1 
 
 20 
 to 
 
 30. 
 
 16 
 9 
 
 7 
 
 2 
 
 "2 
 
 11 
 6 
 5 
 
 1 
 1 
 
 30 
 to 
 
 40. 
 
 7 
 2 
 5 
 
 2 
 
 "2 
 
 2 
 
 2 
 
 40 
 to 
 50. 
 
 8 
 
 6 
 2 
 
 7 
 5 
 2 
 
 1 
 1 
 
 50 
 to 
 60. 
 
 1 
 "l 
 
 1 
 "I 
 
 60 
 to 
 
 70. 
 
 2 
 1 
 1 
 
 2 
 1 
 I 
 
 70 
 to 
 
 60. 
 
 1 
 
 "i 
 
 1 
 
 i 
 
 so 
 & 
 
 ov'r 
 
 . Total of all ( 
 localities -J 
 visited .. ( 
 
 Petersburg -J 
 Dundee. __-j 
 . Deerfield..-] 
 Blissfield .. •] 
 Rai3inville -j 
 
 Ida. j 
 
 Monroe ... -j 
 
 Total.... 
 
 Males 
 
 Females . 
 
 Total.... 
 
 Males 
 
 Females . 
 
 Total 
 
 Males 
 
 Females . 
 
 Total.... 
 
 Males 
 
 Females . 
 
 Total .... 
 
 Males 
 
 Females _ 
 
 Total.... 
 
 Males 
 
 2 
 
 1 
 1 
 
 2 
 1 
 1 
 
 ... 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 l 
 l 
 
 ... 
 
 1 
 
 1 
 
 3 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 3 
 
 
 
 
 
 
 
 
 
 
 2 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Females . 
 
 Total.... 
 Males .... 
 Females . 
 
 Total.... 
 
 Males.... 
 Females . 
 
 2 
 
 1 
 1 
 
 
 
 
 
 2 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 6 
 3 
 3 
 
 
 
 
 o 
 o 
 
 1 
 
 2 
 
 — 
 
 2 
 1 
 1 
 
 1 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 TABLE III. — Exhibiting, by Sex and by Age, tlie number of Deaths from Cerebro- Spinal 
 Meningitis in Petersburg, Dundee, Deerfield, Blissfield, Raisinville, Ida, and Monroe, 
 during the Epidemic of 181 '4- 
 
 This Epidemkj. 
 
 Ssx. 
 
 AGES IN YEARS AND PERIODS OP YEARS. 
 
 All 
 
 Ages. 
 
 29 
 
 15 
 14 
 
 Under 
 One 
 Year. 
 
 1 
 
 to 
 
 2. 
 
 2 
 to 
 5. 
 
 5 
 to 
 10. 
 
 8 
 
 4 
 4 
 
 10 
 
 to 
 15. 
 
 5 
 
 1 
 
 4 
 
 15 
 to 
 20. 
 
 4 
 
 2 
 2 
 
 20 
 
 to 
 
 30. 
 
 3 
 
 2 
 1 
 
 80 
 to 
 40. 
 
 1 
 
 ~i~ 
 
 40 
 to 
 50. 
 
 4 
 4 
 
 50 
 to 
 60. 
 
 1 
 
 T 
 
 60 
 to 
 
 70. 
 
 2 
 
 1 
 1 
 
 70 
 to, 
 
 80. 
 
 80 
 
 & 
 
 ov'r 
 
 r 
 
 1 
 
 Deaths -{ 
 
 { 
 
 Total 
 
 1 
 
 Males.... 
 Females . 
 
 1 
 
 
 
 
 Of the 29 persons who died of this disease in this epidemic : 
 13 out of 29 died on or before the 4th day of the disease. 
 
 ^5 fk a a a u a a a KfU a a a a 
 
 lg a a ft a ti a K a gj.^ a u it a 
 
 •2^ *t a ■ n a a a ft a ^fU a it it t. 
 
CEREBROSPINAL MENINGITIS. 
 
 1*5 
 
 The eight others died as follows: 1 on the 10th ; 1 on the 17th ; 1 on the 
 22d ; 1 on the 26th; 1 on the 27th ; 1 on the 68th ; 1 on the 86th ; 1 on the 
 149th. This last was the first well-recognized case at Petersburg. 
 
 The mortality was greatest in the first part of the epidemic. If the 88 cases 
 in which the date of attack was specified be divided in three parts according 
 to date of attack, out of the first 29 cases there were 12 deaths, out of the next 
 30 cases there were 8 deaths, and in the last 29 cases there were 9 deaths. 
 
 The death-rate in this epidemic was smaller than usually reported, being 
 only 32.95 per cent of all cases. In the epidemic in Massachusetts during the 
 year 1872 it is reported by Dr. Upham as "a little less than 44 per cent." * 
 
 In New York city in 1872, it was reported as 75.45 per cent. It is possible 
 that the large death-rate in New York may be accounted for in part by a fail- 
 ure to report cases in as great proportion as deaths, and in part by unsanitary 
 conditions. It is also possible that the death-rate is quite frequently stated too 
 high because of the constant effort of those who study the disease to exclude 
 all except undoubted cases, which usually means severe cases. Mild cases 
 should, if possible, be considered as well, for they may be important in tracing 
 the cause. 
 
 During the first part of this epidemic more males than females seem to have 
 been attacked with the disease. The sexes were attacked as follows : 
 
 ( First half 11 males, 7 females. 
 
 Petersburg < Last half 4 males, 18 females. 
 
 ( Unknown date 1 male, 1 female. 
 
 Dundee i First half 13 males, 3 females. 
 
 -j k agt j ia ||- 1;L ma i eS) 5 females, 1 unknown sex. 
 
 •dt g^a i First half 2 males, females. 
 
 • bIlssnelcl " I Last half males, 3 females. 
 
 Deerfield -{ One case — 1 male. 
 
 ah „„™r, •« ♦i,:» ( First half 33 males, 11 females. 
 All cases in this ) Lagt ba]f 13 maUa gl fema]eg> 
 
 epidemic. | Unknown date 1 male, females. 
 
 Elmira, N. Y., ( First half 18 males, 4 females 
 
 1856-7-.- ( Last half 12 males, 8 females, 1 unknown sex. 
 
 On page lxxv. of the Registration Report of Massachusetts for the year 1873 
 it may be seen that during the first part of the year more males than females 
 died from this disease, and in the latter part of the year the reverse was true. 
 
 DEATHS from Cerebrospinal Meningitis in Massachusetts in 187 S. 
 
 Sex. 
 
 1873. 
 
 Jan. 
 
 Feb. 
 
 Mar. 
 
 Apr. 
 
 May. 
 
 June. 
 
 July. 
 
 Aug. 
 
 Sept. 
 
 Oct. 
 
 Nov. 
 
 Dec. 
 
 Males 
 
 Females 
 
 393 
 354 
 
 747 
 
 9 
 
 4 
 
 14 
 11 
 
 59 
 
 48 
 
 91 
 94 
 
 185 
 
 79 
 65 
 
 42 
 37 
 
 35 
 
 28 
 
 25 
 17 
 
 12 
 13 
 
 8 
 10 
 
 8 
 16 
 
 11 
 11 
 
 Totals 
 
 13 
 
 25 
 
 107 
 
 144 
 
 79 
 
 63 
 
 42 
 
 25 
 
 18 
 
 24 
 
 22 
 
 Whether or not this was an expression of any general tendency can hardly 
 be determined from the material at band, no other data having been published 
 heretofore, so far as I can learn, which will enable me to ascertain the fact. 
 
 The 
 
 ige of all persons of both sexes taken with cerebro-spinal 
 
 * Report S. B. of Health of Mass., 1874, 
 
 808. 
 
Deaths 
 
 Deaths ._.. 
 
 126 STATE BOARD OF HEALTH-REPORT OF SECRETARY. 
 
 meningitis at Dundee, Petersburg, Monroe, Raisinville, Deerfield. Blissfield, 
 and Ida, during this epidemic, and the average age of each of three equal parts 
 of the whole number, divided according to date of attack, was as follows: 
 
 ["Average age of first third.- __ 13.56 years. 
 
 n J Average age of second third ,__ 18.70 years. 
 
 Gases S Average age of all cases. _ 19.22 years. 
 
 I Average age of last third _ _ 25.31 years. 
 
 The average age of all who died of this disease during this epidemic, stated 
 as above, according to date of attack, was as follows: 
 
 "Average age of first third . 16.10 years. 
 
 Average age of all deaths 22.40 years. 
 
 * Average age of second third _ 24.28 years. 
 
 .Average age of last third 27.00 years. 
 
 In an epidemic of this disease which occurred at Elmira, N. Y., in 1857, in 
 which there were 43 deaths, the average age of all who died, stated as above, 
 according to date of attack, was as follows:* 
 
 "Average age of first third. _ 11.21 years. 
 
 Average age of all deaths. 13.92 years. 
 
 Average age of second third 14.26 years. 
 
 L Average age of last third _ 16.29 years. 
 
 Excepting the deaths during the epidemic at Elmira, reported by Dr. T. H. 
 Squire, I have searched in vain for any table or record of cases from which I 
 could gather information on the subject noted above, as taken from Table I. 
 of this report. So far as this evidence goes, it seems to show that those first 
 attacked are younger than those who are attacked later in the same epidemic. 
 
 Dividing the 29 fatal cases in the epidemic in this State into three groups, 
 according to age o£ decedents, I find 14 aged under 15 years, 7 aged between 
 15 and 30 years, and 8 aged over 30 years. Now, although those first attacked 
 were the youngest, the average duration of the disease was also greater among 
 those aged under 15 years, as appears as follows: 
 
 Average duration ( U a S ed under 15 >' ears ' 26 87 da y 3 - 
 
 of feal case ] 7 a S ed 15 to 30 * ears ' 1057 da ^ s ' 
 ot fatal cases.. { g aged over 3Q yearg> 4 g? d&y& 
 
 The mortality was least among those cases aged 15 to 30, and greatest among 
 those aged 30 years and over. Dividing the 88 cases of which the result is 
 stated into three groups as above, I find 45 cases, including 14 deaths, in the 
 first group ; 24 cases, 7 deaths, in the second group ; and 19 cases, 8 deaths, in 
 the last group. The death-rate is as follows : 
 
 Proportion of deaths ( £ mon S P ersons a - ed ?$ er A 5 ^^'J^ 1 "??*?' 
 to cases j Among persons aged 15 to 30 years, 29.17 per cent. 
 
 """ ( Among persons aged 30 years and over, 42 10 per cent. 
 
 The question relative to what classes of persons are first attacked by this dis- 
 ease is a very interesting one, and one which does not seem to have been 
 studied heretofore. In order to answer this question, it is essential to have the 
 material grouped in a different manner than it is usually tabulated. Tables of 
 cases arranged by ages alone, as is quite common, or by months alone, as is 
 occasionally done, are of no use for this purpose. It is essential to have the 
 
 * Computed from a report of deaths darin£ the epidemic by T. H. Squire, M. D., in Trans. N. Y. Statd 
 Med. Soc., 1858. 
 
CEKEBRO-SPINAL MENINGITIS. 
 
 137 
 
 important facts relative to all cases so grouped as that the date of attack, sex 
 and age of patient, duration and result of the disease, shall all appear in con- 
 nection with each other, as they do in Table L, relative to this epidemic. 
 Inasmuch as evidence of this kind is not very accessible, I have thought it 
 advisable to compile such a table from the report of fatal cases in the epidemio 
 at Elmira, N. Y., published by T. H. Squire, M. D., in Trans. N. Y. State Med. 
 Soc, 1858. From this table the preceding items relative to that epidemic 
 have been taken. 
 
 TABLE IV.— Exhibiting the Date of Attack, Sex. Age, and day of Death after Attack, for eacli 
 fatal case of Cerebrospinal Meningitis reported as having ocurred at or near Elmira, AT. F., 
 in epidemic of 1856-7. 
 
 DATE OP 
 
 
 Age in 
 
 Tears. 
 
 Day of [ 
 
 
 Sex. 
 
 Death after 
 
 ATTACK. 
 
 
 Attack. 
 
 1856. 
 
 
 
 
 Dec. 23 
 
 Male.... 
 
 14 
 
 O 
 
 1857. 
 
 
 
 
 January 1_._ 
 
 Male.... 
 
 13 
 
 5 
 
 February 11. 
 
 Female. 
 
 7 
 
 3 
 
 February 13. 
 
 Male.... 
 
 8-12 
 
 3-24 
 
 February S.- 
 
 Female- 
 
 5 
 
 7-24 
 
 February 24. 
 
 Male.... 
 
 12 
 
 1 
 
 March 4 
 
 Male.... 
 
 1 1-3 
 
 6-24 
 
 March 6 
 
 Male..-. 
 
 6 
 
 1 
 
 March 9 
 
 Male.... 
 
 10 
 
 3 
 
 March 10.... 
 
 Male.... 
 
 5 
 
 1 
 
 March 10 
 
 Male— - 
 
 30 
 
 3 
 
 March 12 
 
 Male... 
 
 42 
 
 1 
 
 March 14 
 
 Male.... 
 
 4 
 
 14-24 
 
 March 16 
 
 Male.... 
 
 7 
 
 3 
 
 March 20.-.. 
 
 Male.... 
 
 7 
 
 53 
 
 March 21.... 
 
 Male.... 
 
 8 
 
 6-24 
 
 March 21 
 
 Female. 
 
 6 
 
 2-24 
 
 March 21.... 
 
 Male.... 
 
 25 
 
 9 
 
 March 24 
 
 Male.... 
 
 39 
 
 3 
 
 March 23.. __ 
 
 Female. 
 
 23 
 
 1 
 
 March 25 
 
 Male.... 
 
 5 
 
 1 1 
 
 DATE OF 
 ATTACK. 
 
 1857. 
 March 25.. 
 March 26.. 
 March 26 _. 
 March 2 S.- 
 March 30. _ 
 April 2.... 
 April 5_.._ 
 April 6.... 
 
 April 7 
 
 April 8_... 
 Aprill3.._ 
 April 28... 
 
 May 5 
 
 May 6 
 
 May 19.... 
 May 19-.. 
 May 21.... 
 May 24.... 
 May 27... . 
 May 27.— 
 June 20... 
 August 15. 
 
 Ser 
 
 Age in 
 
 
 Years. 
 
 Male—. 
 
 2 
 
 Male.... 
 
 36 
 
 Male.... 
 
 16 
 
 Female- 
 
 11 
 
 Male.... 
 
 8-12 
 
 Male.... 
 
 4 
 
 Female- 
 
 17 
 
 Female. 
 
 41 
 
 Male.... 
 
 17 
 
 Female. 
 
 4 
 
 Male.... 
 
 19 
 
 Female- 
 
 11 
 
 Male.... 
 
 23 
 
 Female. 
 
 4 
 
 ._. 
 
 3-12 
 
 Male 
 
 2 
 
 Female. 
 
 1 1-6 
 
 Male.... 
 
 40 
 
 Male— _ 
 
 7 
 
 Female. 
 
 32 
 
 Male.... 
 
 23 
 
 Maie.... 
 
 20 
 
 Day of 
 
 Deaih after 
 
 Attack. 
 
 2 
 
 285 
 
 4 
 
 120 
 
 1 
 
 3 
 
 6 
 
 2 
 
 64 
 
 18-24 
 
 14-24 
 12-24 
 
 2-24 
 6-24 
 12-24 
 
 4-24 
 
 3 
 
 18 
 
 4 
 
 At Elmira, N. Y., in 1856-7, the average duration of the disease was greater 
 in the last half than in the first half of the fatal cases, as appears as follows: 
 
 Average duration of fatal cases ] First 22 attacked, 4 clays and 11 hours, 
 at Elmira, N. Y., in 1856-7.. { Last 21 attacked, 25 days and 3 hours. 
 
 The average duration of fatal cases in this epidemic in Michigan was as fol- 
 lows : 
 
 First 14 fatal cases attacked, 28 days and 2 hours. 
 
 Last 15 fatal cases attacked, 6 " " 9 " 
 
 As stated on a preceding page, however, the mortality was greatest among 
 those first attacked. 
 
 DEFINITION OF CEREBRO-SPINAL MENINGITIS. 
 
 The following definition is from Dr. Clymer's work on this subject: 
 "Definition. — [An acute specific disorder, commonly happening as an epi- 
 demic, general or limited, and, rarely, sporadically, caused by some unknown 
 external influence; of sudden onset, rapid course, and very fatal; its chief 
 
128 STATE BOARD OF HEALTH—REPORT OP SECRETARY. 
 
 symptoms referable to the cerebro-spinal axis, are, great prostration of the vital 
 powers, severe pain in the head and along the spinal column, delirium, tetanic 
 and occasionally clonic, spasms, and cutaneous hyperesthesia, with, in some 
 cases, stupor, coma, and motor paralysis; attended frequently, with cutaneous 
 hasmic spots; its morbid anatomical characters being congestion and inflam- 
 mation of the membranes of the brain and spinal cord, particularly the pia 
 mater, although there is reason to believe that the evidence of these changes 
 may be wanting, even in cases of long duration."] 
 
 "The name cerebro-spinal meningitis is not a proper one for this affection, 
 even with the prefix ' epidemic,' for, as Dr. Valleix remarks, it is ' begotten of 
 anatomical bias and an incomplete appreciation of the facts.' It gives no 
 accurate notion of the real nature of the disorder, and takes heed only of 
 the local structural changes, which are, probably, secondary, and may be 
 wanting. It has also been called typhoid meningitis, malignant meningitis; 
 but to these names the same objections lie. Spotted fever is hardly distinctive 
 enough, there being so many other essential disorders in which spots on the 
 skin appear. Petechial fever has been proposed by Dr. G. B. Wood, of Phila- 
 delphia. Dr. W. Stokes calls it malignant purpuric fever; and Dr. E. D* 
 Lyons feoris nigra"* 
 
 "The name of the disease is apt to fix the attention on local structural 
 changes (which are probably only secondary, and may not always be present) 
 to the exclusion of a consideration of the real nature of the malady." f 
 
 Dr. Rodenste'n has proposed the name Tetanoid Fever. I will hereafter give 
 reasons why I think it the best name yet proposed, although I do not quite 
 agree with the last paragraph quoted. He says: 
 
 " But in a not inconsiderable number of autopsies no such evidence of inflam- 
 mation could be found in the envelopes of the cerebro-spinal axis. These 
 cases, although not as numerous as the others, are nevertheless sufficient to 
 prove that the disease under consideration is not a meningitis. Can we con- 
 ceive of a pneumonia which in the event of a fatal issue would show no evi- 
 dence of inflammation of the lung? Is it easier to conceive of a meningitis 
 without the signs of an inflammation of the meninges? J 
 
 "I believe that meningitis stands in a relationship to tetanoid fever similar 
 to that which nephritis sustains to scarlatina; and that iridio choroiditis, 
 labyrinthitis, arthritis, etc., are independent manifestations of a general tend- 
 ency of tetanoid fever to local inflammation, of which meningitis is another 
 and the most conspicuous illustration.";); 
 
 The following remarks by Dr. Stille tend toward a similar conclusion : 
 
 "As the pulse never acquires the force and sustained frequency which 
 belongs to it in pure inflammations or in idiopathic fevers, so the heat of skin is 
 always less than in those affections, and is constantly undergoing vicissitudes 
 such as are observed in no other disease"! 
 
 In April, 1863, Dr. W. W. Gerhard reported to the College of Physicians of 
 Philadelphia relative to "Spotted Fever" occurring in neighboring towns in the 
 vicinity of that city. In speaking of the nature of the disease he said: 
 
 "The anatomical lesions thus confirmed the conclusions at which I had 
 already arrived respecting the pathology of the disease. That is, it is strictly 
 
 * Meredith Clymer's Cerebrospinal Meningitis, pp. 5-G. 
 
 t Quoted from Aitken'e Sci. and Prac. of Med., Vol. II., p. 443. 
 
 ± '"Thermometry in Cerebro-spinal Meningitis," bv C. F. Rodenstein, M. D., pp. 210, 211. 
 
 I Stflle on Epidemic Meningitis, p. 57. 
 
CEREBROSPINAL MENINGITIS. 189 
 
 a blood disorder unconnected with any structural lesion. The internal ecchy- 
 moses of blood are precisely similar to the spots on the skin, and are evidently 
 depending on the same cause. This fact establishes a wide distinction 
 between them and those appearing in typhus and typhoid fevers, as well as the 
 eruptions of the exanthemata. Although the proof of spotted fever being a 
 blood disease is to my mind conclusive, it must not be ascribed to an impover- 
 ished condition of this fluid from innutritious or deficient food, as none of 
 the patients whom I saw was in a condition of actual poverty, and a large 
 majority of them belonged to a class amply supplied with all the comforts of 
 life."* 
 
 In April, 1564, Dr. Levick reported some cases of " Spotted Fever " to the 
 College of Physicians of Philadelphia. In the course of his report he referred 
 to the nature of the disease as follows: 
 
 " ~Nor do I doubt that there may be in many cases of spotted fever, especially 
 when it assumes the chronic form, inflammation of the meninges of the brain 
 and spinal cord, but that this is necessarily present, — constitutes the essence of 
 the disease, — I do not believe. In scarlet fever we have almost uniformly inflam- 
 mation of the throat, but no one looks upon scarlatina as mere angina; in 
 measles we have coryza and catarrh, but rubeola is not simply inflammation of 
 the air-passages. Still more strikingly there are in typhoid fever inflammation 
 and ulceration of Peyer's glands with suppuration of those of the mesentery, 
 but certainly no one regards this fever as simply meso-enteritis. These are con* 
 comitants, frequent concomitants, of these diseases, local manifestations of a gen- 
 eral constitutional disorder, which may be present or may be absent. So with 
 spotted fever. That this is not simple cerebro-spinal meningitis is proved by the 
 fact that though present in some cases, in others all traces of intracranial inflam- 
 mation have been absent, and this too when all other phenomena of the disease 
 have been characteristically developed. Nor are the remedies which have been 
 found most useful in spotted fever those which are recognized as suited to inflam-? 
 rnation of the brain or its meninges. The testimony which comes to us from 
 almost every quarter, with astonishing unanimity, is that blood-letting, mer^ 
 cury, and other familiar antiphlogistic measures are utterly inefficient, are 
 indeed worse than useless, while the only medicines, the exhibition of which 
 has been attended with any success, are quinia, brandy, and turpentine, the 
 remedies everywhere recognized as those suited to the typhus state. Tried 
 thus by the therapeutic test, the disease fails to hold its position as one of pure 
 inflammation, unless indeed we abandon all our former standards of pathology 
 and of treatment. Hence it is that the name cerebro-spinal meningitis is an 
 objectionable one, as giving erroneous impressions as to the nature of the dis- 
 ease, and as leading to an injudicious and dangerous course of treatment." * * 
 
 " If, then, this disease be not simple cerebro-spinal meningitis, what is 
 it ? I believe it to be, as I have elsewhere expressed it, a malignant febrile 
 disorder, due to a widespread epidemic influence, which acts with intensity on 
 the blood directly, or indirectly through the nervous system. Thus poisoned, 
 the blood is altered in its nature and in its function. Hence follow deranged 
 innervation, impaired nutrition, passive congestions, escape of blood into vari- 
 ous tissues, delirium, coma, prostration, and death, the usual results of septicae- 
 mia. So far as I can discover, in every autopsy of this disease on record, the 
 
 * Am. Jour. Med. Sci., July, 1863, p. 108. 
 
 17 
 
ISO STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 blood Las been found to be fluid, both in the heart and great vessels, or if 
 coagula have been found in the heart they have been small and soft."* 
 
 SYMPTOMS USUALLY PKESENT 12* THIS DISEASE. 
 
 ei A chill, headache, vomiting, prostration, morbid sensitiveness of the skin, 
 jactitation, coldness of the surface, wildness of expression, dilated pupils, 
 irregular breathing, paralyzed deglutition, wry neck, retraction of the head, 
 dullness or abolition of the senses, pulse but little affected, bowels quiescent, 
 petechia, delirium, convulsions, coma; these are impressive symptoms, and 
 many, or all of them, attend each case."f 
 
 SYMPTOMS GEKEEALLY PRESENT IN THIS EPIDEMIC. 
 
 The first case at Petersburg of which I have notes was Frank Gunsolus, 
 aged 13 years, taken sick March 3, J 874. He was a brother of a prominent 
 physician of that place, from whom I received some account of the case. He 
 had a chill with vomiting for thirty hours; then violent fever, opisthotonos, 
 lockjaw, and double vision for four days. There was increased sensitiveness of 
 the skin, large copper-colored spots about the size of a five-cent piece, which 
 were tender to the touch. Before his sickness, was attending school, was 
 active mentally, thin and spare, wore flannel underclothing, slept up stairs. 
 The water used by the family has been analyzed, and will be referred to again 
 further on. This boy was still sick when I visited Petersburg, but died July 
 30th, 149 days from date of attack. Other cases were reported by Dr. Gnu- 
 solus, so far as related to dates, ages, etc., but the symptoms generally present 
 were not detailed. He mentioned one case as being deaf, and in reply to ques- 
 tion staled that he had given the patient no quinine. The disease seems to 
 have displaced the ordinary intermittent and other malarial fevers. 
 
 Dr. Paquette of Petersburg says that the first case of his, this spring, had 
 rash and sore throat, and was mistaken for scarlet fever, which was not to be 
 wondered at, considering the great in frequency of occurrence of spotted fever. 
 The patient was a boy, aged about seven years. He was taken sick March 16th, 
 and died in three hours. The next cases, just one month later, were Charles 
 Boone and Ed. Pierce. Both were taken the same night and same hour. Both 
 played at school together. On the day previous they played " snap the whip." 
 ki They had been whirling the Pierce boy," and he was sick in school the previous 
 afternoon. "He had quite a taste for learning." He went into a high fever. 
 Had delirium, which lasted about six hours, during which time his pulse was 
 regular and full; after that it was only about 80 beats per minute. Many 
 other cases had intermittent pulse. He had pain at the base of the brain 
 behind, and at the prominent bone in the back of the neck. While in active 
 delirium he worked incessantly at his school studies. Pierce took no quinine, 
 but was deaf. All the worst symptoms in this case afterwards disappeared. 
 
 The patients'" mouths were dry, "their nerves * taut.'" I think this some- 
 what singular remark by Dr. Paquette, embodies an important fact. I inter- 
 pret his observation to be that there was general muscular tonicity, which was 
 increased by any initation of the skin, because of its increased sensitiveness. 
 
 The patients' bowels were generally costive and hard to act upon. The 
 urine was not passed freely. It was high-colored, some of it coffee-ground 
 colur. Nearly every case vomited, not bile, but a substance which looked like 
 
 * Am. Jonr. Med. Sci., July. 1864, pp. 138, 189. 
 
 t T. H. Squire, M. D., Trans. N. Y. State Med. Soc, 1858. 
 
CEREBROSPINAL MENINGITIS. 131 
 
 chopped grass and water. Some of it looked like indigo, and settled in tlie 
 bottom of a vessel. None of the patients were tender over the right illiac 
 region ; they were tender all over the spiue, and movements caused pain. 
 Some of them have been spotted ; no pimples were observed. The spots were 
 bluish, were evanescent, and disappeared on pressure. 
 
 The eyes were frequently affected with squint, generally convergent, but 
 sometimes divergent. They were generally glassy, with a peculiar stare; the 
 lids did not freely raise or lower, they did not wink with natural frequency. 
 The pupils were generally dilated. Dr. Paquette speaks of a purulent dis- 
 charge from the nose in some cases; but it was his custom to cause the patients 
 to sneeze, and the discharge may possibly be explained by that fact. Dr. 
 Paquette, from whom this part of the account was received, has four boys and 
 four girls. Three of his girls had the disease in rather a mild form. All 
 taken at the same time, and all recovered. His children had not taken off 
 their underclothing. Another girl that died of the disease had taken off her 
 underclothing the day before she was taken sick. An old lady that died had 
 taken off her underclothing two days before she was taken sick. Two of Dr. 
 Paquette's children slept down stairs and one up stairs. Other cases were 
 about equally divided in this respect, so far as I could learn. 
 
 Concerning the case which occurred at Deerfield, I have notes made from a 
 conversation with Dr. S. L. Jones of that place. The patient was a male aged 
 about 20 years; had been at school at Adrian ; had been complaining for a i'ew 
 days; was taken sick while dancing about 1 A.M., May 13, 1874; he vomited, had 
 a chill and spasms; his head was thrown back ; he was delirious; pupils of his 
 eyes were dilated, but contracted under influence of opium ; his bowels were 
 torpid; he had tenderness of the spine and muscles; was convalescent in ten 
 days. In Summerfield a little girl aged 7 years " had symptoms similar to ague, 
 headache, and pains all over her, had fits in the afternoon, and died after three 
 hours." 
 
 At Dundee, the symptoms, as described by Dr. Q. W. Jackson, were as fol- 
 lows: The patients generally complained for about twenty-four hours of being 
 tired and lame, they bad pain in the back of the head, in some cases in front 
 part of head. Some complained of pain down the spine, and some of pain in 
 the ears. In some cases there was a cold stage, and in others a distinct chill. 
 Vomiting was a prominent fact during and after the cold stage. A few were 
 taken as suddenly as if knocked down. There was tenderness of the body, 
 superficial, and also over sciatic and other deep nerves given off from spinal 
 cord. The head was thrown back in some cases, and in others it was drawn to 
 one side. There were spots on the skin, generally over the chest. The spots 
 were variable, were the size of the point to that of the head of a pin ; were not 
 elevated above the surface, and did not disappear on pressure. The face was 
 flushed and dark. The eyes were affected with squint in some cases, divergent 
 in a few cases. There was sometimes alternate dilation and contraction of the 
 pupils. The dilation was not constant. The temperature was sometimes ele- 
 vated at first, sometimes below normal. About the highest temperature 
 noticed was 105°. Respiration was irregular. The pulse was frequently 
 almost normal, sometimes slower than natural, but accelerated after a few 
 days. It was frequently intermittent. Before death there wa3 bluenass of sur- 
 face, and small wiry pulse* The tongue w T as generally covered with a white 
 pasty coating, through which the papilla were sometimes visible. There was 
 
133 STATE BOARD OF HEALTH— REPORT OP SECRETARY. 
 
 a tendency to a relapse, beginning with a chill which was sometimes repeated. 
 The patients did not sweat of themselves. 
 
 Cases of unusal sickness seen by Dr. M. Wilcox of Dundee, presented symp- 
 toms as follows : One case, taken sick March 24, died March 31, male aged 
 about 23, taken with congestive chill which lasted about two hours ; fever 
 lasted three days ; did not vomit ; had no spots ; face was flushed ; pupils not 
 changed; bowels moved readily ; urine high-colored and scanty ; no tenderness 
 apparent; there was active delirium. Another case, girl aged 11 years, had 
 sore throat, black-coated tongue, had chills at first, and the case terminated in 
 intermittent fever. This patient was tender over spine and back of neck ; 
 had pain in back of head ; the muscles of back and neck contracted so that 
 the head and feet were only about twenty inches apart. She had diarrhoea part 
 of the time. This case was convalescent in 31 days. Some other cases seen 
 by Dr. Wilcox had spots on the chest about five-eighths of an inch in diameter. 
 
 For the characters of the disease as it occurred in the city of Monroe and 
 vicinity I am indebted to Dr. 0. T. Southworth, who kindly wrote me concern- 
 ing it. I quote from his letters as follows: "The cases were not confined to 
 any one neighborhood or street of the city, but were well scattered in the 
 three wards south of the river. The prodromic stage is of variable duration 
 and quality. Some have intermittent fever for a few days, others suffer from 
 tonsilitis, others laryngitis; still others have none at all, the first symptom 
 being a convulsion. The characteristic symptoms do not vary, but the general 
 symptoms may." He speaks of pain in the head, retraction of the head, lock- 
 jaw, and squint as attending nearly all cases, and "paralysis of the lower ex- 
 tremities in four cases." Dr. Southworth mentions u a falling in of the abdom- 
 inal walls, the abdomen appearing as though it had been dug out or emptied of 
 the viscera. This last symptom I think I have found in every case I ever 
 saw." I noticed this appearance, which was very striking, in a case which I 
 saw at Petersburg. I do not remember to have seen any reference to this sub- 
 ject until Dr. Southworth's letter. In the article on Tetanus in Youatt's 
 " Structure and Diseases of the Horse," page 80, mention is made of "tucking 
 up of the belly, which is seen under no other complaint." This same expres- 
 sion, — "tucking up of the belly," — is found in descriptions of the Texas cattle 
 disease. In a report of the Sanitary Committee to the Board of Health of New 
 York city, in June, 1874, relative to hydrophobia, then prevailing in that city, 
 this same condition is referred to as one of the characteristics of dogs suffering 
 from that disease. The expression in that case is: "Skin tight on the ribs, 
 abdomen tucked up." There is a certain similarity between the prominent 
 symptoms of these diseases of animals and cerebro-spinal meningitis; and 
 post mortem examination reveals anatomical changes which in some respects 
 are similar. May not this retraction of the abdomen be an important expres- 
 sion of a general and characteristic fact in the pathology of these tetanoid 
 diseases ; that fact being general contraction of muscular tissue, more particu- 
 larly of the non-striated muscles, involving not only muscular coats of arteries 
 but also of intestines, and possibly including the diaphragm. 
 
 Dr. Southworth writes that "the disease did not appear there in 1873, but 
 in 1872 I treated 19 cases in Monroe county, with only one fatal case." In 
 reply to a question as to whether the cereals were affected with smut in that 
 locality, he writes: " Smut prevailed in 1873, none in 1874. I cannot learn 
 regarding 1871." The flour being used at the time of the epidemic in 1874 
 was probably made from wheat raised in 1873. 
 
CEREBROSPINAL MENINGITIS. 133 
 
 The cases of unusual sickness at Blissfield were not all well-marked cases of 
 cerebro-spinal meningitis, but have been included for the reason that they 
 were unusual, and seemed to partake of the character of that disease. I am 
 indebted to H. 0. Wyman, M. D., for an interesting account of them, includ- 
 ing treatment, and give the main parts concerning one or two of them. A 
 boy, aged 10 years, had not felt well for several days, at night was taken with 
 severe pain in the back of his head, was delirious, had tendency to contraction 
 of the muscles of the neck ; there was coldness of the extremities. Mustard 
 was applied to extremities and along the spine. He was said to be better next 
 morning when Dr. W. saw him, but was then unable to bend his head forward, 
 and complained of tenderness throughout the body. His pulse was natural, 
 skin dry, bowels constipated, urine thick and scanty. He had no appetite, was 
 convalescent on the third day. A male, aged 21 years, was never sick a day in 
 his life before, after working in the field all day was taken suddenly with pain 
 in the head and vertigo, vomited, and fell to the ground unconscious. Dr. W. 
 found him in bed suffering severe pain in the right sciatic nerve, was very 
 restless, and sick at his stomach. He had tenderness along the spine; pupils 
 irregular; pulse first trial 88, next trial 100 per minute; temperature 102°. 
 Patient had another paroxysm similar to first, but milder, and was unable to 
 work for two weeks, owing to stiffness of muscles. 
 
 PATHOLOGY OF THE DISEASE RATIONALLY CONSIDERED. 
 
 In a report to the State Medical Society of New York, in 1858, Dr. T. H. 
 Squire remarks as follows : " Neither is it difficult to give a rationale of these 
 manifestations. With the headache, heavy chill, and cold surface, there is vio- 
 lent congestion of the brain ; the vomiting and irregular breathing indicates 
 disturbance of the pneumogastric nerve ; if there be dilated pupil and loss of 
 sight, they show the nerves of vision to be impaired; when the hearing 
 becomes obtuse, the auricular nerve has suffered ; if the sterno-cleido-mastoid 
 and trapezius muscles are rigidly contracted, their congestion or effusion sur- 
 rounds the spinal accessory; if an arm is convulsed or paralyzed, the difficulty 
 embraces the upper portion of the cord; and in like manner, all the conspicu- 
 ous symptoms may be explained by the congestion or effusion that exists in 
 the cephalic and vertebral cavities. But having philosophised thus far, it is 
 not so easy to take another step, and account for the congestion, or the inflam- 
 mation, whichever it may be. The remote cause of this is epidemic, is subtile 
 in its nature, like all other epidemic influences, and makes its impression 
 directly upon the nervous system, without any previous derangement of the 
 blood or the secretions. The exciting causes are exposure to cold and what* 
 ever else tends to depress the vital energies of the system. If a neglected child 
 creeps about the cold floor, in wet and scanty clothing, or a delicate boy plays 
 in the snow with damp feet, or a lively school-girl dances and sings till she is 
 exhausted,! or a fisherman wades too long in the river, or a debauchee falls 
 into the canal, they will be quite likely to encounter the disease/'* 
 
 CAUSE OF CEREBROSPINAL MENINGITIS. 
 
 Dr. J. Baxter TTpham, in the Fifth Annual Eeport of the State Board of 
 fiealth of Massachusetts, p. 311, says : 
 
 ■■--- 
 
 * T. H. Squire, M. D., Trans. N. Y. State Med. Soc. 1S58> p. 188. 
 
 t The only case of the disease which occurred at Deerfield during this epidemic* was a young man attacked 
 while dancing at an evening party. Over-work and mental anxiety were assigned in a few other cages, 
 
134 STATE BOARD OF HEALTH— REPORT OF SECRETARY . 
 
 "The relations of insanitary conditions in and around the abode of the 
 patient to its origin or supposed cause, demands the most careful considera- 
 tion. In weighing the evidence contained in the returns, I find the scale to be 
 pretty evenly balanced in this particular. The cases are distributed among all 
 classes and grades of society, — the high and the low, the rich and the poor, 
 locations unexceptionable for situation, open to abundant light and air, and 
 the pent-up hovels of the lowly and wretched, have all contributed to the 
 material of the epidemic. We believe, therefore, that the primal origin of the 
 disease is atmospheric, and for the present beyond our ken." 
 
 Dr. John Simon writes : 
 
 " Epidemics have seemed particularly apt to occur in establishments where 
 masses of special population have been living in common domicil, — as in work- 
 houses, convict prisons, schools, and (above all) barracks. And in several such 
 cases the epidemic has seemed to confine itself to one section of the establish- 
 ment, to one block or building, to one floor, or to one room. It is asserted 
 that, as a general rule, the affected segment of'population has been in over- 
 crowded and ill-ventilated quarters. And when the disease has spread from 
 such centres, or has independently arisen among common populations, this, 
 almost always, has been said to have been under similar unwholesomeness of 
 circumstances. Where the epidemic has been among soldiers, officers have 
 enjoved almost entire immunity ; and where common populations have been 
 suffering, the disease has shown great, if not exclusive, preference for the 
 worst lodged classes of the community. * * * In some cases, according to 
 local reports, the distribution of an epidemic has very decidedly not been gov- 
 erned by conditions of over-crowding and ill-ventilation, f 
 
 This would seem to show that, although over-crowding and imperfect ventil- 
 ation may increase the tendency to this disease, it cannot be considered as the 
 essential cause; and it may be that the over-crowding, etc., are only accidental 
 conditions, the real cause being some other condition to which " the affected 
 segment of population " is also exposed. The fact of the disease affecting 
 " segments of population" in the way it does, is evidence against the proposi- 
 tion that it has a general atmospheric cause. Officers may have enjoyed im- 
 munity from the disease because their food was from a different source and of 
 better quality. 
 
 A distinguished writer says: 
 
 " But we may regard it as very probable that epidemic cerebro-spinal menin- 
 gitis does not depend on atmospheric or telluric influences, but is rather due to 
 an infection of the body with a specific poison."* 
 
 The fact that the disease sometimes prevails in one locality in one year, and 
 in a subsequent year in another place near by, while the place first visited 
 escapes, would seem to be good evidence that the disease is not due to a gen- 
 eral atmospheric cause, for if it were, contiguous places should be attacked 
 simultaneously. 
 
 In order that the disease may prevail as an epidemic in the way this disease 
 does, and still be due to such influences, it is essential that many persons, of 
 different ages, and of both sexes, shall be more than usually susceptible to such 
 influences, and that such susceptibility shall be restricted to persons within a 
 ceriain locality, whereas climatic influences are not usually so restricted. In 
 
 t Niemeyer's Text Book of Prnc. Med., Vol. II., p. 219. 
 
 (* Eighth Report of the Med. Officer of the Privy Council, 1SC5.) Quoted from Aitken'e Sc5» and Prac. of 
 Med., Vol. II., p.. 455. 
 
CEREBROSPINAL MENXNGXTI& 135 
 
 Bhort, there seems to be no satisfactory evidence that the disease is due to a 
 general atmospheric cause. 
 
 If it is due to any local influence acting through the atmosphere, the nature 
 of that influence remains to be ascertained. The disease has prevailed in 
 localities subject to malarial diseases, but on the other hand it has prevailed 
 in localities not subject to such diseases. 
 
 IS IT DUE TO THE LOCAL PRODUCTION OF OZOXE ? 
 
 There is, however, one agent which may be formed and added to the atmos- 
 phere in greater quantities in some localities than others, and which from its 
 known action upon organic matter may be supposed to be capable of so acting 
 upon the tissues of the body, and of so influencing the nervous system, as to 
 render it possible for changes in temperature and for mental impressions to 
 produce such phenomena as appear in this disease. That agent is ozone. Dur- 
 ing normal activity of living bodies in our ordinary atmosphere, the tissues of 
 the body are constantly undergoing change through absorption of oxygen and 
 liberation of the products of oxidation. This expenditure of the substance of 
 the body is nominally compensated by a period of repose and repair during 
 suspension of activities in sleep. But if, instead of ordinary atmospheric oxygen, 
 the inhabitants of a given locality are caused to inhale ozone, which is a much 
 more active form of oxygen, it is in harmony with our present knowledge 
 of its properties, to believe that there may result an over-oxidation of the tis- 
 sues of the body, and that those destructive changes, which under ordinary 
 circumstances are repaired during sleep, may go on to excessive and even to 
 irreparable destruction. It is quite probable that the results of this over-oxi- 
 dation, if it occurs, would be first exhibited in a disturbance of the nervous 
 system, through a sense of excessive fatigue, of pain throughout the body, 
 which would be increased by movement, and because of over-oxidation of nerve- 
 substance there would be headache, nausea, and vomiting, and finally delirium, 
 coma, and death. Just as occurs in cerebro-spinal meningitis, there would be 
 a greater liability to succumb to the disease by those who overwork, or those 
 who from any cause are depressed in spirits. Thin and spare persons of active 
 minds would suffer most for the reason that they have less oxidizable material 
 in reserve. There would be especial danger to those suffering from fear and 
 anxiety. The disease would probably be neither contagious nor infectious, 
 except through the over-work, mental anxiety, and grief attendant upon a fatal 
 epidemic. There is one fact connected with the pathology of the disease in 
 question that might receive explanation in this connection, that is, the excess 
 of fibrin in the blood, which may be caused in some way through the oxidizing 
 influence of ozone. The greater prevalence of the disease in the spring of the 
 year may be capable of explanation by some facts concerning either the greater 
 production of ozone at this season of the year, or by reason of there being a 
 less consumption of ozone at such time in the oxidation of decomposing ani- 
 mal and vegetable matter. I have been thus particular to mention the sup- 
 posed possibility of the production of this disease by an excess of ozone in the 
 atmosphere, in the hope of stimulating observations concerning this agent. 
 For several years I have made great effort to obtain a series of observations at 
 different places throughout the State, and if such observations had been gen- 
 erally made and recorded throughout the State, and at the point where this 
 epidemic occurred, it would doubtless have enabled us at this time to have 
 answered this question of its being capable of contributing to the cause of this 
 
136 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 epidemic. If the local board of health where this epidemic occurred had per- 
 formed its duty promptly, and had given notice to this board immediately on 
 the appearance of this epidemic, it is possible that the question might still 
 have been answered at this time, for observation on ozone might then immedi- 
 ately have been begun, even if it required the continued presence of some agent 
 of this board for that purpose. In the absence of evidence as to the relative 
 amount of ozone in the atmosphere of that locality at that time, we can only 
 mention it as possibly contributing, and express the hope that in the next epi- 
 demic we may be able to obtain exact information on this point. 
 
 SOME PACTS RELATIVE TO WATER SUPPLY. 
 
 The soil at Petersburg and Dundee is rather loose and sandy. Water upon 
 its surface will pass quite freely through it. Organic impurities may not be so 
 thoroughly removed from water by passing through this soil as through one 
 containing more iron, or more clay through which it would pass more slowly. 
 In this connection it should be stated that at Petersburg the cemetery is 
 within the village limits. I was also informed that the most thickly settled 
 part of the village was once an Indian burial ground. The bodies of those 
 persons who died of unusual sickness just previous to this epidemic and 
 who were said to have presented some of the symptoms of the disease in 
 question, were buried in the village cemetery. The question arose as to the 
 quality of the water drank by those who contracted cerebrospinal meningitis. 
 
 The first well-marked case which was recognized at Petersburg was Frank 
 Gunsolus, younger brother of a prominent physician of that place. He was 
 taken sick March 3, 1874. The water supply of this family was obtained from 
 a well on the premises. The water was particularly bright and sparkling, was 
 said to be hard, and proved to be on trial, but gave me an impression of being 
 soft water, and I now think it was because of the ammonia which it contained, 
 as shown by the analysis made by Prof. Kedzie, and which will appear further 
 on. 
 
 The next well-marked cases at Petersburg, were Ohas. A. Boone and a boy 
 named Pierce, both taken in a similar manner, at the same time, April 16th. 
 Some of my notes, respecting the first of these boys, are as follows : Charles 
 A. Boone, aged 12 years; slept up stairs until taken sick; wore flannel under^ 
 clothing; attended school; was active mentally. The day before he was taken 
 sick he was made dizzy by playing "snap the whip;" was taken sick Friday 
 morning, April 16th ; was found about 2 A. M. vomiting and insensible. He 
 was sick for a long time, and presented most of the symptoms usually found 
 in this disease, including dilated pupils, retraction of the head, sensitive skin, 
 great tenderness over spine and large nerves, dark spots, and in this case there 
 was a marked discoloration of the skin over the course of the sciatic nerve, in 
 the left leg, where the skin was exquisitively sensitive and looked as if it were 
 about to slough off. The water used by him and his family for drinking and 
 other purposes, was obtained from a spring on higher ground, but only 7 paces 
 from the opening of two sewers, and 6 paces from a privy in the other direc- 
 tion. This spring was 5 paces from a house, and fifteen paces from the ceme- 
 tery which is on ground from twelve to fifteen feet higher than the level of 
 the spring. About 18 paces from the spring was a recent grave made May 
 24th, 1874. Water from this spring was also used by the family living in the 
 house near by, — a rather old man and his wife, who appeared to be in their 
 usual health. The Boone family had not always enjoyed good health since 
 
CEREBROSPINAL MENINGITIS. 137 
 
 tbey had lived here. The cellar of their house was not used, and was not in 
 excellent condition. Mr. Boone informed me that he lately had some diffi- 
 culty in obtaining good flour; had returned some that they could not well use. 
 I endeavored to secure some of it for examination, but did not succeed in 
 obtaining it. The following communication from Prof. Kedzie contains the 
 facts revealed by analysis of the water from the two sources mentioned. 
 
 Lansing, Aug. 20, 1874. 
 H. B. Baker, M. D., Sec. of State Board of Health: 
 
 Dear Doctor — I have analyzed the specimen of water from the spring near the grave- 
 yard in Petersburg, and also the specimen of water from the well of Dr. Gunsolus in the 
 same place. 
 
 From this examination I conclude that these waters are unfit for domestic use, and may 
 be sources of serious disease in those who make use of them either as potable water or for 
 domestic use. I do not base my conclusion on their physical appearance, for the spring 
 water, while presenting a certain milky appearance at the spring, was bright and clear when 
 it reached me, and the well water was beautifully bright and clear when I received it. The 
 reasons for condemning these waters in a sanitary point of view arise from the chemical 
 reactions which these waters exhibit, as shown in the following statement : 
 
 1. These waters contain an abnormal amount of chlorides in solution ; the spring water 
 contains chlorides equivalent to 356 parts of hydrochloric acid in 1,000,000 parts of water; 
 while the well water contains 1019 parts in 1,000,000. The soil from which these waters 
 are obtained is alluvial, and we cannot suppose that these chlorides are directly derived from 
 the salt-bearing rocks which yield chlorides so abundantly in some parts of our State. The 
 presence of a large amount of chlorides in water under such circumstances is usually 
 attributed to "sewage contamination" by writers on hygiene, i. e., to the presence of 
 organic matter rich in chlorides. 
 
 2. These waters contain an unusual amount of ammonia: the spring water contains one 
 part and the well w T ater seven and a half parts in 1,000,000 of water. 
 
 3. Tuese waters contain an abnormal amount of " albuminoid ammonia," that is, organic 
 matter containing nitrogen, and which yields ammonia by putr< faction or by the action of 
 oxidizing agents, e. g., the permanganate of potassium. The spring water yields in 
 1,000,000 parts 1| parts of ammonia, and the well water 1.7 parts of ammonia when treated 
 with caustic potash and permanganate of potassium, after all ammonia ready formed had 
 been expelled by prolonged boiling with carbonate of sodium. This albuminoid ammonia 
 is a most suspicious circumstance, as it reveals the presence of putrescible material in the 
 water. 
 
 4. These waters contain a large amount of nitric acid in the form of a nitrate. The 
 spring water contains in 1,000.000 parts 15 parts of nitric acid, and the well water 109 
 pans. This shows the presence of organic matter containing nitrogen which has become 
 completely oxidized. While the nitrates may not be directly injurious to the human sys- 
 tem, yet the presence of so large an amount of nitrates in water which contains putrescible 
 nitrogenous matter is very suspicious. 
 
 5. These waters contain a startling amount of nitrous acid in the form of nitr ites. The 
 amou -.t in quantity I am not able to state ; but when Price's Test (pure Iodide of Potas- 
 sium free from iodate, acetic acid, and gelatinised starch) is added to these waters without 
 any concentration, they both become deeply blue. I never before found natural waters 
 which gave so decided a reaction with Price's test. The presence of nitrous acid or ^itrites 
 is accepted by all hygienists as sufficient ground to reject any water for domestic use. 
 
 6. These waters contain very distinct traces of phosphoric acid. When a quart of water 
 is evaporated to dryness, the residue dissolved in nitric acid, and excess of molybd ate of 
 ammonia added, a distinct yellow precipiiate of phospho-molybdate of ammonia Is formed. 
 Phosphates are very seldom found in solution in natural waters. The alumina and oxide of 
 iron in soils have so strong an affinity for phosphoric acids, that it will speedily withdraw it 
 from solution by forming insoluble phosphates. That phosphates are found In solution in 
 this water indicates that some organic matter, rich in phosphorus, is undergoing decompo- 
 sition in such quantity that the soil is not able to completely withdraw it from solution. 
 
 The presence in these waters of unusual quantities of chlorides of ammonia, of albuminoid 
 ammonia, of nitrates and nitrites, and finally of phosphates, shows these waters to be very 
 unusual in tbeir composition. We might account for the presence of all these substances if 
 matters very rich in nitrogen and phosphorus, e. g. flesh, were undergoing decomposition in 
 their vicinity and the results of thisdecompostion passed directly into this water. The fact 
 that the spring is near and lies below the level of a graveyard, that the well is in the midst 
 
 18 
 
138 
 
 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 of an old Indian graveyard, gives much plausibility to this explanation. The fact that the 
 first person attacked with cerebrospinal meningitis in Petersburg used the water of this 
 well, and that others who used the spring water were attacked with the same disease 
 would very naturally attract very significant attention to the composition of these waters 
 as having some possible connection with the terrible epidemic which has wasted that village. 
 
 Very respectfully, 
 
 R. C. KEDZIE. 
 
 Grouped in tabular form, the results obtained by Prof. Kedzie, appear as 
 follows: 
 
 1 ABLE I.— Exhibiting remits of Analysis of Water from Spring near Cemetery, Petersburg, 
 
 Michigan. 
 
 IMPURITIES. 
 
 Parts in 
 
 1,000,000 of 
 Water. 
 
 Hyd rochloric acid 
 
 35.6 
 
 1. 
 
 1.5 
 
 15. 
 
 Unusual 
 
 amount. 
 
 Distinct 
 
 traces. 
 
 Ammonia 
 
 Albuminoid ammonia 
 
 Nitric acid._ 
 
 Nitrous acid , as nitrites _ _ . . 
 
 Phosphoric acid -~~ 
 
 
 TABLE IL 
 
 •Exhibiting results of Analysis of Waterfront Well on premises of Dr. Gunsolus, 
 Petersburg, Michigan. 
 
 IMPUPJTIBS. 
 
 Hydrochloric acid 
 
 Ammonia 
 
 Albuminoid ammonia.. 
 Nitric acid 
 
 Nitrous acid, as nitrites 
 Phosphoric acid 
 
 Part? in 
 
 1,000,000 Of 
 Water. 
 
 101.9 
 7.5 
 1.7 
 100. 
 Unusual 
 amount. 
 Distinct 
 traces. 
 
 These two analyses were all that were made of drinking-water used by per- 
 sons having the disease at this place, as they were about the only instances 
 where the persons were still sick with the disease at the time J made the 
 investigation. Frank Gunsolus has since died, after a sickness of some 149 
 days. When I last heard from the Boone boy he was convalescent. He had 
 been sick about 80 days. 
 
 In talking with a gentleman in this city, whose wife was very sick with 
 cerebro-spinal meningitis in the spring of 1873, he said she was taken sick 
 " about the time the water in the well began to be bad in the spring." He was 
 not sick at that time, but his work kept him away from home except at meal- 
 times and nights. At Petersburg, however, several persons used water from 
 the Gunsolus well and the spring near the graveyard, and did not have the dis- 
 ease. There has not yet been sufficient evidence collected on this point to 
 warrant a definite opinion, but it $eerns quite possible that water containing 
 
CEREBROSPINAL MENINGITIS. 159 
 
 certain impurities may predispose persons to this, as well as to other forms of 
 disease; and although healthy adults may sometimes use such water without 
 serious results, it may have been one of the factors in bringing down the 
 Boone boy, who was at the growing age, bad eaten food made from bad flour, 
 had an active mind, was using it at school, and took violent exercise the day 
 before his sickness, probably attended with extreme changes in his bodily tem- 
 perature. It may be that he could have endured any one of these conditions 
 singly, but that taken altogether they made him sick. This was rather a 
 typical case, except that it ended in recovery. Possibly, if other cases could 
 have been studied as closely, a similar group of unfortunate conditions might 
 have been found. 
 
 DOES THIS DISEASE DEPEND TTPOX A2*Y LOCAL ATMOSPHERIC CAUSE? 
 
 Ignoring the possible local influence of ozone, concerning which no evidence 
 could be collected, a careful study of the local conditions actually found in 
 connection with this epidemic, such as those of soil, sewerage, sources of 
 malaria, and general and private sanitary conditions, does not reveal evidence 
 of any influence capable of acting on the human system through the atmos- 
 phere, and which appeared to be so different from those in other localities 
 where this disease did not exist, as to warrant the belief in its being the cause 
 of this epidemic. 
 
 In this connection, there is one point which should receive attention here- 
 after. It was noticed in New York city that in the epidemic of 1872 the dis- 
 ease was at first almost entirely confined to original water courses. In study- 
 ing the disease as it has been reported in the Vital Statistics of this State, I 
 find that it is found more particularly in localities through which streams run. 
 The epidemic of which this is a report occurred in villages situated along the 
 bank of the Eiver Raisin. Many of the inhabitants are inclined to attribute 
 the disease to some influeuce from the river. If it was due to any such cause, 
 it must have been one which does not ordinarily exist there, as this disease is 
 extremely uncommon in that vicinity. There is one fact which may possibly 
 be found to have some bearing upon the subject, so far as streams are con- 
 cerned : it is that tons of the refuse from wheat ground at the various mills 
 are annually thrown into the river. It is called "smut," but in ordinary sea- 
 sons it consists largely of the fine velvety material from the small end of the 
 kernels. In the year preceding that in which the disease prevailed along this 
 river, the wheat and other grain raised in that vicinity was more than usually 
 affected with what is called "smut," and the refuse from such wheat would 
 contain vast numbers of the spores of the so-called smut,— a fungus known as 
 Tilletia caries. Some of the mills were running during the winter and early 
 spring months, — that was true of one at Norvell, — but as soon as spring fairly 
 opened there was undoubtedly a great deal of this kind of organic matter 
 present in the river water. It probably tended to collect in the sluggish bay- 
 ous along the river banks, and as the warmer weather arrived it may have 
 undergone decomposition and yielded a poisonous vapor to the atmosphere, or 
 the living spores may have germinated. Milch cows may have drank it,- — and 
 they probably did so, — possibly with safety to themselves, but to the detriment 
 of those who used their milk. These conjectures are all that can be brought 
 forward now, as no knowledge of the epidemic came to this board until it was 
 nearly over. But, given the two facts stated above, and the hypotheses are at 
 
140 STATE BOARD OF HEALTH -IMPORT OF SECRETARY. 
 
 once suggested as of sufficient importance to warrant further examination, if, 
 as is altogether probable, another epidemic shall give the opportunity. 
 
 This brings up another question somewhat closely related to this last. It is : 
 
 CAN THIS DISEASE BE CAUSED BY MILK FEOM COWS FED ON POISONOUS 
 
 FUNGI ? 
 
 Edible fungi are sometimes poisonous when their spores are ripened. A case 
 occurred in Scotland : 
 
 " Not long ago the Pharmaceutical Society in Edinburgh was promised a lec- 
 ture by Mr. Sadler on edible and poisonous fungi, but when the evening came 
 Mr. Sadler was ill. * * While preparing his lecture for the Pharmaceutical 
 Society he accidentally swallowed a great quantity of the spores of a large 
 species of puff-ball (Lycopcrdon Giganteum), and within the space of an hour 
 and a half was seized with severe illness, accompanied with violent pains. The 
 violent symptoms were not subdued until nine days after the first attack. Sir 
 Robert Christison, Dr. Balfour, and Dr. William Craig, who attended Mr. Sad- 
 ler, were of the opinion that the continued irritation was kept up by the 
 fungus spores. The giant puff-ball is edible in its young state, but its ma- 
 tured spores ought certainly to be avoided." * 
 
 It is well known that cerebro-spinal meuingitis occurs most frequently in the 
 winter and spring. At such seasons milch cows are fed largely on hay and 
 ripened grain, while in summer their food is green, and, as a rule, spores of 
 fungi may not be so generally ripened as in the winter and spring food. 
 Whenever another opportunity is offered, it is to be hoped that the milk used 
 by those who contract the disease will receive thorough microscopical and 
 chemical examination, and that the food of the animals from which it is ob- 
 tained will be closely examined. Mouldy hay would of course have thoroughly 
 associated with it the spores of the particular fungus of which the mould con- 
 sisted, and even these common moulds have been charged with poisoning. 
 
 Dr. M. L. Holbrook says : 
 
 "Johier has signalized the poisoning of three animals which had eaten 
 mouldy bread. Westerhoff has made known the case of two children who had 
 taken rye bread containing the Mucor Muceclo, the most common species of 
 mould." f 
 
 Binding " rusty " straw is said to occasionally cause sickness. 
 
 Dr. Salisbury of Ohio claimed at one time that a disease something like 
 measles could be produced by some fungus connected with straw. 
 
 Pavy mentions the production of diabetes by inhalation of spores in the 
 dust of a "puff-ball." He has further found that "through the agency of 
 the inhalation of puff-ball smoke an immediate and strong diabetic state may 
 be induced, and that the effect is accompanied with such a modification of the 
 circulation that the blood flows through the vessels as is the case after section 
 of the sympathetic, without becoming properly de-arterialized. His experi- 
 ments, he considers, suggest that in diabetes of the human subject, the blood, 
 in consequence of vaso-museular paralysis, is allowed to reach the portal vein 
 in an imperfectly de-arterialized condition, and thus determines the escape of 
 sugar from the liver." J 
 
 ♦Boston Jonr. of Chemistry, Aug., 1874, p. 24. 
 
 t Page 134, " Eating tor Strength." 
 
 t Lancet, Aug. 29, 1874. Quoted in " Medical News and Library, Oct., 1874, p. 15 6. 
 
CEREBROSPINAL MENINGITIS, 141 
 
 HOW DO FUNGI DESTROY ANIMAL AND VEGETABLE LIFE? 
 
 Without attempting to answer this difficult question, it may be proper to 
 make a few suggestions regarding some of the possible methods of action of 
 some fungi. Omitting, for the present at least, anything more than a refer- 
 ence to the directly poisonous action of the substance of some of them, by its 
 action on the nervous system, the spores of some fungi, and perhaps the par- 
 ticles of germinal matter of which the spores are composed, may, and by some 
 who have studied the subject are believed to be, capable of inducing changes 
 within organisms analogous to those changes occurring outside of organisms 
 which result in the production of the various alcohols, of vinegar, etc., etc., 
 which are formed at the expense of more highly organized matter through a 
 conversion of a part of it into the proper substance of the fungus. The same 
 idea is applicable to those low forms of organic life which cause, or at least 
 attend, those putrefactive changes in animal matter which liberate hydro- 
 carbon or sulpho-hydrogen gases. These latter changes are believed to be 
 connected with the presence of the lower forms of organic life, and the first- 
 mentioned are accepted as resulting from a specific vegetable fermeut in each 
 particular case. Judging from the foregoing, taken in connection with the 
 phenomena of the disease, we might expect to find that typhoid fever, for 
 instance, may be caused by a low form of life capable of acting as a ferment or 
 of reproduction at the expense of more highly organized matter. Eemember- 
 ing the peculiar "intoxication" in cerebro-spinal meningitis, we might also 
 suspect that this disease, as also cholera, may be produced by a ferment or fer- 
 ments of vegetable origin and character. 
 
 This is but an imperfect reference to a part of the subject which seems 
 worthy of examination, but it was thought best to call attention to it, especially 
 as this disease has been classed among zymotic diseases. 
 
 IS THIS DISEASE DUE TO INFECTION, BY MEANS OF FUNGI? 
 
 When certain fungi are found present in certain diseases, the question then 
 arises whether they are the cause of the disease, or are dependent upon the 
 diseased condition for a suitable soil in which to exist. This question seems to 
 be already answered for some diseases. In small-pox, for instance, the condi- 
 tion requisite for the reproduction of the virus through implanting it in the 
 system is not one of disease. The person must not only not be sick with 
 small-pox, but must not have had the disease for some considerable time past. 
 This is characteristic of the ferments. A ferment added to a solution which 
 has just completely undergone the particular fermentation dependent upon 
 such ferment produces no marked effect; but if added to a solution which is 
 not fermenting, and has not undergone such fermentation, if the solution con- 
 tain material capable of maintaining such fermentation, it will go through 
 such changes if under suitable conditions of temperature, etc. The uniform- 
 ity with which these phenomena present themselves is so generally understood 
 as hardly to require proof. Every housekeeper who raises bread with yeast can 
 certify that the fermentation appears to depend upon the yeast, and that the 
 quantity of yeast is increased in this way. Knowing this uniform mode of 
 action of ferments, whether within or without the body, the explanation of 
 the regular course of the contagious diseases and of the reason why they do 
 not, as a rule, appear but once in the same person, does not seem difficult to 
 understand. Now that we know this characteristic action of ferments, and 
 know that the virus of vaccine and of small-pox consists of " living and inde- 
 
148 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 pendent organisms, belonging to the smallest and simplest of all living things, 
 which multiply, without the formation of mycelium, by cell -division alone, and 
 perhaps by the production of resting-spores," * it seems reasonable to expect 
 that the other contagious or infectious self-limited and self-excluding diseases 
 will also be found to depend upon the introduction into the system of a par- 
 ticular ferment which causes each disease, and that thorough and systematic 
 search will reveal the precise nature of each one of these special ferments. As 
 regards that of small-pox, '''according to Dr. Cohn's observations, these cor- 
 puscles are single cells of a spherical form, not more than one twenty-five 
 thousandth of an inch in diameter. They belong to the genus Micrococcus, 
 and those of the vaccine lymph are designated by the name of Micrococcus 
 Vaccina. They increase in numbers if kept at the temperature of the living 
 body, forming chains and groups of associated articulations." f 
 
 There is additional encouragement in the search for these specific ferments, 
 in the fact that already "another kind of micrococcus has been described by 
 Dr. Oertel of Vienna, and by Prof. Ebert of Zurich, as constantly present in 
 cases of diphtheria; and both observers have found that its innoculation in 
 different parts of the body in healthy animals produces a diphtheritic malady 
 having its starting-point at the place of innoculation." f 
 
 The existence of fungi or other parasites as the cause of disease is not neces- 
 sarily negatived by the fact of a disease being continuous. The Achorion 
 Schonleinu is capable of continuously maintaining itself and thereby the 
 peculiar disease known as favus. It seems probable that in order that diseases 
 dependent upon fungi shall run a definite course and protect against future 
 attacks, the fungus must undergo its changes in the blood of the patient, and 
 the disease be a general one, causing a chauge throughout the whole 
 organism. In cerebro-spinal meningitis the disease seems to be dependent 
 upon some blood-poison and, considering the usual phenomena of fermenta- 
 tion and of diseases dependent upon special ferments, it would seem that a very 
 important question to be asked in the study of the cause of this disease, is as 
 to whether it both runs a regular course and is protective against future attacks 
 of the same disease. Although individual cases of cerebro-spinal meningitis 
 present considerable variations, there still appears to be a greater tendency to 
 death at certain stages of the disease, and a certain change in the symptoms of 
 the disease after a certain period in its progress. But this alone, without pro- 
 tective influences, does not indicate whether or not the disease is due to a spe- 
 cific ferment, for the symptoms may be the same whether the blood-poison be 
 a ferment or a simple mineral or vegetable poison. On the question of protec- 
 tion against future attacks of the same disease, it seems almost impossible to 
 obtain any data, for the reason that the outbreaks of this disease occur so 
 erratically. One might nearly as well inquire whether lightning ever strikes 
 twice in the same place. Without this kind of data we lack important evi- 
 dence of its being caused by a specific ferment. Inasmuch as no such ferment 
 has ever been discovered in connection with this disease, we must conclude 
 that we have not as yet satisfactory evidence on this point. Unless it can be 
 proved that the disease is due to an ordinary poison, it is to be hoped that ob- 
 servers will endeavor to collect evidence of its protective influence, and search 
 
 * Dr. Colin, quoted by Prof. John C Dalton, M. D , in Address on the Origin and Propagation of Disease, 
 Am. Chemist, Apr., 1S74, p. 3S0. 
 tProf. J. C. Dalton, in Address on the Origin and Propagation of Disease, Am. Chemist, April, 1874. 
 
CEREBROSPINAL MENINGITIS. 143 
 
 for the presence of a specific zymotic cause. Evidence as to its commnnica- 
 bility by infection should also be sought for. 
 
 Fear is frequently an important element in the causation of spinal conges- 
 tion. The following evidence bears upon its influence in this disease : Dr. 
 Gnnsolus of Petersburg tells me that Mr. G-radolph was very apprehensive on 
 the subject of cerebrospinal meningitis during its prevalence there. His 
 brother-in-law, — Mr. Harvey, — also expressed fear that he should contract the 
 disease. One little girl more than once went home from school to her mother, 
 and, putting her hands up to her mothers face, sa^.d, " I am not feverish, am I 
 mother? I am not going to have the fever." Another little girl, some time 
 before coming down with the fever, said she knew she should have the dis- 
 ease, — she was sure she should catch it. All these persons contracted the dis- 
 ase and died. It may be that in such cases the fear is partly due to effects of 
 the poison of the disease not yet sufficiently powerful to produce its full effect ; 
 but there can be no doubt but that fear is capable of causing serious disturb- 
 ance in the circulation, aud it may be, and probably sometimes is, a factor in 
 the cause of this disease. 
 
 Just how such impressions upon the nervous system tend toward the pro- 
 duction of this disease may be made to appear more evident further on, after 
 studying some more powerful exciters of vaso-motor nerves. 
 
 SEASON OF YEAR. 
 
 Dr. Aitken, in his Science and Practice of Medicine, says: 
 
 " Of 182 European epidemics, 24 were in October and .November, 46 in De- 
 cember and January, 48 in February and March, 30 in April and May, 24 in 
 June and July, and 10 in August and September (Simon). 
 
 The outbreaks in this country have been chiefly during the winter and early 
 spring. In Sweden, of 41? local outbreaks, 311 were in winter and 100 in 
 summer. Of 85 epidemics in Europe and the United States, noted by Hirsch, 
 33 prevailed in winter, 24 in winter and spring, 11 in spring, 1 in spring and 
 summer, 2 in summer, 1 in summer and autumn, 1 in autumn, 1 in autumn 
 and winter, 3 in autumn, winter, and spring, and 6 throughout the whole 
 year." * 
 
 The epidemic concerning which this is a report, occurred in the spring of 
 the year. 
 
 Difference in temperature is perhaps the most prominent fact connected with 
 the seasons of the year. But because a large proportion of epidemics occur in 
 winter and spring it does not necessarily follow that they are due entirely to 
 the temperature. The food is somewhat different at differeut seasons, and there 
 are other conditions which cannot properly be ignored, although temperature 
 may be considered first. 
 
 COLD AND CHANGES IN TEMPERATURE. 
 
 Is this disease due primarily to some external influence exerted upon the 
 nervous system? Of such influences, heat and cold are among the most 
 prominent. It is believed that the influences of heat and cold are sufficient to 
 cause spinal anaemia and spinal congestion. It is claimed, but not proved, that 
 these influences in connection with a wound are sufficient to cause tetanus. 
 In some respects these diseases are similar to the one in question. There is, 
 however, a general belief that something more than unusual conditions of heat 
 
 *Vol. II.,p. 455. 
 
144 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 and cold are required for the production of epidemic ce-rebro-spinal menin- 
 gitis. 
 
 But temperature is a subject too important to be dismissed without an effort 
 to learn the nature of its action upon the living body. Can the nature of the 
 action of cold be explained ? 
 
 Cold is one of the causes to which tetanus is attributed. Torticollis (wry 
 neck) is believed to result from exposure of the part to cold. Most people 
 who, during a cold winter day, have ridden a long distance, exposed to a cold 
 atmosphere, in an open vehicle, have also experienced a peculiar stiffness of the 
 muscles of the neck, with more or less difficulty of turning the neck from side 
 to side. Swimmers are quite frequently taken with cramp while exposed to the 
 influence of cold in the water. The action of cold in contracting the surface 
 of the body, making it to appear like "goose flesh," is well known. Living 
 human tissue subjected to extreme cold, is comparatively pale and bloodless. 
 From this grouping of facts, it would seem that one prominent action of cold 
 is to cause tonic (tetanoid ?) contractions of muscular tissue; and this action 
 is not confined to non-striated muscles. This appears to be the explanation 
 of the phenomena mentioned above. 
 
 The fact that such muscular action is caused by cold is important, and 
 should not be overlooked in studying the cause of this disease. Tetanoid con- 
 tractions are so common in this disease that it has been proposed to change 
 the name to "Tetanoid Fever." We see from the foregoing that, within the 
 limits of our ordinary experiences, cold is known to produce cramps and con- 
 tractions which are essentially tetanoid. The subject of tetanoid contractions 
 will be studied more at length in another part of this paper. The following 
 facts in physiology and anatomy may also be profitably considered in this con- 
 nection, as also for their bearing upon the subject of disturbance of the cir- 
 culation in cerebro-spinal meningitis. 
 
 "From all of these observations, and others of the same kind which we 
 have not thought it necessary to quote, the existence of vaso-motor nerves and 
 their connection with centres in the cerebro-spinal axis are sufficiently well 
 established. It is certain, also, that centres presiding over particular functions 
 may be located, as the genito-spinal centre, in the spinal cord opposite the 
 fourth lumbar vertebra, and the cilio-spinal centre, in the cervical region of 
 the cord, both described by Budge. A stimulus generated in these centres, 
 sometimes as the result of impressions received through the nerves of general 
 sensibility, produces contraction of the non-striated muscular fibres of the 
 iris, vasa de'erentia, etc., including the muscular walls of the blood-vessels. 
 The contraction of the muscular walls of the vessels is tonic; and when their 
 nerves are divided relaxation takes place, and the vessels are dilated by the 
 pressure of blood. By this action the local circulations are regulated in 
 accordance with impressions made on sensory nerves, the physiological require- 
 ments of certain parts, mental emotions, etc. Secretion, the peristaltic move- 
 ments of the alimentary canal, the movements of the iris, etc., are influenced 
 in this way."* 
 
 As shown in the foregoing quotation, the circulation is controlled through 
 the influence of vaso-motor nerves, and "local circulations are regulated in 
 accordance with impressions made on sensory nerves," etc. It may thus be 
 understood how cold may powerfully influence the circulation. We may 
 
 * Flint's Physiology, Vol. IV., pp. 438-9. 
 
CEREBROSPINAL MENINGITIS. 145 
 
 notice in passing that Prof. Flint says, "'the movements of the iris, etc., are 
 influenced in this way/' that is, through the same system of nerves which con- 
 trols the circulation. Disturbed movement of the iris, particularly dilatation, 
 is a common occurrence in this disease. One fact relative to the circulation in 
 this disease is that the pulsations of the heart are sometimes lessened in fre- 
 quency, a condition nor usually found in other fevers, and which may be due 
 to irritation of the pneumogastric or the spinal accessory nerves. 
 
 "All that can be said, in the present state of our knowledge, is. that the 
 pneumogastrics have a direct inhibitory influence on the heart. When they 
 are divided and the heart removed from their influence, the pulsations become 
 more rapid. When the peripheral ends of the divided ends are galvanized the 
 heart beats more slowly, or its action may be arrested by a current of sufficient 
 power. This action may also be reflex, due to an impression conveyed to the 
 centres by what have been described by the brothers Gyon and Ludwig, as the 
 depressor nerves." * 
 
 u When the central ends were stimulated in dogs the pupils became dilated, 
 the ey^s protruded, sometimes vomiting occurred, and always the number of 
 respiratory acts was diminished, and, with a powerful current, were arrested in 
 inspiration ; but the pulsations of the heart were not affected" ( 
 
 If the phenomena attending irritation of both extremities of this nerve be 
 grouped together, more of the phenomena sometimes present in cerebro-spinal 
 meningitis appear than when taking them separately. In the living person, 
 any stimulation of such nerves at their roots or near the medulla oblongata 
 would be equivalent not simply to stimulating either the peripheral or central 
 ends, but both peripheral and central ends. This bears more particularly upon 
 a part of the subject treated of further on, namelv the influence of substances 
 in the food which may enter the blood, act upon the vaso-motor nerves to con- 
 trol the circulation, and, by so doing, cause serious damage to the cerebro- 
 spinal nervous tissue. But these considerations also have a bearing in th ; s con- 
 nection ; for it seems that the circulation may also be influenced by cold ; and 
 in this connection I desire to call attention to a fact which may be of importance 
 as an aid in appreciating the manner in which cold may cause serious trouble. 
 This fact is, that when a person is exposed to a cold atmosphere nearly every 
 part of the body is protected by warm clothing, but the cold atmosphere is 
 inhaled into the lungs at every breath. This is also true at night, when a per- 
 son is sleeping in a warm bed in a cold room. It is an important question 
 which remains to be proved, whether or not this fact has any necessary con- 
 nection with such other facts as that epidemics of cerebro-spinal meningitis 
 occur more frequently in cold weather, that persons affected with the disease 
 complain of pain in the back of the head and neck, which pain is increased 
 by movement of the neck, especially forward, that the pupils are dilated, and 
 that in the beginning of the disease vomiting is a frequent occurrence. Some 
 of the prominent phenomena of this disease, such as tetanoid contractions of 
 the muscles, are such as may be accounted for by the influence of cold, while 
 some of the other phenomena would be accounted for by irritation of the 
 pneumogastric nerves. These nerves are distributed mainly to the lungs, the 
 heart, and the stomach. Cold air taken into the lungs would furnish bo Lb. the 
 conditions just mentioned. 
 
 * Flint's Physiology, Vol. IV., p. 233. 
 t Flint's Physiology, Vol. IV., p. 22S. 
 
 19 
 
146 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 That cold is one of the causes of this disease appears probable. That it is 
 the most important cause seems improbable. If it were, the disease should 
 appear in every cold season. It does not; and what is more, it sometimes 
 appears in summer and autumn, in seasons when cold could not be supposed to 
 account for its prevalence. 
 
 DRYNESS OF THE ATMOSPHERE. 
 
 Id a brief sketch of this disease as it appeared in Livingston Co., Mo., in the 
 winter of 1861-2, Dr. T. F. Prewitt mentions (St. Louis Med. and Surg. Jour- 
 nal, May and June, 1865,) that it "first made its appearance among the soldiers 
 stationed at Chillicothe, during an unusually severe and protracted spell of dry 
 cold weather." * 
 
 In speaking of the epidemic which began in New York city about the begin- 
 ning of the year 1872, Dr. Moreau Morris says: 
 
 "In this connection, with reference to the present epidemic, an investigation 
 of the meteorological conditions immediately preceding its outbreak exhibits 
 the fact that, during the last three months of 1871 and the first three months 
 of 1872, there had been comparatively with the corresponding six months of 
 ten previous years, a very unusual and marked dryness of the atmosphere; 
 and when we remember that this disease began to develop coincident with the 
 lowest point of humidity, and rapidly increased during that dry state of the 
 atmosphere, we may, perhaps, recognize an element having a most important 
 bearing upon the question." f 
 
 This subject should receive attention. It may turn out, however, that the 
 dryness as well as the disease is closely connected with extreme cold, and in a 
 great degree dependent upon the temperature. 
 
 POISOK IN FOOD AS A CAUSE OF THIS DISEASE. 
 
 JSfext to atmospheric influences, the most constant and controlling in their 
 action are those of food and drink. A careful study of the literature of this dis- 
 ease makes it apparent that it has at various times prevailed, under very different 
 circumstances, in localities subject to malaria, and in those not subject te it, 
 in one locality at one time and in another near by at another time. The evi- 
 dence is not conclusive that it is contagious; it attacks persons of both sexes 
 and at all ages. Now some injurious article of food, or some temporary qual- 
 ity of the water supply of a locality might account for this irregular appear- 
 ance of the disease. 
 
 Taking up the question of food, we know that frequently the main articles 
 of food of a given locality are the same for a large proportion of the inhab- 
 itants. The flour that supplies a locality with material for its breadstuff's is 
 generally supplied in considerable quantities from one source. Any poisonous 
 ingredient in it would be distributed to all persons alike, leaving those most 
 susceptible to its influences to suffer most. 
 
 There are certain facts connected with outbreaks of the disease in foreign 
 countries which point strongly to some poison in the food as the cause of epi- 
 demic cerebro-spinal meningitis. Dr. J. Netten Radcliff says: \ 
 
 '•' During the outbreak in France in 1837 and following years, the ravages of 
 the malady were principally confined to certain garrisons, and even to small 
 
 * Am. Jotir. Med. Sci., p. 278. 
 
 t Report, Board of Health of New York City, 1S71, p. 854. 
 
 X Epidemic Cerebro-Spinal Meningitis, by J, Netten Radcliffe. 
 
CEREBRO SPINAL MENINGITIS. 147 
 
 sections of a garrison, without affecting the surrounding population. A like 
 limitation of the disease to certain detachments of troops was observed during 
 the recent war in the United States; and the restriction of the malady to small 
 portions of workhouse populations, as in the first outbreak in Ireland, is an 
 analogous phenomenon." "In France, from 1838 to 1848, the disease re- 
 appeared again and again among the forces in Bayonne, Versailles, and Avig- 
 non, notwithstanding changes of garrison." "During 1837 and 1838 the gar- 
 risons of Bayonne, Dax, Bordeaux, Rochefort, and La Rochelle suffered. From 
 1838 to 1841 the disease was prevalent among the garrisons of northeastern 
 France, particularly those of the valley of the Rhone. Thus it broke out at 
 Toulon, Marseilles, Aigues-Mortes, Nismes, Avignon, and Pont-Saint-Esprit. 
 In the course of the four years, 1839-40-41-42, the malady appeared in suc- 
 cession among the troops occupying the fortresses of Strasburg, Schelestadt, 
 Oolmar, Nancy, Metz, and Givet." "From 1839 to 1842 [same years as above] 
 it prevailed among the forces at Versailles, Saint Cloud, Rambouillet, and 
 Chartres." " Those stationed along the coast of Brittany, at Brest, L'Orient, 
 Nantes, and Ancenis, suffered in 1841 ; and during 1840 and 1841 the disease 
 manifested itself among divers detachments of a regiment scattered at Laval, Le 
 Mans, Chateau-Goutier, Tours, and Poitiers." " In 1840 it broke out among the 
 French garrison at Donera, Algeria, and during the next seven years it attacked 
 numerous towns and localities of the province, affecting the civil population, 
 both European and native, as well as the military." "During 1849 and 1850 
 the disease was prevalent to some extent among the French troops in Italy." 
 Speaking of the outbreak in Ireland in 1866, the same writer remarks: 
 " It is noteworthy that, as in the earlier outbreaks in France, the military in 
 Ireland, in proportion to their strength, suffered prominently from the disease. 
 In some of the country districts cases were recorded among the troops alone, 
 or among persons in immediate connection with them." "In January and 
 February, 1867, an outbreak of a disease characterized by severe rigors, tetanic 
 convulsions, intense neuralgic pain in the head and upper part of the trunk, 
 increased sensitiveness of the surface, obstinate vomiting, restlessness, and, in 
 one instance at least, by a dark purple eruption, but of which not a single case 
 died, took place at Bardney, in Lincolnshire, a village about ten miles east of 
 Lincoln, on the verge of a fen country, and having a population of 1,500, the 
 bulk of whom are engaged in agricultural pursuits." * 
 
 One can hardly study these facts without coming to the conclusion that in 
 the cases mentioned the disease as it occurred in the armies was produced by 
 some article of army supply furnished to troops. There would not be likely to 
 be any peculiarity of the water supply which should affect troops so much 
 more generally than the surrounding population. Atmospheric influences 
 would not be likely to be so restricted, except through defective ventilation, 
 and this does not seem capable of explaining all the epidemics that have oc- 
 curred, particularly as it occurs in localities where the ventilation is the same 
 as previously, and as after the disease has disappeared. The disease does not 
 appear to be contagious, and the evidences exhibited of infection of localities 
 are not prominent except as connected with troops. It seems probable that the 
 disease was caused by some article supplied to the troops, only in those years, 
 or which only had deleterious power sufficient to cause the disease in those 
 years. Unless evidence can be produced of some unusual supply to the troops 
 
 * Quoted from " Epidemic Cerebro-Spiaal Meningitis," by J. Netten Badcliffe, as are preceding statements 
 of epidemics among garrisons. 
 
148 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 at that time, it remains to conclude that the cause was perhaps due to some 
 temporary quality of the usual food. This would be a cause capable of ex- 
 plaining the facts, and no other cause which has been suggested would so well 
 account for all of them. Some of the prominent facts relative to the epidemic 
 just mentioned may be briefly recapitulated as follows : In France, in Ireland, 
 and in the United States, at different times, the disease was principally con- 
 fined to garrisons and detachments of troops. In the years 1837 to 1842 the 
 disease attacked the French troops, and in two instances while serving abroad. 
 In one instance, also, the troops of a particular regiment suffered, although 
 scattered about in different localities. Now it is quite probable that the com- 
 missary supply of that regiment may have been the same for all its several 
 detachments, and quite possible that it was in part the same as furnished to 
 those garrisons and detachments at home and abroad, which suffered from this 
 disease. In order that this should be true, however, the article causing the 
 disease must have been one which was uniformly used in small quantities, 
 purchased in large quantities, or one which was the product of some crop 
 which was affected throughout wide areas of production, as, for instance, the 
 wheat crop, which may have been unusually affected during those years, in 
 which case a larger proportion of affected grain may have found its way into 
 the breadstuffs supplied to the troops than was retained by the agriculturists 
 for their own use. 
 
 If those epidemics in France in the years 1837 to 1842 were due to such a 
 cause, it is somewhat singular that they were not traced out at the time, for I 
 find accounts of several serious epidemics which in times long past have 
 occurred in France and in other countries, and which were believed to be due 
 to ergotism ; and on page 486, Vol. L, Chapman's Therapeutics, published in 
 1825, the author says: " It has been a generally received opinion in Europe 
 for a century or two, that bread made of grain vitiated in this way, occasions 
 diseases of a very extensive and violent description. Of these, however, the 
 most common is a species of dry gangrene, pervading at the same time entire 
 districts of country." In a footnote referring to the possibility of such dis- 
 eases being caused in this manner, the same author says: " This is no longer 
 doubtful. By a series of well-conducted experiments, Dr. Charles Byrd has 
 shown that pigs, ducks, and fowls, eating for a week or two food containing 
 the ergot, acquire a gangrenous state by which the former lose their hoofs and 
 the latter their bills, etc. These experiments are contained in his Inaugural 
 Essay, 1821." On page 628 of Coxe's American Dispensatory, published in 
 1831, is an extract from this same inaugural essay of Dr. Charles Byrd of Vir- 
 ginia, giving some further details of his experiments. He says: "From the 
 results of my own experiments, I am led to the certain conclusion that the 
 ergot is capable of producing the dry gangrene ; but at the same time I am 
 convinced, and indeed the fact is mentioned by M. Bossau that the gangrene 
 is not always of the dry kind, which certainly is proved by my last experi- 
 ment." In the extracts from this essay which I have found, the prominent 
 symptoms of cerebro-spinal meningitis do not appear, but this experimenter 
 seems to have been looking mainly for certain symptoms which had been men- 
 tioned in connection with this cause, and he may have overlooked many of the 
 actual results. In fact it is certain that he either overlooked some of the 
 results, or the poison is capable of producing different effects undsr different 
 circumstances. His experiments were with animals. The effects of ergot of 
 rye on human beings are stated on page 382 of the U, S. Dispensatory of 1870, 
 
CEREBRO-SPIKAL MENINGITIS. 149 
 
 as follows : " In the quantity of half a drachm or a drachm it often occasions 
 nausea or vomiting, and in still larger doses produces a sense of weight and 
 pain in the head, giddiness, dilatation of the pupils, delirium, and even stupor." 
 Now these, so far as they go, are precisely the symptoms exhibited in cerebro- 
 spinal meningitis. 
 
 In an article on Epidemic Cerebro-Spinal Meningitis, by J. Netton Radcliffe, 
 in J. Eussell Reynolds' System of Medicine, I find the following: 
 
 "Diseased Grain. — Dr. B. "W". Richardson has suggested that epidemic 
 cerebro-spinal meningitis may possibly arise from the consumption of diseased 
 grain, after the manner of ergotism, and perhaps acrodynia. He thinks the 
 probabilities are altogether in favor of the suggestion, that * the cause, in fact, 
 is a diseased grain, or fungus, contained in some kinds of flour out of which 
 the breadstuff's are made. This fungus may not be present in large quantities, 
 and many persons may eat of the food without getting a poisonous part; but 
 one will get it out of a number, and this without any communication beyond 
 the breaking of bread together. The disease may occur in one member of a 
 family, leaviug the rest free; and in this irregular way it may be distributed 
 in an epidemic form over a large surface of the country.' He adds: 'If my 
 hypothesis, as regards cause, be correct, there is little danger of the disorder 
 extending widely in this country; for of our cereals used as food, nearly the 
 whole of the population now select wheat, and our wheat generally is selected 
 for the market with great judgment and circumspection. Any cases, there- 
 fore, that might occur would be isolated, and would be easily traced out and 
 prevented.' 1 This suggestion opens out an altogether new field of inquiry 
 respecting the origin of the disease, and it demands active and thoughtful con- 
 sideration in subsequent outbreaks. Dr. H. Day of Stafford has endeavored by 
 experiments on the lower animals to obtain some light on the subject. He fed 
 three rabbits with unsound grain (wheat, oats, ergot of rye, and mouldy 
 bread) with this result: In all the animals a spasmodic affection was pro- 
 duced, and in two inflammatory changes in the right eye, proceeding in one 
 case to ulceration of the cornea and evacuation of the contents of the globe. 
 One of the rabbits died on the eighth day, the other two were killed on the 
 twelfth day, and in all more or less congestion of the membrane of the spinal 
 cord was found on dissection.' " 2 
 
 SOME EFFECTS OF EEGOT. 
 
 The following quotation from Wood's Therapeutics, is a description of some 
 of the effects of ergot; but omitting such words as " dose," " drachm," etc., it 
 might well pass for a description of the symptoms present in many mild cases 
 of cerebro-spinal meningitis. It should be borne in mind that the author is 
 describing the effects of ergot in doses insufficient to cause death : 
 
 *' If the dose be increased to half a drachm or a drachm it will, in both 
 sexes, occasion some degree of nausea, and more or less cerebral disturbance, 
 attended, generally, with some diminution in the frequency and force of the 
 pulse. In still larger doses, of from one to two drachms or more, it evinces de- 
 cided narcotic properties. With nausea and a disposition to vomit, and some- 
 times actual vomiting, there are now 7 dilatation of the pupils, giddiness, a feel- 
 ing as of intoxication, heaviness or pain in the head, and not unfrequently 
 more or less drowsiness or stupor. Sometimes irregular and involuntary 
 
 1 Social Science Review, May, J 865, p. 403. 
 s Clinical HUtories and Comments, pp. 18-28. 
 
150 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 muscular contractions have been noticed; but they are not common symptoms. 
 The dilatation of the pupil is an ordinary phenomenon. It is usually, how- 
 ever, moderate, and unattended with disorder of vision. Sometimes the bowels 
 are disturbed, and evidences of gastro-intestinal irritation or inflammation are 
 said to have been presented in some instances ; but this is certainly not a 
 necessary or even common result. Sensations of itching, numbness, or fatigue, 
 are occasionally felt in the limbs. The circulation is usually depressed, and 
 sometimes greatly so. In female subjects, the uterine contractions are in- 
 duced much more quickly than the nervous symptoms here described, and do 
 not continue so long. What dose would be sufficient to prove fatal in man has 
 not been ascertained; nor can I find that any instance of death has been 
 traced to a single dose, however large." * 
 
 ERGOT HAS BEEN USED AS A REMEDY. — MAT IT BE A CAUSE OF THE DIS- 
 EASE ? 
 
 Ergot has been recommended and used for the treatment of this disease, 
 and it is believed by some that it is useful for this purpose. This being true, 
 it is quite probable that some will be inclined to reject, without any examina- 
 tion whatever, the idea of the disease being caused by ergot or by a fungus 
 similar to ergot. It may therefore be worth while to show that, instead of be- 
 ing opposed to such idea, the fact may, possibly, be explained in a way to sup- 
 port that view. 
 
 It is well known that after the long-continued application of cold to the 
 human body it is entirely unsafe to allow the body to be subjected to the action 
 of heat, even that borne under ordinary circumstances. In the case of chilled 
 fingers, it is considered good practice to apply snow, and, afterwards, cold 
 water, and only to allow the temperature of the part to increase very slowly, in 
 order to avoid too violent reaction, which has been found dangerous. We may 
 also bear in mind the proposition that '''action and re-action are equal and 
 opposite/' 
 
 Cold is believed to cause the contraction of non-striated muscular tissue, 
 and thereby lessen the calibre of the blood-vessels and the supply of blood to 
 the parts. The influence of heat in an opposite direction is well known. Heat 
 and cold have been recognized as sufficient to cause spinal congestion. From 
 what we know of such influences in other parts of the body, we may assume 
 that alternations of heat and cold would be a much more efficient cause. If 
 there were brought to us a patient whose whole body had been subjected to 
 extreme cold, we would expect that his nervous system, or other tender parts of 
 his body, would be in great danger if we immediately allowed him to be sub- 
 jected to the influence of heat. We would expect the best result from the 
 application, at first, of culd, that is, compared with normal temperatures. 
 
 Ergot is also believed to cause contraction of the non-striated muscular tis- 
 sue of the body generally, as it is known to do in the uterus, and as it does in 
 the blood-vessels when it restrains hemorrhage. ISTow it seems quite possible 
 that the long-continued use of flour made from ergotted rye or smut wheat 
 may produce a condition of the system somewhat analogous to that produced 
 oy extreme cold, and that whenever a person previously subjected to such food 
 is suddenly exposed to heat or any other such influences as tend to relax non- 
 striated muscular tissue, that person is in danger from congestion, and espe-. 
 
 ♦Wood's Therapeutics aDd Pharmacology, Vol. H., pp. 693-9. 
 
CEREBROSPINAL MENINGITIS. 151 
 
 cially from congestion of those parts which soonest feel the influence of snch 
 relaxation. It may be just as dangerous to suddenly withhold ergot, after its 
 long-continued use, as it is to suddenly expose a person to heat after long-con- 
 tinued exposure to cold ; and, possibly, for yery much the same reason. 
 
 That ergot has seemed to be useful in certain stages of this disease does not 
 therefore necessarily weaken, but it may rather strengthen the view that the 
 disease may be caused by a similar fungus. 
 
 A large number of epidemics of cerebro-spinal meningitis occur, — as did the 
 one reported in this article, — in the spring of the year, when we have a cessation 
 of the cold winter weather. It is also well known that ergot loses its power by 
 age, and it is possible that the same flour which has during the cold weather 
 contained ergot or smut of rye, buckwheat, or wheat, in an active form, may 
 as spring comes on lose some of its active power over non-striated muscular 
 tissue. If this should be found to be true, then the explanation of the man- 
 ner in which this disease might be caused by ergot would not be much more 
 difficult than the explanation of congestion resulting from sudden exposure of 
 a part to heat that had previously been subjected to cold. In the spring of the 
 year the influence of heat following cold would be added to the other cause or 
 causes more generally than at any other season of the year, except perhaps in 
 winter, when the cold is usually present out of doors and the heat iadoors, and 
 alternations of temperature are as rapid as the passage from one place to the 
 other. This may account for the fact that epidemics of this disease have been 
 most frequent in the first half of the year. 
 
 There is another fact capable of a similar explanation. That is the frequent 
 onset of this disease during sleep. In studying the epidemic at Petersburg 
 this fact was more than once mentioned, and in looking over histories of cases 
 elsewhere I have frequently observed that the first knowledge of the disease 
 appeared at night, after the person had retired, the patient being awakened by 
 nausea or vomiting, or being found in distress by others. Here the influence of 
 a warm bed would be one element in the case; the position of the body is 
 another, and, it may be, a stronger one. " In the recumbent posture on the 
 back, the blood gravitates in large amounts to the spinal vessels." * 
 
 And, again, the relaxation of tissue in sleep, dependent upon suspension of 
 active stimulation of the cerebro-spinal system of nerves, probably favors that 
 stagnation of blood from diminished tonicity of the blood-vessels, whether 
 caused by heat following cold, or by a lack of other accustomed stimulus to 
 their muscular walls, such, for instance, as might result from a change from 
 the use of food containing ergot to that containing none. 
 
 Prof. Flint says: "The contraction of the muscular \ walls of the blood- 
 vessels is tonic; and when their nerves are divided, relaxation takes place, and 
 the vessels are dilated by the pressure of blood/' * * * " The vaso-motor 
 filaments are not confined to the branches of the sympathetic, but they exist as 
 well in the ordinary cerebro-spinal nerves." f 
 
 The foregoing is offered in order to induce certain persons to investigate this 
 subject. To the writer it seems fully as probable that the disease may be 
 caused by the direct action of ergot or other fungi, in conjunction with cold, 
 as will appear further on. There are, however, at least two classes of cases. 
 
 * Diseases of the Nervous System— Hammond, p. 892. 
 
 t " Physiology of Man," by Austin Flint, Jr., M. D., p. 439. 
 
153 STATE BOARD OF HEALTH—REPORT OF SECRETARY. 
 
 THE PBODUCTION OF TETANOID CONTRACTIONS. 
 
 One of the most prominent phenomena of cerebro-spinal meningitis is the 
 tetanoid contraction of muscles, more particularly those of the neck and back. 
 It is therefore important to learn, if possible, how such contractions are pro- 
 duced. 
 
 Strychnia is a substance which, if taken into the blood, is capable of causing 
 tetanoid contractions. It seems to be generally believed that strychnia pro- 
 duces its effects by its action upon the nervous centres of the spinal marrow. 
 Tetanus, also, '-is generally admitted to have its essential seat in the spinal 
 marrow." * 
 
 Hydrophobia is another example of tetanoid convulsions now attributed to 
 an affection of the spinal cord. A course of reasoning similar to that which 
 has lead to the belief that strychnia produces its effects through the nervous 
 centres of the cord, leads to the opinion that the tetanoid contractions which 
 occur in cerebro-spinal meningitis are due to the action of a blood-poison or of 
 mechanical pressure upon the cerebro-spinal nervous centres. May not the 
 production of all tetanoid contractions be reduced to a general law of method ? 
 
 In reference to tetanoid symptoms in this disease, Dr. Stille says: "Their 
 presence unequivocally denotes the existence of spinal lesions." f His view 
 seems to be that they are due to either inflammation or congestion ; but 
 tetanoid contractions occur in non-striated muscular tissue through irritation 
 of sympathetic or vaso-motor nerves; and it seems possible that they may 
 occur in other muscles through irritation of cerebro-spinal nervous centres, 
 without inflammation or even congestion. 
 
 May not these phenomena of pathology be explained in accordance with 
 recognized phenomena in physiology ? Prof. Flint says : 
 
 u Taking into consideration the most reliable direct observations upon the 
 sympathetic ganglia and nerves, the fact that their stimulation induces move- 
 ments in the non-striated muscles to which they are distributed can hardly be 
 doubted. This action is particularly well marked in the muscular coat of the 
 blood-vessels; but here the function of the nerves is so important that it mer- 
 its special consideration, and will be treated of fully under the head of the vaso- 
 motor nerves. The mechanism of these movements, however, is peculiar. 
 Hie action does not immediately follow the stimulation, as it does in the case of 
 the cerebrospinal nerves and the striated muscles, hit is induced gradually, 
 beginning a few seconds after the irritation, endures for a time, and is more or 
 less tetanic. 1 % 
 
 "This mode of action is peculiar to the sympathetic nerves and the non-stri- 
 ated muscular fibres." § 
 
 Now such action maybe peculiar to the sympathetic nerves and to non-stri- 
 ated muscles, so far as physiological action is concerned. Voluntary (striated) 
 muscles may not physiologically act in that manner; but in such pathological 
 states as those of tetanus, cramp, cholera, and the opisthotonos of cerebro- 
 spinal meningitis, voluntary muscles do act in such manner. In tetanus the 
 gradually increasing and continuous contraction goes on, in some cases, until 
 the striated muscle is ruptured by its own contractile force, which even then 
 
 * Wood's Therapeutics, Vol. I., p. 823. 
 + Stille on Epidemic Meningitis, p. 38. 
 X Italics mine. 
 
 1 Letrros- et Ouimus, De la contraction des muscles de la vie vegetative, Journal de l'Anatomie, Paris, 1869, 
 tome VI., p 433. 
 § Austin Flint, Jr., M. D., Physiology, pp. 428-9. 
 
CEREBROSPINAL MENINGITIS. 153 
 
 is not abated. In cerebro- spinal meningitis the retraction of the head is some- 
 times so powerful and continuous that, if the patient be so placed, he will rest 
 only upon the back of the head and the heels. So far as is known to me, 
 there has not been offered any explanation of the physiological or pathological 
 mechanism of such action as this. But if the view of Valentin and Prof. 
 Kolliker as to the non-specific character of the sympathetic nerves be accepted, 
 the explanation does not seem difficult. 
 
 " Allowiug that the great number of very fine pale fibres in the sympathetic 
 is a prominent anatomical fact, as is also, indeed, the case in the higher nerves 
 of sense and in the gray substance, still, speaking physiologically, I am by no 
 means of opinion that the fineness of the fibres in the sympathetic indicates 
 anything of a special nature in them, and which does not exist elsewhere; but, 
 perhaps, that where this condition does exist, both in them and in other sit- 
 uations, it is connected with a distinct kind of fanction ." * 
 
 In this connection it seems important to bear in mind, that apparently just 
 such action as is caused in non-striated muscles, by stimulation of sympathetic 
 nerves, occurs in striated muscles during tetanoid contractions, and appar- 
 ently by stimulation of either the nerves as they enter the muscle, the mus- 
 cular tissue itself, or, what seems most probable, those finer fibres in the sub- 
 stance of the spinal cord which Prof. Kolliker seems to believe to be anato- 
 mically the same as sympathetic nerves, and " connected with a distinct kind 
 of function/ 5 
 
 If it be admitted that direct stimulation, or irritation of nervous centres of 
 the spinal cord may cause tetanoid contractions of striated, so-called voluntary 
 muscles, the conception may be of very great importance in the study of the 
 nature of the causes not only of cerebro-spinal meningitis, but of all that class 
 of diseases which manifest tetanoid symptoms; such as tetanus itself, hydro- 
 phobia, cholera, etc. The phenomena attendant upon poisoning by strychnia 
 seem to be capable of explanation in accordance with this view. This sub- 
 stabce is absorbed into the blood, and circulates through the tissues. It 
 causes simultaneous tetanoid contractions of different striated muscles supplied 
 with spinal nerves, and when it is excreted from the body, such contractions 
 cease. As stated by most authors, the contractions are probably due to the 
 influence of the drug upon the spinal centres. Dr. Brown-Sequard has ex- 
 pressed the opinion that strychnia ha? the power of stimulating the nervous 
 centres of the spinal cord "independently of the quantity of blood which it 
 contains"! According to Stille, it also augments the tone of the muscular 
 coat of the bowels and bladder. "In like manner it is reported to excite uter- 
 ine contractions." | It appears, therefore, to act upon the non-striated as well 
 as the striated muscular tissue. If the direct irritation of the spinal centres, 
 by substances iu the blood, can cause action of striated muscles supplied with 
 nerves from that source, similar to that caused in non-striated muscles by irri- 
 tation of the sympathetic nerves of the part, then the fact is entirely in har- 
 mony with the view of Kolliker, that the nerves in the two situations are 
 anatomically the same, and we would expect that substances capable of acting 
 upon non-striated muscles through the sympathetic nerves, if applied as a 
 blood poison would be, directly to the cerbro-spinal centres, would produce 
 
 ♦Kolliker's "Microscopical Anatomy, 11 p. 428. 
 t Stille Therap. & Materia Medica, Vol. II., p. 151. 
 Stille Therap. & Materia Medica, Vol. II., p. 152. 
 
 20 
 
154 STATE BOAED OP HEALTH-REPORT OF SECRETARY. 
 
 somewhat similar effects in the striated muscles supplied with nerves from the 
 cerebro-spinal centres. 
 
 But, of the post-mortem appearances in poisoning by strychnia, "congestion 
 of the membranes of the brain and spinal marrow is probably the most com- 
 mon," * and the tetanic contractions may be largely due to mechanical pressure 
 and irritation of the nervous tissue. 
 
 It seems proper to look for the cause of the tetanoid contractions in cerebro- 
 spinal meningitis among those agents which have been known to produce such 
 results. There is no evidence that it is due to strychnia. There is evidence 
 that leads to the belief that cold is a factor, but it also seems probable that it 
 is only a factor, and that there is some other cause, and perhaps a more im- 
 portant one. Next to the two just mentioned, one of the most powerful 
 causes of contraction in non-striated muscular tissue is ergot. If given in 
 sufficient quantity, and continued sufficiently long, may not ergot stimulate to 
 contraction voluntary as well as involuntary muscles? May it not act upon 
 the cerebro-spinal nervous centres in the same way that it is known to act upon 
 the sympathetic and vaso-motor nerves ? f For our present purposes an affirm- 
 ative answer to this question is not essential, for congestion of the spinal cord 
 is usually found in all of these diseases in which tetanoid contractions occur, 
 and this, in my opinion, may be caused by the direct action of ergot, as will 
 perhaps appear in another part of this paper. That ergot does cause contrac- 
 tion of the non-striated muscular tissue there can be no doubt. Dr. H. 0. 
 Hitchcock, President of this Board, says: "I venture this proposition, viz.: 
 4 the physiological action of ergot is upon the lanstriped muscular fibre 
 wherever found, to produce tonicity and contraction therein.'" \ 
 
 Dr. Stille says: "We have elsewhere (Vol. I., p. 782) directed attention to 
 the grounds upon which Dr. Brown-Sequard explains the curative power of 
 ergot in certain cases of spinal paralysis. This eminent physiologist has 
 shown that by its power of causing contraction in the unstriped muscular 
 fibres of the arteries it limits the afflux of blood to the parts upon which the 
 medicine specifically acts, and in the present case diminishes the amount of 
 blood in the spinal cord and its membranes." || This last statement may re- 
 quire modification, because of the thinness of the muscular walls of the 
 blood-vessels in that part. 
 
 Dr. Hammond says : 
 
 "The action of the ergot is to lessen the diameter of the blood-vessels of the 
 cord by its constringing power over the organic muscular fibre entering into 
 the composition of their walls. Ten years ago I spoke as follows : * But I 
 have recently ascertained by actual experiment that ergot does exert the influ- 
 ence in question. I prepared a weak aqueous infusion of this substance, and 
 placed it on the web of a frog's foot, under the microscope. In a few moments 
 contraction of the capillaries ensued, and they became so small as not to allow 
 of the passage of the blood-corpuscles. This experiment I have repeated sev- 
 eral times, and I am perfectly satisfied that the result is as I have stated. 
 More, I have frequently injected small quantities of the infusion into the 
 stomach of frogs, and contraction of the capillaries of the web always fol- 
 lowed."^ 
 
 * Taylor's Prin. & Practice of Medical Jurisprudence, Vol. I., p. 406. 
 
 t See page 621, Vol. II., Stille Therap. & Mat. Medica. 
 
 $ Peninsular Med. Journal, Oct., 15*74, p. 485, 
 
 B Stille's Therapeutics and Materia Medica, Vol. II., p. 628. 
 
 § Diseases of the Nervous System, by Wm. A. Hammond, M. D., pp. 892-S. 
 
CEREBROSPINAL MENINGITIS. 155 
 
 Here we have direct proof of the action of ergot upon the non-striated tis- 
 sue of the blood-vessels. 
 
 "In its operation upon the pregnant uterus, it produces a constant, unremit- 
 ting contraction and rigidity, rather than that alternation of spasmodic effort 
 and relaxation which is observable in the natural process of labor." * 
 
 In this city, a few years since, expulsion of an immature foetus was caused 
 by the use of ergot alone, there being good reason to believe that no other 
 cause contributed to the result. 
 
 " Dr. Henschel reports a case in the New York Medical Record for Septem- 
 ber 1, 1874, where thirty minims of Squibb's fluid extract of ergot were given 
 by mistake to an infant. Soon afterward there were severe abdominal pains, 
 recurring every fifteen minutes, and lasting hardly sixty seconds. There were 
 slight tetanic contractions of muscles of face and extremities. Diarrhoea set 
 in four hours after administration, and continued fourteen days." f 
 
 There is also other evidence that the action of ergot is not confined to nou- 
 striated muscular tissue, but is capable of causing convulsions of the entire 
 body. From Cyclopedia of Practical Medicine, 1845, Vol. IV., p. 456, 1 quote 
 as follows: "When the ergot is exhibited to man in a dose of about two 
 drachms, the symptoms usually produced by it are vertigo, headache, suffusion 
 of face, nausea, succeeded by vomiting and purging, spasms of the stomach 
 and intestines, and an universal feeling of debility and fatigue. If gradually 
 introduced into the system, as occurs to those who have used for a consider- 
 able time rye meal impregnated with it, the effects are materially different, and 
 of a two-fold description. Either a convulsive disorder is established or the 
 disease usually known under the name of dry gangrene. The former begins 
 with dimness of sight, giddiness, and insensibility, symptoms which are quickly 
 succeeded by frightful convulsions of the entire body. I In this severe form the 
 disease proves rapidly fatal; but in milder cases the convulsions occur only in 
 paroxysms,|| and in the intervals the chief indication of disease which pre- 
 sents itself is an extreme voracity of appetite. This voracity either terminates 
 in death, preceded by coma and convulsions, or in recovery afcer the previous 
 appearance of anasarca, diarrhoea, cutaneous eruptions f X or abscesses in differ- 
 ent parts of the body." 
 
 A CASE OF TETANUS FOLLOWING THE USE OF ERGOT. 
 
 In the Am. Med. Times, May 9, 1863, a case of puerperal tetanus is reported. 
 Just after an attack of mumps the patient had a miscarriage, being three 
 months pregnant. She had hemorrhage, for which 10 drops of fluid ext. of 
 ergot were given every four hours. The hemorrhage ceased, but after three 
 days, during which it seems the ergot was continued, she felt stiffness of the 
 jaws, followed by difficulty of swallowing, and the head was occasionally drawn 
 back in tonic spasm. She died about three days after the attack. 
 
 FATAL POISONING BY BRGOTIZED GRAIN. 
 
 " A case of acute poisoning from ergot is recorded by Dr. Pratschke, in 
 which uneasiness in the head, oppression of stomach, diarrhoea, urgent thirst 
 
 * U. S. Dispensatory, p. 370. 
 
 t The Cincinnati Lancet and Observer, Nov., 1874, p. 704. 
 
 % Italics mine. 
 
 | May not the distinction usually made between clonic and tonic spasms be only one of difference of 
 degree ; the clonic spasm resulting from an excitation less than that which causes tonic or tetanoid maacalar 
 contraction ? 
 
156 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 burning pains in the feet, tetanic spasms, violent convulsions, and death ensned 
 from eating freely of ergotized grain (Lond. Med. Gaz., Oct., 1850, p. 579)".* 
 
 The following instance of ergot poisoning is taken from The American 
 Journal of Medical Sciences of 1868, Vol. LVL, p. 577 : 
 
 Poisoning from Eating Bread Containing Ergot— "Dr. Flinzer (Von Horn's 
 Vjschr. f. Gess. VIIL, 1868) states that the entire family of a farmer, consist- 
 ing, with his laborers, of over ten persons in all, after partaking of bread con- 
 taining a large portion, say one-tenth, of ergoted rye, sickened. The symp- 
 toms were at first debility, giddiness, and loss of appetite; subsequently were 
 added a feeling of distress, a creeping sensation in the hands and feet, tonic 
 contractions of the extremities, profuse sweating, great thirst, and diarrhoea. 
 A pregnant female was brought to bed five weeks before her proper time. Two 
 of the patients died, but the fact became known too late to allow of an 
 autopsy being made." 
 
 Speaking of ergotism, Prof. Gross says : "In this country I am not aware 
 that it has ever been noticed in the human subject. It is said, however, to 
 have prevailed extensively among the horned cattle of Chester county, in this 
 State, in 1819, and in the following year in Orange county, New York, in con- 
 sequence, as was supposed, of the free use of the green grass, the poa viridis f 
 the seeds of which were affected with ergot." f 
 
 From "The Half- Yearly Abstract of the Medical Sciences" of 1869-70, 
 Vol. LI., p. 100 we extract the following : 
 
 CASE OF POISONING BY ERGOT. 
 (By O. S. Oldbright, M. D., in Canadian Medical Journal, March}) 
 
 "In the case related by Dr. Oldbright, the ergot was given three days after 
 delivery, to control secondary hemorrhage. The loss of flooding was very 
 slight. About two hours or more after the administration of the ergot the 
 patient began to feel a tingling in the fingers and feet, cramps in the legs, 
 arms, and chest, dizziness, and weakness. The pupils became dilated, and the 
 pulse very small, and, if memory serves, accelerated ; at the same time a feel- 
 ing of coldness was complained of. Stimulants and warmth were applied. In 
 about an hour the symptoms gradually subsided, and all went on well for a 
 few hours, when the same symptoms recurred, but with greater intensity. 
 Stimulants were again administered. Heat was applied to the surface of the 
 body by means of extra bed-clothes, hot bottles, and flannels dipped in hot 
 water. This was continued for two or three hours, and it was not till the end 
 of that time that the slightest diaphoresis, or even a good glow of heat was in- 
 duced. Then the face and head suddenly became intensely congested, being of 
 a purplish-red color. Pain was felt in the head, and the patient seemed much 
 excited and confused. A brother practitioner was called in, and it being 
 feared that convulsions would occur, cold cloths were applied to the head. 
 This intense engorgement gradually subsided, but the congestion continued 
 for two or three days, as manifested by pain in the head, photobia, etc. 
 Another symptom which was noticed was a diarrhoea, in which the stools were 
 of a dark gray color, looked as though meal had been stirred through them, 
 and had a peculiarly sickly, indescribable odor. They were accompanied by 
 
 * U. S. Dispensatory, p. 870. 
 
 i Gross' System of Surgery, Vol. 1., p. 209. 
 
 1 Abstract of a paper read before the Medical Section of the Canadian Institute, Toronto, Feb. 4, 18TQ. 
 
CEREBROSPINAL MENINGITIS. 157 
 
 griping pains. This condition of the bowels was noticed in another case, 
 occurring a few months after, where ergot had been given. Here, also, there 
 had been a good deal of weakness, and a continual recurrence of faintness, but 
 this was atributed to loss of blood during labor and before it, the case having 
 been almost one of placenta praevia." 
 
 " After alluding to two other cases, not so well marked as that given above, 
 however, of which he had been informed by other medical men, Dr. Old bright 
 dwelt briefly upon the modus operandi of ergot in these cases. Wood, in his 
 Materia Medica and Dispensatory, teaches that it is a direct depressant, par- 
 tially paralyzing the heart and the capillaries. Dr. Oldbright did not feel pre- 
 pared to go very deeply into the question, but it seemed to him probable that 
 its primary action is excitant to the special and sympathetic portions of the 
 nervous system, exciting muscular contraction and increased tonicity of 
 musculo-fibrous and fibrous tissues. Hence the spasms which it causes. In 
 this way it could diminish the calibre of the arteries and capillaries, whilst it 
 would impede (and here we must remember how continuous and unremitting 
 is its action on the womb), the action of the heart, keeping it in a condition of 
 continuous partial contraction. This causes starvation of the brain (as well as 
 of the other parts), and at once brings on the second stage, — faintness, vertigo, 
 etc., etc. This is soon followed by the third stage of reaction and congestion 
 of the brain." 
 
 "Amongst a number of arguments the following were adduced: It is in- 
 consistent to attribute to the same drug the power of directly exciting muscular 
 action in one organ, and of directly paralyzing others. Dr. Wood himself con- 
 fesses, when speaking of the recommendation ergot has received in paraplegia 
 and paralytic conditions of the bladder, that its ' applicability in these cases 
 would scarcely be inferred from anything that is known (according to his 
 theory) of its physiological effects.' This points to a power of inducing mus- 
 cular action : so, also, do the cramps in the legs, chest, etc., which he does not 
 explain. Again, paralysis of the capillaries would not, as Dr. Wood asserts, 
 arrest hemorrhage. He takes it for granted that the capillaries have, in se, the 
 power of propelling the blood." 
 
 ANIMALS SOMETIMES HAVE CEREBRO-SPINAL MENINGITIS. 
 
 During the epidemic at Petersburg I did not learn of any case of the disease 
 affecting the lower animals, but in other localities it has done so. Dr. Upham 
 of Massachusetts says: "Returns from Boston, Brighton, Charlestown, Fall 
 River, Lynn, Newton, Stockbridge, Wakefield, and Worcester, all speak of the 
 existence of the disease, to a greater or less extent, among animals. Horses 
 and cows appear to have been most often affected; after that hens and chick- 
 ens, and in some instances dogs and cats." * * * " Dr. 0. H. Flagg, a well- 
 informed and reliable veterinary surgeon of New Bedford, writes as follows : 
 ' Since the first of January sixteen cases of the so-called cerebro-spinal menin- 
 gitis have come under my observation and treatment. Of these, fifteen were 
 horses, and one a calf four months old." * Dr. Flagg gives the symptoms and 
 post-mortem appearances, which are similar to those in the human body. 
 
 " Dr. Robert Law of Dublin, in reporting several sporadic eases of cerebro- 
 spinal meningitis, observed by him in 1865, writes: 'It is a fact worthy of 
 recording, that at the time we were attending this lady [suffering from cerebro- 
 
 ♦Beport StaU Board of Health, Masa., 18U, p. 809. 
 
158 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 spinal meningitis] nine rabbits out of eleven, which her son had, died all in 
 the same way ; their limbs seemed to fail them, they fell on their side, and 
 then worked in convulsions, and died. Two hens fell lifeless from their 
 roost.' Three of the rabbits were examined ; in two there was congestion of 
 the vessels of the base of the brain, and in the other vascularity of the mem- 
 branes of the spinal marrow (Dub. Jour, of Med. Scu, May, 1866)"* 
 
 "It is a noteworthy fact, that during the past eighteen months a very fatal 
 purpuric disease has been rife among pigs in Dublin. Dr. Mapother thinks that 
 there is much resemblance between this epizootic and human purple fever. 
 Mr. Hugh Ferguson, the veterinary officer of the Privy Council for Ireland, 
 states that l purples' among pigs was very prevalent during 1846, when cerebro- 
 spinal meningitis was epidemic at Dublin and Belfast"! 
 
 ACTIOS - OF ERGOT OX ANIMALS. 
 
 "Several experimenters have called attention to the remarkable aversion 
 shown by dogs to food containing ergot. Tessier says they would rather die of 
 hunger than eat it. Gross found it impossible to make them retain any of it 
 except by fastening the mouth, and even then a portion of it would be vomited 
 through the nostrils. Wright, in his numerous experiments, introduced the 
 medicine into the stomach through a gum-elastic tube. Diez noted as its 
 principal effects profuse salivation, vomiting, dilatation of the pupils, hurried 
 breathing, frequent pulse, cries, trembling, staggering, paraplegia, sometimes 
 diarrhoea, sometimes constipation, prostration, urgent thirst, convulsions, and 
 death. Similar symptoms were observed by Wright. (Ed. Med. and Surg. 
 Jour., LIIL, 319.) This experimenter injected a strong infusion of ergot into 
 the jugular veins of dogs. The symptoms were dilated pupils, a rapid pulse, 
 convulsions, and flaccidity of the limbs followed by their tetanic rigidity, which 
 continued after death. When a weaker infusion was employed, it caused great 
 temporary excitement, followed by depression. A still more diluted preparation 
 seemed to exhaust life by a progressive seductive operation. Similar results 
 ensued when the solution was thrown into the peritoneal cavity. The more 
 gradual action of ergot upon dogs was shown by Wright. He mixed from one 
 to two ounces a day with the animal's food, and produced its death in the 
 course of six or seven weeks. The succession of symptoms may be thus 
 described. An immediate but temporary effect was shown by weakness of the 
 hinder legs and dullness of vision, but day after day the animals grew duller, 
 suffered from thirst, loss of appetite, and dryness of the notrils. Then paralysis 
 and anaesthesia of the hinder legs became more evident, the flesh wasted, acrid 
 tears destroyed the hairs upon the face, sight and hearing failed, the heart was 
 slow and feeble, the breath fetid, the stools and urine passed involuntarily, and 
 death took place by exhaustion. The muscles were found, on dissection, to be 
 pale and flabby, the heart was fall of dark blood, the bronchial lining mem- 
 brane and trachea were bathed in pus, the mucous membrane of the small 
 intestine was injected. Tubercles were found in the lungs in some cases, and 
 in some there were purulent collections in the joints." 
 
 " In Tessier's experiments, ergot was mixed with the food of pigs. (Revue 
 Med., XLIIL, 140.) They showed a reluctance to eat it. Its first effects were 
 redness of the eyes and ears; the latter organs and the limbs then grew cold, 
 
 * Qnoted from Aitkin's Sci. and Prac. of Med., Vol. II, p. 456. 
 
 t Quoted from the Half-Yearly Abstract of the Med. Sciences, July to Dec, 1867, page 15, being an abstract 
 of a paper read before Epidemiological Soc. of Dublin, by E. D. Mapother, M. D. 
 
CEREBROSPINAL MENINGITIS. 159 
 
 the joints swelled, gangrene attacked the ears, limbs, and tail, and the animals 
 died in convulsions. One of them, six months old, lived for sixty-six days. Its 
 intestines are described as having been inflamed and gangrenous." 
 
 " Parola (Annales de Therap., ii, 89) gave from half an ounce to two ounces 
 daily to a mule. From the second day the pulse fell, the heart grew feeble, 
 irregular, and jerking, the breathing low and deep; the appetite and flesh 
 failed; tremulonsness, a staggering gait, and dullness succeeded, * * ." 
 
 " The action of ergot upon birdsis much more distinct and decided. Bonjean 
 (Traite Theoreque et pratique de V Ergot de Seiqle, Paris, 1845) gave two 
 drachms daily of powdered ergot to codes and hens. About the seventh day 
 they became dull, languid, without appetite, and were effected with diarrhoea. 
 In some cases the comb grew cold, blue, flaccid, and covered with ecchymoses ; 
 in others it was ulcerated. Black blood flowed from the nostrils, the animals 
 were unable to walk, their breathing grew slower, and emaciation and death 
 followed. In other cases the plumage was shed, and the beak and claws were 
 surrounded by a bluish circle. The experiments of Tessier on ducks (Revue 
 Med., XLIIL, 138) furnished results almost identical with these; and in a tur- 
 key the symptoms were precisely like those just described. Gross, of Breslau 
 (Cantatas Jahresbericht, 1845, p. 255) gave ergot, or else bread that contained 
 either it or ergotin, to pigeons. At first they were disposed to vomit, but in 
 the course of two or three days showed an increased appetite. This, however, 
 was followed by dullness, restlessness, or immobility, convulsive twitches of the 
 muscles, diminished action of the heart and lungs, and death between the 
 fourth and seventh day.* 
 
 Similar effects were produced in fowls and small birds, such as linnets and 
 sparrows, the former of which died within forty-eight hours after eating fifteen 
 or twenty spurs of ergot." 
 
 a Bonjean gave three drachms of the oil of ergot to a rabbit ; it appeared 
 distressed and feeble, and was afterwards convulsed with opisthotonos."* 
 
 To birds it generally proved fatal, but first produced symptoms of narcotism. 
 Six drachm doses were not fatal to dogs, but occasioned in one case spasmodic 
 symptoms, and in another only nausea and drowsiness. The earlier experi- 
 ments of Wright with oil of ergot gave similar results to these." 
 
 " The lesions produced in animals by chronic ergotic poisoning may be thus 
 summarily described. The venous system is engorged. f In poultry, the gene- 
 ral color of the comb and wattles is purplish, with small blackish points, and 
 the edges of these appendages are always quite black, and sometimes also hard 
 and brittle. The gastro-intestinal mucous membrane is usually injected, par- 
 ticularly at its upper portion,! sometimes softened, and occasionally ulcerated 
 and gangrenous. In birds, the gizzard is soft and vascular; the liver is gene- 
 rally enlarged and its consistence is sometimes diminished; the meningeal ves- 
 sels are usually injected, and the brain and spinal marrow, in a small proportion 
 of cases, softened ;*f the lungs are congested, and the blood is liquid and black ;f 
 in nearly every case the muscles are rigid for some time after death ; in some 
 instances this condition is permanent, especially in the hinder legs of quad- 
 rupeds." 
 
 " The influence of ergot upon the gravid uterus in animals is not uniform. In 
 some cases it seems to have been purely negative, in others to have destroyed the 
 
 * Italics mine. 
 
 t Compare with cerebro-epinal meningitis. 
 
160 STATE BOARD OF HEALTH-REPORT OF SECRETARY. 
 
 prodnct of conception without producing its expulsion, and in still others, and 
 these are the most numerous, to have caused abortion. Bonjean gave ergot to a 
 female guinea-pig during the early stages of gestation ; abortion was not occa- 
 sioned, nor, indeed any symptoms whatever ; so that the result of the experi- 
 ment was purely negative. {Op. cit., p. 78)" It may be that the lack of 
 uniformity of action upon the uterus was due to the fact that the oil of ergot 
 extracted with ether does not act in that manner, while that part which is left 
 after the oil has been thus abstracted, does act upon the human uterus.* The 
 two observers, Bonjean and Wright, who failed to get any action upon the 
 uterus of animals, were the same who were mentioned as having experimented 
 with the oil of ergot. "The experiments of Wright were to this effect; he 
 mixed ergot with the food of a pregnant rabbit; no tendency to abortion was 
 excited, and in due time six healthy young ones were born. The animal, still 
 kept upon the same food, was again impregnated ; she looked drowsy and 
 moped, the fur grew erect and rough, gestation was protracted beyond its 
 usual term, and three young ones were born, two of which were dead, and the 
 third one survived but a few hours. Subsequently an abcess formed under the 
 lower jaw, the front teeth droped out, pus flowed from the eyes, diuresis and 
 diarrhoea succeeded. In the twelfth week the animal died. The lungs and 
 mesentary were tuberculous, but the intestines were sound. The same experi- 
 menter, after many trials of ergot upon pregnant bitches, concluded that it did 
 not act as a parturifacient in them, although it sometimes appeared to injure 
 or destroy the product of conception." 
 
 " On the other hand, according to Diez, it produced abortion in ditches and 
 in guinea-pigs without harm to the mother or the young, when the dose was 
 moderate; but large doges destroyed both, and excited inflammation of the 
 womb. In 1825, Dr. Oslere gave ergot to a sow, a cow, and a cat, before the 
 completion of pregnancy, and in each case produced abortion (Phila. Jour, of 
 Med. and Phys. Sci., XI. 106). In 1841 an epidemic of abortion among cows 
 occurred in the neighborhood of Trois Croix, in France, which was traced to 
 the ergotted state of the rye and other gramineae in that district. (Edinb. 
 Month. Jour., Jan., 18J$,p. 73). According to Percey and Laurent, a decoc- 
 tion of ergot injected into the veins of a cow caused the animal to calve 
 speedily." 
 
 ' f The following statement of Youatt shows conclusively that ergot acts upon 
 the uterus of animals in labor precisely as it does in the case of the human 
 female. ' I have for the last six or seven years been in the habit of adminis- 
 tering the ergot of rye to quadrupeds, in cases of difficult or protracted par- 
 turition. . . . In the monogastric, if I may venture to use the term, I have 
 never known it to fail of producing considerable effect, even when the uterus 
 has been previously exhausted by continued and violent efforts. In the 
 ruminant, with its compound stomach or stomachs, I have witnessed many a 
 case of its successful exhibition. . . The uterus has in every case responded ; 
 it has been roused to a greater or less degree of renewed action. (Pereira, 
 Mat. Med., 3d Am. Ed., ii., 137)."f 
 
 ACTION OF ERGOT OK MAN. 
 
 " On Man. — In 1824 Lorinser and several companions took each of them two, 
 drachms of powdered ergot upon bread and butter. The symptoms in all the 
 
 * See last paragraph on pace 621, Vol. II., Stille's Therap. & Mat. Medica. 
 t The foregoing quoted lrom Stille Therap. & Mat. Med., Vol. II., pp. 610-618. 
 
CEREBROSPINAL MENINGITIS. 161 
 
 cases were alike, and consisted of some colic, nausea, and vomiting, salivation, 
 occasionally diarrhoea, and a sense of fulness in the head. (Edinb. Med. 
 and Surg. Journ., XXVL, 453.) Similar effects were obtained by Gross and an 
 associate who each took a drachm of ergot. (Canstatt's Jaliresbericht, 1845, 
 p. 256.) And such also are the symptoms ascribed to the medicine by Raige- 
 Delorrne {Did. de Med., 2eme ed., XVIIL, 271). Trousseau and Maisonneuve, 
 besides the above effects, particularly noticed dilatation of the pupils as the 
 most constant phenomenon. It began within twelve or fourteen hours, and 
 continued for several days. The sight was not affected. Headache and ver- 
 tigo, sometimes so marked as to resemble intoxication, and followed by drowsi- 
 ness, were also observed. (Bull, de TJierap., IV., 106.) Hussa describes sim- 
 ilar symptoms as produced by bread containing a sixth or a fifth part of ergot. 
 The headache generally continued for several days. (Ibid., JAIL, 285.) Bon- 
 jean took a drachm of powdered ergot in three equal doses before breakfast, 
 and found that the symptoms were precisely such as have been described. 
 Other testimony to the same purpose might be adduced, but it is scarcely neces- 
 sary, since the results here cited were so uniform." ***** 
 
 " The power of ergot to lower the pulse is unquestionable. In some experi- 
 ments upon himself, Parola found that his pulse fell from 74 to 60, and from 
 79 to 72 (Annales de Therap., II., 91), and Dr. Quinton Gibbon of New Jersey 
 observed a decline of the pulse in himself from 70 to 57, and in another per- 
 son from 64 to 55. In this case a repetition of the trial produced the same 
 result. Arnal's numerous experiments showed that the action of a drachm of 
 ergot commenced within an hour, and in the course of four hours lowered the 
 pulse from 84 to 62. After allowing for the influence of natural causes, the 
 time of day, rest, etc., it appeared that the pulse was still lowered, on an average, 
 eight beats in a minute. In febrile affections, the influence of the medicine 
 was still more marked, and sometimes the pulse fell 30 and even 36 beats in 
 the course of five hours. The experiment upon the healthy system was four 
 times repeated at intervals of ten days, and uniformly with the same result. 
 (Bull, de Therap., XXXVL, 534.) Bonjean found that a drachm of ergot 
 lowered his pulse from 70 to 60. In parturient females Dr. Hardy observed 
 that within 15 or at most 30 minutes the medicine produced a marked diminu- 
 tion of the pulse, which sometimes continued for several days. {Dublin Journ. 
 of Med. Sci., XXVIL, 225.) Beatty estimated its reduction, under like cir- 
 cumstances, at 20 beats in a minute. According to Bonjean ergoiin reduces 
 the force but not the frequency of the pulse; but Guilland and Arnal state 
 that it does both." 
 
 f * The earliest experiments to illustrate the power of oil of ergot were per- 
 formed by Dr. Charles Hooker of New Haven, in 1831-2. He obtained the 
 oil by macerating ergot for several days in ether, decanting the liquid and 
 evaporating the ether. To a medical student he gave half a drachm at two 
 o'clock P. M., a drachm at three o'clock, and the same quantity at four 
 o'clock. Under the second dose the pulse fell from 82 to 65, and under the 
 third dose to 36 ; and the respiration from 19 to 8. Of the general symptoms, 
 the first was a sense of tightness, followed by an unpleasant, heavy, and con- 
 fused feeling in the head, and nausea like sea-sickness, general languor and 
 lassitude, constant spitting, and vivid flashes of light before the eyes. Under 
 the second dose there was, in addition, painful rigidity of the muscles, lassi- 
 tude, lividity of the skin, dilated pupils, and a heavy countenance.* Under the 
 
 * Compare with Cerebro-Spinal Meaingitis. 
 21 
 
162 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 third dose there was, besides an increase of these symptoms, diuresis. The 
 same phenomena were manifested in another experimenter, and in neither case 
 did they entirely disappear for nearly a week afterwards. For three days the 
 pulse continued under 50, the skin was still dusky, and the muscles sore. 
 When the same oil was given in labor, no influence whatever on the uterus 
 was displayed, but upon the child a very marked impression, as will presently 
 be seen. Dr. Hooker then used the ergot, from which the oil employed in the 
 above experiment had been abstracted, and found that its ecbolic powers were 
 entirely unimpaired. [Post. Med. and Surg. Journal (1834), X., 298.]" 
 
 "If the phenomena here described are compared with those produced upon 
 man by ergot in large doses, it is evident that they are identical, and that the 
 toxical effects of this substance are due entirely to the oil which it contains." 
 
 "Schroff, in his experiments, observed that pure ergo tin in doses of from 
 one-third of a grain to one grain produced fullness of the head, headache, and 
 dilatation of the pupils, followed by colic and infrequency of the pulse. 
 {ReiVs Mat. Med., d. rein, chem., Pflanzenstoffe, p. 166.)" 
 
 "Among the effects of ergot may be noticed those which are occasioned by 
 the use of food containing a large proportion of this substance, and which are 
 included under the general name of ergotism. The records of this disease 
 have been traced back to classical times, but they are more clearly to be recog- 
 nized in the descriptions of epidemics of dry gangrene, one of which was 
 recorded by Sigebert de Gremblour in 1096 ( Goupil, Journ. des Progres, III.. 
 161.) In 1597, a spasmodic disease which was attributed to ergoted rye, pre- 
 vailed in Hesse and the adjacent territories. Epidemics of the same sort 
 occurred in 1648, 1675, 1702, and 1716, in Germany, as well as in Flanders, 
 and in France. In Cologne, a French province where rye is much cultivated, 
 this disease has repeatedly been prevalent. Two forms of the affection have 
 been described, the spasmodic and the gangrenous. (Ozanam, Maladies Epi- 
 dem., IV., 226; Bergen and Muller, nailer's Disputations, I., 78 ; Duvivier de 
 Saint Hubert, Traite Philosophique des Maladies Epidemiques, etc., Paris, 
 1836; Heusinger, Studien uberden Ergotismus, Abstract in Journ. f. Pharma- 
 kodyn, I., 404.)" 
 
 "Spasmodic ergotism begins with malaise, formication of the whole skiu, 
 cramps, and numbness of the extremities, and pains in the head and back. 
 This state lasts from one to three weeks, and ushers in heartburn, epigastric 
 oppression, vertigo, syncope, deafness, paroxysmal or permanent flexure of the 
 joints, or equally violent extension and opisthotonos, twitching of the facial 
 muscles, in some cases violent delirium, with cold skin, intense internal heat, 
 and fetid sweats. The attacks are sometimes preceded by digestive disturb- 
 ance, and last from half an hour to two hours or more. After a time the con- 
 vulsions cease. They are followed by exhaustion, debility, oppression, heart- 
 burn, and a ravenous appetite, which it is dangerous to gratify. Sometimes 
 strabismus or loss of sight succeeds (Meier of Kronstadt has shown that cata- 
 ract is a very usual consequence of chronic ergotism, — see Archives Gen. de 
 Med., Mars., 1863, p. 350), with an eruption of bulla? upon the skin, or general 
 insensibility. After death in fatal cases, the stomach and bowels are found 
 inflamed, and the parenchymatous organs congested. The attack usually lasts 
 for three or four weeks, and is very fatal. In 1735, during an epidemic in 
 Wurtemburg, out of 500 persons attacked, 300 under 15 vears of age per- 
 ished." 
 
 "The gangrenous form of ergotism is quite different from the foregoing. 
 
CEREBROSPINAL MENINGITIS. 163 
 
 The first symptom is a dull pain and weariness of the limbs, with a heavy and 
 stupid expression of countenance. The skin has an earthy or jaundiced hue. 
 The extremity or the nose about to become affected grows quite cold, and the 
 skin over it is of a dusky red color. The gangrenous process generally begins 
 in the central parts of the limb, and afterwards attacks the skin, extending 
 upwards towards the trunk from the fingers and toes, causing these parts to 
 blacken, shrivel, and harden, until they resemble the flesh of a mummy. 
 Sometimes, however, they present the appearance of ordinary gangrene. In 
 either case the finger, the toe, the nose, or even the extremity, separates itself 
 from the body without hemorrhage, leaving a clean wound behind. Some- 
 times the flesh only is thrown off, and the bone has to be divided artificially. 
 Cases are reported in which all four of the extremities were thus lost. Mean- 
 while the digestion is not always deranged, although death is sometimes pre- 
 ceded by diarrhoea. The attack is seldom shorter than three weeks, and in the 
 vast majority of cases is fatal." * 
 
 TWO FORMS OF ERGOTISM. 
 
 It may be well to suggest an explanation of the manner in which ergot may 
 act to produce sometimes spasmodic symptoms and at other times gangrene. 
 It seems to have been proved that the oil extracted from ergot by ether, 
 although it has active properties, does not cause well marked contraction of 
 non-striated muscular tissue, and that what remains of ergot after the oil has 
 been thus abstracted is capable of such action, f 
 
 The active properties of the oil may exist in a volatile acid (ergotic) and a 
 volatile alkaloid (propylamia) extracted with the oil, as the oil itself has been 
 stated to be a fixed oil, and " when procured by expression, this has been found 
 to be inactive." * * " Mr. Wenzell claims to have discovered in it [ergot] 
 two new fixed alkaloids which he proposes to name respectively ecbolina and 
 ergotina, and in which, along with the volatile alkaloid propylamia, the virtues 
 of the medicine reside." J 
 
 Just which "virtues of the medicine" reside in the fixed alkaloids be does 
 not state, but that it is the action upon non-striated muscular tissue, is in 
 accordance with the facts stated above, that the ergot after the oil had been 
 abstracted was still capable of causing contraction of non-striated muscles 
 and the poisonous properties of the oil were due to a volatile acid and alkaloid 
 extracted with the oil. " Mr. "Wright also states that the oil of ergot lowers 
 the pulse and renders it less frequent. It may also be mentioned here that he 
 found the vapor of this preparation [etherial extract of ergot] diffused through 
 the air of a close room produced a tingling sensation in the limbs, distressing 
 lassitude, irritability, and giddiness. {Edinb. Med. & Surg. Journ,, Julv, 1840, 
 p. 51.)" | 
 
 If it be true that certain of the poisonous properties of ergot exist in great 
 part iu the volatile principles, and that to the fixed alkaloids is due the con- 
 tractions of the uterus and non-striated muscles generally, it may be that we 
 have in these facts an explanation of the two kinds of ergotism which have 
 been observed, viz., the spasmodic and the gangrenous ; and that the first 
 named symptoms result more particularly from the volatile, while the gangrene 
 is due to the action of that part of ergot which is left after the volatile por- 
 
 * The foregoing quotations are from Stille's Therapeutics and Materia Medica, Vol. II., pp. 610-610. 
 t Stille's Ther., Vol. II., pp. 612, 614, 615, and 621. 
 % U. S. Dispensatory, 12th Edition, p. 36S. 
 I Stille's Therap., Vol. II,, p. 615. 
 
164 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 tion has been driven off, as, for instance, it might be during the baking of 
 bread. 
 
 More exact observation and analysis of facts are needed, however, before a 
 conclusion can be reached on this point, and the suggestion is offered with a 
 view of stimulating observation and experiment in this direction. 
 
 Dr. Gross says : 
 
 " The manner in which ergot acts in producing this disastrous effect has not 
 been explained. It is very singular that its virulence should explode upon 
 those parts of the body which are most remote from the heart, as the feet and 
 legs, and the corresponding portions of the upper extremities, along with the 
 nose, chin, and ears. I am myself inclined to believe that the primary im- 
 pression of the poison is upon the blood, rendering it abnormally stimulant, 
 and plastic, and the secondary upon the inner coats of the arteries, which, 
 becoming inflamed, thereby intercepts the liquid, and thus leads to the forma- 
 tion of fibrinous clots. In a word, there is reason to believe that mechanical 
 obstruction of the vessels is the direct and immediate cause of gangrene." * 
 
 In speaking of ergot and its action upon the uterus, a writer in Appleton's 
 Cyclopedia says : " Its action has been shown to extend to other organs pos- 
 sessing smooth muscular fibres/' * * "It is probably by this action upon 
 the blood-vessels that the epidemics of ergotism from the use of diseased grains 
 as food have occurred in different parts of Europe. Ergotism assumes two 
 forms, spasmodic and gangrenous, and probably requires for its production not 
 only the poisonous action of ergot but the additional depressing influences of 
 cold,"t etc. 
 
 Noticing, first, that this writer refers both kinds of ergotism to the action of 
 ergot upon non-striated muscular fibre, it maybe remarked, in passing, that he 
 has reached the same conclusion respecting the influence of cold in causing 
 serious illness from ergotism that has been arrived at as regards cerebro-spinal 
 meningitis, in the causation of which cold is also believed to be a factor. 
 
 There is another possible explanation of these two forms of ergotism. If 
 we conclude that the main action of ergot, taken continuously, is that upon 
 non-striated muscular tissue, and suppose persons exposed to this action con- 
 tinuously for a long time without the occurrence of anything to cause a 
 reaction, we must conclude that, whatever other symptoms may present them- 
 selves, there will be a lessened calibre of those blood-vessels which have mus- 
 cular walls, and this may go on to a complete closing of the blood-vessels in 
 certain places, as occurred in the web of the frog's foot experimented upon by 
 Dr. Hammond. J 
 
 Under such circumstances we would expect atrophy, gangrene, or death of 
 such parts as were most poorly supplied with capillaries, and most remote from 
 the heart; and this without supposing any other action than that known to 
 result from the use of ergot. Continuous use of ergot, without reaction, 
 would seem, then, to b© capable of producing the gangrenous form of ergotism. 
 The gangrene is not always of the dry kind, and this may be for the reason 
 that there is congestion and stagnation of blood in the veins, caused by the 
 more forcible contraction of the arteries. 
 
 Now, if in addition to the use of ergot there be some such influence as 
 alternations of heat and cold, and through such means there be temporary in- 
 crease of contraction of capillaries, followed by reaction, equally excessive, it 
 
 * Gross 1 System of Surgery, Vol. I., p. 208. 
 t Appleton's* Cyclopedia, Vol. VI., pp. 708-9. 
 X Diseases of the Nervous System, p. 393. 
 
CEREBROSPINAL MENINGITIS. 165 
 
 seems possible to conceive of the production in this manner of the •' spas- 
 modic ergotism " through disturbance of the capillary circulation in the nerv- 
 ous centres, especially as, though there be capillary congestion from relaxa- 
 tion of striated muscular tissue, the venous congestion may not be removed 
 thereby, because of defective action of the heart, which is known to be influ- 
 enced by ergot. 
 
 This line of thought leads us to consider the question : 
 
 CAN" ERGOT OR A SIMILAR FUNGUS CAUSE CEREBROSPINAL MENINGITIS ? 
 
 If we understand this question to be : Can an inflammation of the cerebral 
 and spinal meninges be caused by such agents? then I think we must reserve 
 final decision until post-mortem examination of a sufficient number of bodies 
 dead from this cause shall disprove or establish the fact ; for, although a very 
 great number of epidemics of ergotism have been recorded and described, I 
 know of no satisfactory record of the post-mortem appearances of the brain 
 and spinal cords of persons dead from ergotism. The experiments of Dr. H. 
 Day of Stafford, England (previously quoted), did not fully establish this point 
 as regards lower animals, although in one rabbit, that died on the eighth day and 
 in the other two killed on the twelfth day, "more or less congestion of the 
 membranes of the spinal cord was found on dissection." The only abnormal 
 appearance which I observed in the membranes of the brain and spinal cord of 
 a cat which died after eating " smut" from the mill at Petersburg, was an un- 
 usual dryness. This has been observed in some cases after death from cerebro- 
 spinal meningitis, and has sometimes been the only abnormal appearance, and 
 it is important to bear in mind that in order to show that the disease in ques- 
 tion may be caused by fungi, or by one special fungus, it is not necessary to 
 prove that the fungus always causes death through inflammation of the 
 meninges of the brain and spinal cord, for in many deaths from this disease 
 post-mortem examination has demonstrated the absence of such inflammation. 
 But that such inflammation does occur in a certain proportion of cases of 
 cerebro-spinal meningitis cannot be denied, and before anything can be accepted 
 as the cause of this disease, it must be shown that it causes the same post- 
 mortem results as well as similar phenomena during life. * 
 
 ERGOTISM COMPARED WITH THIS DISEASE. 
 
 In another place I have given the effects of ergot in doses insufficient to 
 cause death, and remarked that, with a few modifications, the quotation would 
 answer for an account of the symptoms of mild cases of cerebro-spinal menin- 
 gitis. In the following account of an epidemic caused by the use of ergotized 
 grain, one cannot fail to notice the very great similarity to the accounts we 
 have of some epidemics of cerebro-spinal meningitis, especially as regards 
 vertigo, disturbance of sight and hearing, formication, anaesthesia, partial gan- 
 grene, flexure of forearm or arm, convulsions, clonic and tetanic spasms, 
 smallness of pulse, absence of well-marked fever, normal appetite, uncertain 
 length of the disease, slow recovery, and tendency to relapse. 
 
 "In another epidemic, ascribed to the same cause [ergotism], which occurred 
 in Upper Hesse in the year 1855-6, and was described by Dr. Heusinger, the 
 nervous and spasmodic phenomena were predominant, with little tendency to 
 gangrene. Out of 102 persons attacked, 12 died, and these were all under 12 
 years of age. Not a single individual in good circumstances was affected ; but 
 only the miserably poor, who were compelled to live on a damaged crop, in 
 which ergot was proved to exist. The malady generally commenced with ver- 
 
 * For pQst-mcrUm results in animals, see page 159 of this report. 
 
166 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 tigo, and disturbance of sight and hearing, which were followed by formication 
 in the ringers and toes, gradually extending over the body. Spasmodic con- 
 tractions of the muscles soon appeared ; the ringers were firmly flexed, and 
 could be extended only by violence ; the forearm was flexed on the arm, and 
 the hands were pressed against the chest ; and the toes were also flexed, and 
 the ankles and knees strongly drawn inward. The muscles of the abdomen 
 and chest, including the diaphragm, were also contracted, and the patients 
 breathed with difficulty. The muscles of the face participated in the affec- 
 tion, and even those of the glottis, causing paroxysms of violent dyspnoea 
 The uterus, whether pregnant or not, was never attacked with spasm. The 
 formication and the tonic si?asms were often very painful. The pulse was 
 small, the digestion slow, the appetite normal, and in no instance was there 
 fever. In some cases there was a loss of sensation, generally limited to the 
 fingers and toes, but sometimes occupying large extents of surface, or even the 
 whole body. This anaesthesia always followed the contractions, and was some- 
 times itself followed by partial gangrene. The loss of sensibility extended 
 sometimes to sight, hearing, smell, and taste. The malady was usually of a 
 paroxysmal character, with intervals more or less prolonged. In the paroxysms 
 there were sometimes tetanic spasms, epileptiform convulsions, loss of con- 
 sciousness, and delirium of variable duration. The length of the disease was 
 altogether uncertain ; generally it continued several months ; the recovery 
 was slow; and relapses common. When death took place, it was always in a 
 convulsive paroxysm, and by asphyxia. (Ibid., IX., p. 596, Mai, 1857.) 'Note 
 to second edition.'** 
 
 (i The effects produced by the use of spurred rye as an article of food are 
 very various. In some individuals the iufluence of the poisonous ingredient is 
 chiefly exerted on the brain and nervous system, the most remarkable symp- 
 toms being vertigo, dimness of sight, pain, loss of sensibility, cramps and con- 
 vulsions, yellow discoloration of the skin, thirst, and feeble pulse. These 
 symptoms are greatly modified in degree in different individuals, and are 
 sometimes slow and afc other times very rapid in their progress. In the most 
 acute form of the disease death may take place at the end of one or two days, 
 preceded by dreadful cramps and convulsions of the whole body. Even in the 
 milder cases, the convulsions are more or less severe towards the fatal termina- 
 tion of the disease ; and hence this form of the disease is called convulsive 
 ergotism by French writers, and is vulgarly denominated in Germany Kriebel- 
 Jcranheit, or creeping sickness. In other individuals placed apparently in sim- 
 ilar circumstances, the most remarkable effect which follows the operation of 
 the same septic agent is gangrene or sphacelus of certain parts of the body. 
 Hence this form of the disease has received the name of gangrenous ergot- 
 ism, necrosis ustilaginea, seu epidemical * * * 
 
 "Lang, who observed the gangrenous ergotism in Lucerne, Zurich, and 
 Berne, says that the disease commenced with lassitude and a sensation as of 
 insects creeping under the skin, without fever. Soon after, the extremities 
 became cold, pale, wrinkled, and benumbed, and at last quite insensible and 
 incapable of motion ; afterwards acute pain was felt, referable to the central 
 parts of the limbs, which was exasperated by heat and mitigated by cold appli- 
 cations; there was then, also, fever and headache; the pain extended from the 
 hands and feet to the shoulders, legs, and thighs; and lastly, the affected parts 
 became dry, shrunk, and black, and dropped off at the joints. Entire extrem- 
 
 * Wood's Therapeutics and Pharmacology, third edition, Vol. II., p. 722. 
 
CEREBRO-SPINAL MENINGITIS. 167 
 
 ities were thus separated from the body without hemorrhage. Many patients 
 lost both legs, several the arms, and a few both legs and arms. (Descriptio 
 morborum ex usu clavorum secalinorum cum pane, 1707.) In other cases, the 
 chief symptoms were, at first, spasmodic contractions of the limbs, afterwards 
 great weakness of mind, voracity, and dyspepsia, which generally terminated 
 in fatuity or sphacelus. (Rust's Magazine, XXV., to which the reader is re- 
 ferred for a detailed account of the local and general effect of spurred rye.) 
 The parts most frequently attacked with gangrenous ergotism are the inferior 
 extremities. Men are more subject to the disease than women, and children 
 and old people than adults." * * * 
 
 " All these local changes appear to be produced as direct consequences of the 
 spurred rye, acting through the medium of the blood or nervous system, or 
 both at the same time. For we have seen that the dead parts are separated 
 without hemorrhage, and it is stated that the blood, when taken from a vein, 
 is dark and so very thick that it only oozes out from the orifice of the 
 wound." f 
 
 " The attention of the profession was first directed to the subject in a 
 prominent manner in 1676, by Mons. Dodard, a French physician, and since 
 then it has been frequently noticed by other writers. For a long time doubts 
 were entertained respecting the power of ergot to produce this effect, and in 
 order to solve these, Mons. Tessier of Paris was commissioned, many years ago, 
 by the Eoyal Academy of Medicine, to investigate the matter experimentally 
 For this purpose he selected various animals, especially pigs, ducks, and tur-. 
 keys, which he fed exclusively upon ergot; he found that most of them 
 died between the tenth and twenty-fourth day, aud that distinct marks of 
 mortification existed in all, both externally and internally." J 
 
 Mr. W. T. Wenzell, of LaCrosse, Wisconsin, has investigated the properties 
 of two alkaloids which he isolated from ergot and named "ecbolina" and 
 "ergotina." || From "ecbolina" in the dose of one-half grain, equivalent to 
 thirty grains of ergot, he experienced the following effects: " The functions 
 of the brain were excited to a species of intoxication, in which participated the 
 muscular system, causing involuntary contractions of the muscles, soon fol- 
 lowed by nausea, loss of appetite, a sense of weight and shooting pains through 
 the head, stiffness and soreness of the muscles of the neck and extremities, a 
 creeping sensation along the spine." a * * * "The pulse was not materially 
 affected until the stage of debility supervened, when the pulse fell about four 
 beats per minute." 
 
 "Mr. W. gave a physician a solution of the chlorate of ecbolina to test its 
 medicinal qualities in uterine hemorrhage and in parturition. * * " From 
 the symptoms produced in the doses I had directed him to give, he was com- 
 pelled to lay it aside, from the energetic and poisonous action it evinced, caus- 
 ing great nausea, with distressing vomiting and intense headache. He thinks 
 the ecbolina to be a powerful agent." § 
 
 GANGBENE ACCOMPANYING CEREBRO-SPINAL MENINGITIS. 
 
 Dr. Henry Wyman of Blissfield, Mich., tells me of an epidemic of cerebro- 
 spinal meningitis wdiich occurred in Madison Co., Ind., in 1848. Out of 
 twelve cases four died. In many cases the arms were flexed, as were the lower 
 
 a Compare with Cerebro-Spinal Meningitis*. 
 
 t Cyclopedia of Practical Medicine, 1845, Vol. III., pp. 3C1. 3C2. 
 
 % Gross' System of Surgery, Vol. 1., pp. 20S-0. 
 
 II Am. Jour. Pharm., May, 1864. 
 
 § Quoted from Am. Jour. Med. Sci., Jnlr, 18G1. pp. 27S, 279. 
 
168 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 limbs in two cases. There was coma at first, followed by rigidity of the 
 muscles; opisthotonos on the third day; convalescence in about five days. 
 It was a spring following a winter of unusual sickness. During the preva- 
 lence of meningitis the usual cases of remittents and intermittents were 
 scarce. There was a case of dry gangrene within three miles of the cases of 
 meningitis. It occurred in February. Two other cases of gangrene occurred 
 in March. He thinks there was black rust on the wheat the previous year. 
 
 In the St. Louis Medical and Surgical Journal for May and June, 1865, 
 Dr. T. F. Prewitt, in speaking of cases of this disease, says: "In one, a 
 woman aged about 50, there were large livid-looking bullae upon the feet." * 
 
 Speaking of the various eruptions attending certain cases of epidemic men- 
 ingitis, Dr. Alfred Stille says : " In some cases gangrene of the skin has been 
 noticed where the spots have been peculiarly dark, and occasionally, as in 
 typhus, from prolonged pressure." f 
 
 In a "Report of five cases of cerebro-spinal meningitis, by Henry Gray 
 Croly, F.R, 0. S.I. (Medical Press and Circular, June 5)," a case is mentioned 
 where "black spots became larger, and before death were continuous on his 
 arms, like gangrene." % 
 
 In speaking of the gangrenous form of ergotism, Prof. Gross says : " The 
 constitutional symptoms vary, being at one time very slight, at another excess- 
 ive; in general, however, the patient is tormented with fever, thirst, restless- 
 ness, and high delirium. Under favorable circumstances \ ulcerative action is 
 set up, and this, gradually progressing, at length eventuates in spontaneous 
 amputation of the sphacelated structures." § 
 
 Concerning an epidemic of " Cerebro-Spmal Typhus," in Ireland, it is said 
 (Med. Times and Gazette, May 25, 1867) that "in some cases of recovery, or 
 in those in which life has been sufficiently prolonged for the maturation of the 
 morbific action, or rather for nature to exhibit the process by which she strug- 
 gles to eliminate the zymotic poison from the system, the livid ecchymosed 
 spots take on a gaugrenous action, thereby producing a degree of constitutional 
 irritation, under which many of the cases succumb."J 
 
 In the second case of the epidemic of this disease at Petersburg — Charles 
 Boone — the skin over the course of the sciatic nerve of the left leg was 
 discolored, and looked as if about to take on gangrenous action. In this case 
 it could hardly be the result of pressure, as it was not over the points of great- 
 est pressure, but was a band of considerable width, extending down the back 
 of the limb towards the knee joint. 
 
 DISEASES OF THE EYE II* CEREBRO-SPIKAL MEKINGITIS, COMPARED WITH 
 SUCH DISEASES CAUSED BY ERGOT. 
 
 In this epidemic I was told of a little girl about three years of age, that had 
 " sore eyes, the pupils were dilated; she was blind from some internal cause." 
 She recovered from the disease and also recovered her sight. "Dr. Geo. 
 Fletcher, of Lima, Ind., says that in one case which recovered, the patient 
 lost permanently the use of one eye, there being complete amaurosis."!" 
 
 * Am. Jour. Med. Sci., Jul}-, 1865, p. 279. 
 
 t Scille's " Epidemic Meningitis, or Cerebro-Spinal Meningitis," p. 6T. 
 % Half-yearly Aba't of the Med. Sci., July to Dec, 1S67, pp. 19, 21. 
 !! Italics mine. 
 
 § Gross 1 System of Surgery, Vol. T., p. 209. 
 
 T Dr. E. W. Jenks, in Buffalo Med. and Surg. Jour., Oct.. 1803. quoted from Am. Jour. Med. Sci., Jan., 18C4, 
 p. 250. 
 
aEKEBRO-SPINAL MENINGITIS. 160 
 
 Speaking of the course of cerebrospinal meningitis, Dr. Meredith Clymer 
 says: "Blindness may happen as an early, almost initial symptom, lasting 
 from a few hours to several days, though Jenks reports a case of permanent 
 loss of sight. Purulent ophthalmia, softening and ulceration of the cornea, 
 choroiditis, hypopion, opacity of the vitreous humor, and posterior synechia 
 may happen, or even rapid destruction of the globe " * 
 
 Stellwag says: "In some cases there is only a severe catarrhal conjunctiv- 
 itis, which subsequently may be connected with ulceration of the cornea, and 
 thus possibly destroy the eye. In other cases the ophthalmia has from the 
 outset the character of a suppurative iridio-ehoroiditis, and is developed with 
 severe inflammatory symptoms, intense redness, swelling of the conjunctiva 
 and lids, which also quickly leads to adhesion of the papillary margin to the 
 anterior capsule, and causes large purulent products, which are partly exuded 
 into the anterior chamber as a hypopion, and partly infiltrate the vitreous 
 humor, especially its anterior portion, while the greater impairment, or entire 
 loss of vision, announces the internal participation of the retina, choroid, or 
 optic nerve. The infiltration of the vitreous is betrayed by a very marked 
 bright yellow reflex, which evidently proceeds from a thick opacity lying 
 immediately upon the posterior surface of the lens, and which, from its want 
 of vessels, may be plainly distinguished from a detached portion of retina 
 lying upon the crystalline body. Such suppurative inflammations of the eye 
 have been seen in meningitis in various stages of the disease, the occurrence 
 of which is explained by the extension of the proliferate processes along the 
 sheath of the nerves. Pathological examinations support this view." 
 
 "Sometimes an opthalmia, in the course of a case of epidemic cerebro-spinal 
 meningitis, has the character of a metastatic process." 
 
 "Atrophy is the ordinary result of suppurative choroiditis in epidemic 
 cerebro-spinal meningitis, and is often evident at an early period by a marked 
 softness of the globe. As a further consequence, suppurative perforation and 
 phthisis of the globe have been seen/'f 
 
 Dr. Moreau Morris says: Purulent opthalmia; softening and ulceration 
 of the cornea; choroiditis and opacity of the vitreous humor, not unfrequently 
 are subsequent symptoms or affections." \ 
 
 PRODUCTION OF LENTICULAR CATARACT BY THE USE OF ERGOT OF RYE. 
 
 Abstract of a Paper by Dr. Ignaz Meier of Kronstadt. 
 
 " The consequences of the chronic intoxication by ergot of rye produced by 
 the continued use of impure cereals (ergotismus convulsivus and gangriinosus) 
 are, as is well known, nervous diseases of various kinds, contractures, anaesthe- 
 sia, and alterations of the sensitive organs. The author has observed that 
 ergotism (raphania) is also the cause of cataract. In 1857 the disease pre- 
 vailed in the southeastern part of Seibenbiirgen, Austria, the uncommon wet- 
 ness of the summer having produced a great frequency of ergotic rye. Two 
 hundred and eighty-three individuals were attacked in six towns, ninety- 
 eight of whom died. The symptoms of chronic intoxication were in the 
 beginning gastric affections, loss of appetite, nausea, diarrhoea, or constipation, 
 and after that a creeping sensation, and a kind of torpor of the limbs ; finally 
 cramps. Permanent contractions of the feet the author saw as the conse- 
 
 * Meredith Clymer's Cerebro-Spinal Meningitis, p. 21. 
 
 •\ Treatise on Diseases of the Eye, Roosa's and Hackley's translation : New York, 2d ed., 1871. Quoted in 
 •'Cerebro-Spinal Meningitis," bv Meredith Clymer, M. D. 
 $ Report of Board of Health of New York City, 1871, p. 351. 
 
170 STATE BOARD OF HEALTH-REPORT OF SECRETARY. 
 
 quence of the latter. The pupils were generally dilated, the nails bluish, the 
 skin yellowish or whitish, the temperature of the surface of the body low. 
 The elimination of worms was not observed, nor the occurrence of abortion 
 in pregnant women. The consecutive diseases were, in those more seriously 
 affected, typhus fever, vertigo, amblyopia, or even amaurosis, impairment of 
 hearing, difficulty of speech, insanity or idiocy, epilepsy, periodic fits of laugh- 
 ter, and debility. 
 
 " The inhabitants of the district live very poorly, and are much devoted to 
 the abuse of alcohol. The majority of the patients were young. In one hun- 
 dred and thirty-three cases the age was recorded, and it was found that twenty- 
 five were from 1—10, thirty-one from 11—20, thirty-seven from 20—30, sixteen 
 from 31— 40, eleven from 41 — 50, nine from 51—60, four from 61 —70 years. 
 Death mostly occurred in younger individuals.* 
 
 " In the year following the epidemic the author was called on by a compar- 
 atively large number of individuals with cataracts, and came to the conclusion, 
 after careful inquiry, that cataract was frequently consecutive to ergotism. Of 
 twenty-three persons affected, fifteen were females and eight males; three were 
 from 10—20, seventeen from 20=— 30, and three from 50 — 60 years. The rapha- 
 nia had lasted in these cases from six weeks to three months. The prevailing 
 symptom had been cramps. In fifteen cases, a headache, lasting for months, 
 or even a year, and combined in some cases with vertigo and noises in the head, 
 had followed the disease, and after it had subsided, or sometimes during its 
 existence, the gradual loss of sight in one, and soon in the second eye, had 
 taken place. The production of cataracts was always slow, and in all cases 
 bilateral. The consistency of the diseased lens was found to be hard two, soft 
 twelve, and semi-fluid nine times. Complications were not present; the optic 
 nerve and retina seemed unaffected, and the operation had mostly a good result. 
 
 " The author believes to have a right to assume that the cataracts were pro- 
 duced in consequence of the disturbances of nutrition of the crystalline body, 
 caused by the chronic intoxication, or rather on the thereon dependent changes 
 in the nervous and vascular system. 
 
 "The symptoms produced by ergotine and the oil contained in the ergot of 
 rye are, according to Professor Schroff (Pharmacology, Vienna, 1856, p. 548), 
 nausea, dryness of the throat, loss of appetite, fullness, pain and stupor in the 
 head, dilatation of the pupils, gastralgia, and enteraJgia, and diminution in 
 frequency of the pulse. It is rendered probable, the author states, in conclu- 
 sion, by observations of a less recent date, that ergotine has a peculiar influ- 
 ence on the system of the ciliary nerves, and influences that way the nutrition 
 of the lens, while on the other hand, the convulsive contractions of the eye- 
 muscles, as they were frequently observed by the patients, may have caused a 
 change in the nutrition of the lens, like the cataracts occurring after convul- 
 sons in young children. [?] — Am. Journal of Optlialmoloqy." f 
 
 SOURCES OF FLOUR IX CITIES AND IS" RURAL DISTRICTS. 
 
 Excepting outbreaks of the disease in garrisons and at workhouses, etc., I 
 think it will be found that a small proportion of the epidemics of cerebro- 
 spinal meningitis has occurred in large cities. If this is true, it is a remark- 
 able fact, and one which needs explanation. If there is any relation between 
 this disease and the poison of smut, the following facts may bear upon this 
 subject. 
 
 * Compare with Cases and Mortality from Cerebro-Spinal Meningitis, page 124, 
 t Quoted from Am. Jour. Med. Sei., p. 540, Apr... 1SG4. 
 
CERkBRO-SPINAL MENINGITIS Hi 
 
 There is one great distinction between the source of the flour used in large 
 cities and that used in many rural districts. Cities are supplied, in great part 
 at least, with flour made at large mills called "merchant mills," while in rural 
 districts much of the flour used is made at smaller mills, from wheat raised in 
 the vicinity. In visiting mills, during my investigations, my attention has 
 been called to the fact that there is a very great difference between the elab- 
 orate machinery employed for cleaning the wheat in "merchant mills " and 
 the antiquated and imperfect arrangements for this purpose in many of the 
 " custom mills." And while some of this latter class of mills are provided 
 with ordinary smut machines, others have nothing of the kind worthy of 
 mention. 
 
 It is not safe to rest on the assumption that because there are now elaborate 
 and complete machines for cleaning wheat, all mills are supplied with such. 
 This assumption is not in accordance with the facts. I was told that very 
 near the locality where cerebro-spinal meningitis prevailed at Manchester, in 
 this State, there is a mill that has no suitable apparatus for separating the 
 smut from the wheat. 
 
 SMUT IN BUCKWHEAT USED FOR FOOD. 
 
 Some facts, which seemed to me of importance, were communicated to me 
 by Mr. Wm. Swindells, the miller at Petersburg, where the epidemic of cerebro- 
 spinal meningitis occurred. He said that buckwheat was more frequently than 
 other grains affected with smut, and that it was not the custom at his mill, 
 and I understood him to say that it was not at other mills, to run buckwheat 
 through the smut machine before grinding it. The greatest number of epi- 
 demics have occurred during the winter and spring months; and that corre- 
 sponds to the season of the year when buckwheat is most freely used. I did 
 not succeed in finding out much about the proportion of persons at Peters- 
 burg who used this article of food and afterwards had the disease in question ; 
 but I was told that the buckwheat contained more than the usual quantity of 
 smut, and, as before stated, it was not run through the smut machine before 
 being ground. 
 
 Mr. Swindells also told me that it was not the custom for millers to take any 
 measures for removing smut from corn. But, as a rule, no considerable 
 amount of smutty corn is ground for human food. 
 
 In this connection it seems worth while to bear in mind the possibility of 
 
 THE DISEASE BEING COMMUNICATED BY MEANS OF MILK. It IS not improb- 
 able that the milk of cows fed upon grain or grass affected with smut may 
 contain some of the poisonous material derived therefrom, especially such 
 principles as tend to go with the oily portion, and which, from the experiments 
 of Dr. Hooker and Mr. Wright,* appear to be, to some extent, volatile. " He 
 found the vapor of this preparation, diffused through the air of a close room, 
 produced a tingling sensation of the limbs, distressing lassitude, irritability, 
 and giddiness." * 
 
 If milch cows eat grain or hay affected with smut, or drink it in w 7 ater, it 
 seems quite probable that the milk will contain at least a portion of the 
 poisonous principle, as it is a well-known fact that milk is quite generally 
 flavored by substances used as food. Act No. 26, Laws of Mich., 1873, very 
 properly forbids the sale of milk from cows fed on refuse from distilleries 
 
 * Stilus Therap. Vol. II., p. 015. 
 
172 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 or breweries; doubtless for the very good reason that such milk has been 
 proved to be injurious to persons using it.* 
 
 QUANTITY OF SMUT SEPARATED FROM WHEAT. 
 
 Perhaps this is as good relation as any in which to place another class of 
 facts ascertained during my investigations in connection with this epidemics 
 I was informed that the quantity of smut and other refuse material separated 
 from grain by the smut machines amounted to several tons at each flouring 
 mill. There is a flouring mill at each of the two villages where this epidemic 
 was most fatal, — Petersburg and Dundee. 
 
 The river Raisin, along which this epidemic occurred, has a large number of 
 flouring mills on its banks. The method of dealing with smut is not quite 
 the same in all of these mills. In many of them the smut is conveyed by a 
 shaft into the river. In others it is simply blown out into the air. At Man- 
 chester it is thus disposed of, being discharged on that side of the mill toward 
 the river. The mill is on the west side of the river, and just below the dam. 
 During the summer and autumn of 1873, cerebro-spinal meningitis broke out 
 on the east side of the river, not far below the mill. The prevailing wind in 
 this locality is, I believe, generally from the west and southwest. There may 
 be no relation of cause and effect between these facts; certainly no such rela- 
 tion is proved; but since smut is known to be a violent poison, I have thought 
 it well to report these facts. In one of the largest mills in Jackson, — on 
 Grand River,- — the smut is collected in a tight room, and a large part of it 
 removed to the country by a farmer who, it seems, makes some use of it. In 
 ordinary seasons this "smut" consists largely of the little hair-like material 
 from the small end of the wheat kernels; but in certain seasons a considerable 
 proportion is really what is known as smut, and consists of spores of fungi. 
 
 WHAT IS ERGOT ? 
 
 In Dr. H. 0. Woods' late Treatise on Materia Medica and Toxicology, I find, 
 on page 458, a concise statement, as follows: 
 
 " Among the lowest of vegetable organisms, and distinguished from all 
 other plants by the absence of chlorophyll, are the fungi. There are in most 
 cases two distinct states or stages in the life of a fungus: in the first of these, 
 the vegetative period, it exists as a mycelium, a usually filamentous mass or 
 flocculus, whose sole function is to grow and increase; in the second stage the 
 thallas, or ordinary fungus or mushroom, is formed ; to it is assigned the func- 
 tion of developing reproductive bodies, after whose formation it perishes. 
 Between these stages there is in some fungi an intermediate one, in which the 
 plant exists as a sclerotium. The genus Claviceps comprises a number of 
 parasitic fungi, which develop in the pistils of the various species of Gram- 
 inse. The officinal ergot is the sclerotium of the Claviceps (C. purpurea 
 Tulasne) which infests the grain of the Secale cereale, or common rye. The 
 first appearance of the fungus is during the earliest life of the pistil, at 
 the base of which there arises a minute flocculent mass of mycelial fila- 
 ments. These filaments, continually growing and invading all parts of the 
 tissue of the pistil, at last form of it an irregular whitish body, at the base of 
 which, after a time, appears a dark-colored body, the sclerotium, which con- 
 tinues to grow, lifting up the diseased and withering mass formed out of the 
 original pistil, and finally developing into a perfect ergot. 
 
 *See Pages 8t' to 66, Trans. Med. Soc. of N. Y. Communication of N. Y. Academy of Med., being Report 
 ©f Com. on City Milk, by S. R. Percy, M. D. 
 
CEREBRO-SPINAL MlENXNGITiS. ITS 
 
 " If a fresh, living ergot be placed in a damp, warm place, after a time little 
 cracks will appear in its surface, and out through these cracks little round 
 bodies will project, and finally be raised up on stalks, and constitute perfect 
 thalli, — minute fungi, which finally produce spores." 
 
 This is very different from the various fungi known as '''smut," this name 
 conveying an idea of the fine, dusty blackness of the spores which in the smut 
 known as Tilletia caries are produced in immense numbers in the germen of 
 the grain itself without the production of a distinct thallus. 
 
 Taylor, in his Principles of Medical Jurisprudence, Vol. II., p. 184, says: 
 
 " The ergot in ordinary use is that of rye ; but the ergot of wheat is said to 
 be equally effectual, and the same perhaps may be stated of the ergot of all 
 grasses." 
 
 Dr. Stille says: 
 
 "Ergot is produced by other cereals besides rye. Mialhe found that the 
 ergot of wheat is identical with that of rye in the qualities of its proximate 
 principles and in its action upon the gravid uterus (Bull.de Therap,, XXXIX., 
 41). His conclusions have been confirmed by Pourcher (Ibid., XLVIIL, 467), 
 and by Jobert (Am. Journ. of Med. Sci.. Oct., 1856, p. 479.)'' * 
 
 Dr. H. C. Wood says : 
 
 "It is not always the rye which causes these frightful losses of life, as 
 Heusinger (Journal fur Pharmakodynamik, Bd. I., p. 405) has traced one epi- 
 demic to diseased oats." f 
 
 Referring to ergot, it is stated in the U. S. Dispensatory, twelfth edition, 
 page 365, that "It is probable that this morbid growth has similar properties 
 from whatever plant derived; and the fact has been proved in relation to the 
 ergot of wheat. (See Am. Jour. Med. Sci., K S., XXXIL, 479.)J Indeed, in 
 a case reported by Dr. D. L. McGugin (Iowa Med. Jour., IV., 93), J this variety 
 of ergot is said to have succeeded promptly when that of rye, previously tried, 
 had failed." In a footnote to this last sentence it is stated that the ergot of 
 wheat has been recommended because less liable to change, and that there is 
 reason to believe that this is true, " for Prof. Bentley of London found that of 
 two specimens, one of the ergot of rye, the other of wheat, which had been 
 kept under similar circumstances for ten years, the former was quite destroyed, 
 while the latter was apparently unchanged. Ergot is rarer in wheat than in 
 rye ; and in the head of the former there is generally but one and very rarely 
 more than two of the diseased grains. It is produced usually in wheat in wet 
 seasons, and on that side of the head most exposed to dampness. It is shorter 
 and much thicker than the ergot of rye, being about half an inch long and 
 three-quarters of an inch or more in circumference, and cleft into two or 
 three divisions. In color and smell it resembles the spurred rye. (Pharm. 
 Jour., March and April, 1863, pp. 423 and 442.)" % 
 
 On page 485, Chapman's Therapeutics, Vol. I., 1825, I find the following- 
 relative to the production of ergot. " The Abbe Fontana planted a number of 
 single grains of rye, and upon the top of each placed several grains of ergot. 
 The result was a crop of this substance, showing something similar to infec- 
 tion." 
 
 WHAT IS THE "SMUT" WHICH AFFECTS DIFFERENT KINDS OF GRAIN. 
 
 In this part of the world very many different kinds of fungi are commonly 
 designated simply as "smut." We hear of "smut wheat," "'smut corn," 
 
 * Therapeutics and Materia Medica, Vol. II., p. 607. 
 
 t Materia Medica and Toxicology, p. 469. 
 
 % I regret that I have not been able to eee the original papers referred to above. 
 
iU STATE BOARD OF HEALTH-REPORT OF SECRETARY. 
 
 "smut buckwheat," and occasionally of "smut grass." Although these are 
 known to mycologists as belonging to different species and genera, they have 
 certain general characters in common; they are "'parasitic on living plants," 
 and most of them, as also the "brands" and "rusts," belong to the order 
 Oseomacei.* 
 
 One of these well known to farmers is the " smut" which is found in wheat 
 after it is threshed, the kernels affected being not very different from the per- 
 fect wheat in external appearance, but which are filled with myriads of black 
 spores. In England this seems to be commonly known as " bunt," and in 
 works on fungi, as Tilletia caries, the first name indicating the genus and the 
 last the species. As before mentioned, it belongs to the order Casomacei, 
 which is included in the family Coniomycetes, while ergot of rye — Olaviceps 
 purpurea, belongs to the order Spha?riaeei, and family Ascomycetes. Accord- 
 ing to Berkeley, one of the best authorities on such subjects, "This family 
 [Coniomycetes] is distinguished by the vast predominence of the reproductive 
 bodies over the rest of the plant, if not in size, at least in abundance, and 
 from the ease with which, in general, they fall from the point of attachment, 
 in consequence of which, as the name implies, they have a dusty appearance, 
 and often soil the fingers of those who handle them." f 
 
 Unfortunately this character admirably fits the members of this family to 
 maintain their existence. Rev. M. J. Berkeley of England has experimented 
 with the spores of Tilletia caries, and ascertained that their germination pro- 
 ceeds through the development of four successive generations. In Cooke's 
 Introduction to the Study of Microscopic Fungi, this process is briefly described 
 as follows : " When these are made to germinate, a kind of stem is protruded, 
 upon which small clusters of elongated thread-like spores of the second gen- 
 eration, or sporidia, are produced. After a time the spores conjugate, or 
 become united by short transverse processes in the same manner as has been 
 observed in some of the lower forms of algae. The conjugated spores in the 
 next stage germinate and produce a third kind of fruit, different from either of 
 the preceding, and constituting a third generation. These in turn germinate 
 and produce a fourth order of re-productive organs, so that in the process of 
 growth the 'bunt' spores evidently pass through four generations. Hence, as 
 one result, the number of germinating bodies is greatly increased, as well as 
 their power of inflicting injury in a corresponding diminution of size. There 
 are still many points in the history of the growth and development through 
 successive generations of the 'bunt' spores, but enough is known, on the one 
 hand, to show that this is a true vegetative parasite, and not merely a diseased 
 condition of the tissues of the wheat plant, and on the other, that it is per- 
 fectly distinct from all the phases of the other and similar parasitic fungi 
 which affect the wheat crop." % 
 
 There is a growing belief that "like causes produce like effects," and it is a 
 fact worthy of attention that so many diseases which are in many respects 
 similar, have been attributed to fungi which are also different from, but have 
 many things in common with each other. A few years since the Texas cattle 
 disease was quite thoroughly studied by the Board of Health of the city of 
 New York, and, although the cause was not certainly proved, yet there was 
 some reason to believe that it might be a fungus taken in with the food of the 
 animals. Great numbers of '-'micrococci" were uniformly found present in 
 the blood and bile of the diseased animals, and it was claimed that these 
 
 * Hand-JBook of British Fungi, Vol. II., p. 511. 
 
 t Hand-Book of British Fungi, Cooke, Vol. I., p. 414. 
 
 t Rust. Smut, Mildew, and Mould, Cooke, pp. SS. S». 
 
CEREBROSPINAL MENINGITIS. 175 
 
 micrococci could be arid were artificially developed into a mature fungus. This 
 fungus is figured and described in the report of the New York Board of 
 Health for 1868, which also contains a very complete account of the disease. 
 (Drs. Billings and Curtis, of Washington, D. C, have tested the development of 
 the micrococci, and did not verify the statement.*) The symptoms of the disease 
 as well as the post-mortem results were similar in many respects to the disease 
 being studied, in this report. It began with a chill or cold stage, after which 
 the temperature was increased ; there was delirium, the neck was not thrown 
 back, but the head was retracted or straitened on the neck, there was retrac- 
 tion of the abdomen, — -'-'tucking up of the belly,"— constipation, difficulty in 
 urinating, and, frequently, bloody urine; after death numerous ecchymoses 
 were found in different parts of the body, and occasionally extravasations of 
 blood; there was enlarged spleen. f "In three instances the condition of the 
 brain was carefully examined, because it was presumed that those particular 
 cases might be found to have suffered from acute meningitis or from cerebral 
 congestion. No trace of actual inflammation was found, but there was evi- 
 dence of congestion of the cerebral vessels in two of the cases. The medulla 
 oblongata was examined in these cases, and sufficient effusion was found in one 
 instance to have produced morbid, nervous, and muscular phenomena. Yet 
 the observations finally led to the conclusion that all, or nearly all the delirious 
 actions, distorted movements and postures, and comatose conditions that 
 characterized various cases, were attributed to the toxaemia which constitutes 
 the essential quality of the disease." J We see here a conclusion similar to 
 that by most writers as regards cerebro-spinal meningitis, namely, that many of 
 the symptoms referable to the cerebro-spinal system are not due to an inflam- 
 mation therein, but to blood-poisoning. It seems to me that a more rational 
 explanation would be to let the actual post-mortem results, such as congestion 
 of the veins and sinuses of the brain and spinal cord, ecchymoses and extrav- 
 asations of blood, account for much of the nervous disturbance, and then let 
 the excessive muscular contraction, which is also evident, account for the 
 forcing of blood into the veins in such situations, as also into the spleen, 
 which is found softened as well as enlarged. 
 
 As pointed out in another part of this report, the known action of some of 
 these fungi is to cause muscular contraction, particularly of the involuntary 
 muscles, and it would not be inconsistent with this knowledge if it should 
 turn out that the Texas cattle disease was due to a fungus taken into the 
 bodies of the animals. 
 
 In 1862, J. H. Salisbury, M. D., of Newark, Ohio, communicated to the 
 American Journal of the Medical Sciences, a paper on fungi, with an account 
 of experiments showing the influence of the fungi of wheat straw on the 
 human system. He innoculated several persons with spores obtained from 
 wheat straw allowed to ferment by means of heat and moisture. " From the 
 innoculations as far as they have gone, in from twenty-four to seventy-two 
 hours, the effects' begin to show themselves in lassitude, chilliness, catarrhal 
 symptoms, and pains through the forehead and temples." || 
 
 The symptoms which he describes are: Chills, followed by fever, pain in 
 the head and back, nausea, fullness and throbbing in the head, deafness, 
 sneezing, sensitiveness sometimes amounting to inflammation of the eyes, 
 
 * Report U. S. Com'r of Agriculture on Diseases of Cattle, 1S69-T0, pp. 156-170. 
 
 t Enlarged spleen has been mentioned as one of the post-mortem evidences in'cereforo-spinal meningitis. 
 
 t Report Bkl of Health of N. Y. City, 1S6S, p. 254. 
 
 || Am. Jonr. Med. Sci., July, 1S62, p.' 27. 
 
176 STAl*E BOARD OF HEALTH-EEPORT OP SECRETARY. 
 
 burning congestive feeling in the scalp, oppression in the chest, dryness and 
 soreness of the throat, hoarseness, coughing, redness in spots under the skin, 
 and an eruption somewhat similar to that of measles, these manifestations dis- 
 appearing after about eight days, 
 
 In this same article the following statement appears : 
 
 "At the monthly meeting of the 'Farmers' Club,' near Newark, Ohio, last 
 month, several of the farmers stated to Mr. Dille that it was quite common, 
 after threshing wheat, for persons who had been exposed much to the dust, to 
 be taken with severe chills, followed by a high fever, catarrhal symptoms, and 
 an eruption on the face. None of them could state that any one had ever had 
 the attack twice ; nor whether they had known any cases to follow the thresh- 
 ing of any other kind of grain than wheat. 
 
 " It is well known among swine growers that when they bed their hogs in 
 straw they are affected with an eruption in the throat, fauces and roof of 
 mouth, accompanied with coughing."* 
 
 The fungi figured and described by Dr. Salisbury as found on straw allowed 
 to "heat" or ferment, although somewhat similar, were different from any 
 others which have been mentioned in this report. 
 
 On page 241 of his work on Food and Dietetics, Dr. Pavy says: 
 
 "Bread also becomes the seat of development of certain species of fungi 
 — (Penicillium oidium, etc.) — in other words, becomes mouldy on keeping, 
 and the more quickly so in proportion as it contains water. The same likewise 
 happens with wheat and flour under the presence of moisture. The existence 
 of this low form of vegetable growth renders the articles pervaded dangerous 
 for use. They are liable to produce injurious and even fatal consequences. 
 Dr. Christison states that on the continent repeated instances have occurred 
 of severe and even dangerous poisoning by spoiled or mouldy rye bread, barley 
 bread, and wheat bread; and that several instances have been observed of 
 horses having been killed in a short space of time with symptoms of irritant 
 poisoning by eating such bread with their ordinary food. It has further been 
 noticed that the consumption of mouldy oats has been followed by fatal con- 
 sequences. Dr. Parkes [Pract. Hygien, 3d Ed., p. 223], quoting from Professor 
 Varnell, states that ' six horses died in three days from eating mouldy oats ; 
 there was a large amount of matted mycelium, and this, when given to other 
 horses for experiment, killed them in thirty-six hours. 7 " 
 
 EFFORTS TO TRACE THE CAUSE OF SOME PREVIOUS EPIDEMICS. 
 
 Cerebro-spinal meningitis prevailed at the State Reform School near Lan- 
 sing in 1863 and again in the winter of 1865-6. I have been unable to learn 
 much concerning the conditions existing at that time. There seems to have 
 been some complaint in regard to the insufficiency of the clothing of the 
 boys, and of the coldness of the dormitories where they slept. It has not yet 
 been proved that cold or the reaction therefrom is sufficient of itself to cause 
 the disease, but the fact that a large proportion of the epidemics occur in the 
 winter and spring would seem to indicate this as one of the factors, and there 
 is other evidence tending to the same conclusion. An effort was made to 
 ascertain the source of the breadstuffs used at the Reform School at that time. 
 Application was made to the Superintendent for this information, but after the 
 lapse of a considerable time his reply was that he had been unable to learn that 
 fact. There is, however, indirect evidence bearing upon the subject, so far as 
 
 *Am. Jour. Med. Sci.. July, 1SG2, p. 22. 
 
CEREBROSPINAL MENINGITIS. 177 
 
 relates to the winter of 1865-6. It is stated by numerous authorities that 
 ergot of rye is more prevalent in wet than in dry seasons, and this seems to be 
 true of many of those species of fungi which attack the different kinds of 
 grain. Now the character of the season in Michigan during the time when 
 the cereals used for food in the winter of 1865-6 were ripening and being 
 harvested was unusually wet, and in addition to the inference that the fungi 
 which attack wheat would be likely to be present, we find a statement of the 
 presence of some of them. 
 
 "This year [1865], over a large portion of the State, particularly the central 
 and western,* the summer and early autumn were so wet as to seriously injure 
 some farm products." * * " Through the summer of 1865 rain fell at short 
 intervals, and with the constantly damp atmosphere which prevailed, even the 
 surface of the ground was scarcely dried." * * 
 
 "According to the returns received by the Commissioner of Agriculture, 
 Washington, D. C, the deficiency in the yield of wheat in the country for 
 1865, as compared with 1864, is 12,172,994 bushels. It will be observed that 
 this relates only to the quantity of the crop. Its quality is inferior through- 
 out the Western States." * * In this State, " rust, also, made its appearance 
 on many fields,* induced, probably, by the prevalence of wet weather, alternat- 
 ing with warm sunshine. Add to these casualties the injury from rains after 
 the crop was cut, and the depreciation in the quality of the grain must be 
 obvious, though not easily stated in figures." f 
 
 The winter of 1865-6 is said to have been " a dry and rather cold winter."! 
 
 As regards the prevalence of the disease at the Eeform School during the 
 winter of 1865-6, it appears to be, at least, possible that it may be accounted 
 for by the facts just stated, and which may be summarized as follows: 
 Throughout that part of the State from which its food supply was probably 
 derived, the grain raised in 1865 was of poor quality because of the fungi 
 which attacked it during the wet and warm summer months; the winter of 
 j 865-6 was dry and cold; the inmates were not warmly clothed, and their 
 dormitories were unusually cold. 
 
 It is much to be regretted that the conditions of the crops and seasons pre- 
 ceding and during the outbreak of 1863 were not recorded in some State pub- 
 lication, but at that time the State Board of Agriculture was only just organ- 
 ized, and had not begun that work. 
 
 It has been remarked that the fungi which destroy wheat and other grains 
 are most destructive during wet seasons, but it will not answer to conclude 
 that they are present in every wet season, for heat is also required for their 
 most active growth. In examining with reference to wetness of season during 
 ripening of grain, it will be seen that the summer of 1866 was unusually wet, 
 and the question may arise, why did not cerebro-spinal meningitis prevail in 
 the winter of 1866-7, if the fungi of cereals are factors in its causation. By 
 referring to the statement of crops in this State in 1866, it is found that 
 although the wheat crop was below the average yield, and was to some extent 
 damaged by heating and sprouting in the stack, still, where not injured in this 
 manner, it was of "good quality" and there was no mention of rust or smut, 
 the season being wet, but cool. 
 
 Epidemic cerebro-spinal meningitis prevailed in Philadelphia and vicinity 
 
 * Italics mine. 
 
 t Report of Secretary of the State Board of Agriculture of Michigan, for the year 1S65, pp. 7, S, 9, 10. 
 
 :£ Report of Secretary of the State Board of Agriculture of Michigan, 1S65, p. 63. 
 
 23 
 
178 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 during the winter of 1863, and spring of 1864. The meteorological conditions 
 observed at Philadelphia in spring and summer of 1863, were as follows: 
 '•'The amount of rain that fell during the spring and summer [of 1863] was 
 28.542 inches, being 8.210 more than 1862, while the number of days it 
 rained amounted to 82, which exceeded the number in 1862 by 20 days. The 
 seasons, therefore, have been uncommonly wet."* From meteorological ob- 
 servations by Prof. J. H. Kirkpatrick of the Philadelphia High School, pub- 
 lished in same journal as above, I learn that for the month of June, 1863, the 
 maximum temperature was 91.5 deg., the mean temperature was 69.48 deg., 
 the average dew point was 54.43 deg. This evidence is not very valuable as it 
 is, but may lead to the bringing forth of some more conclusive one way or 
 the other. It is not probable that the city was supplied to any great extent by 
 food derived from cereals raised near the city, and yet the comparatively few 
 persons in the city who contracted this disease may have used the same food as 
 did those in the various villages near by, and which may have been raised in 
 that vicinity; or the milk used may have been from cows fed on hay made and 
 cured in that vicinity during that warm and wet. summer of 1863. The ques- 
 tion which I wish to present, and ask evidence concerning, is this: Does 
 cerebro-spinal meningitis usually appear during or following an unusually cold 
 winter following an unusually warm and wet summer during which fungi 
 were caused to pervade the cereals and grasses afterwards directly or indirectly 
 used for human food ? 
 
 An epidemic which occurred at Elmira, New York, in 1857, has been men- 
 tioned in this report. An effort to learn the condition of the wheat raised in 
 1856 proved unsuccessful. W. A. Armstrong, Secretary of the Elmira Farm- 
 ers' Club, writes as follows : "I am sorry to say no precise information is 
 attainable. I have accurate knowledge of my own crop for that year, but I 
 was not then a resident of this county. I have inquired of old farmers here 
 about the characteristics of that season's crop, but there are only vague im- 
 pressions regarding its character; these, however, seem to indicate an unusual 
 amount of smut." 
 
 So far as I can learn from the Vital Statistics of Michigan, the deaths from 
 cerebro-spinal meningitis in this State appear as follows: During the year 
 1868, 7 deaths: 1869,5 deaths; 1870, 9 deaths; 1871, 18 deaths; 1872, 248, 
 including those returned as from " meningitis," etc. For the year 1873 the 
 returns are not yet all in, and for 1874 the deaths are not yet collected by the 
 supervisors, but judging from the best evidence at hand it seems probable that 
 in 1873 there were more deaths from this cause in this State than in any pre- 
 vious year, and more than in 1874. 
 
 By careful examination of the Reports of the State Board of Agriculture, I 
 find that it is not the uniform custom of the correspondents in different parts 
 of the State to record the diseases which affect the crops, or the peculiarities of 
 the seasons, although these subjects are occasionally mentioned. So far as 
 relates to the wheat crop for the year 1870, the following is about the only pos- 
 itive record of its quality being affected : " The wheat crop was more than an 
 average yield, but, owing to the wet season, was somewhat damaged." f 
 
 In some parts of the State it was reported as of good quality. 
 
 For the year 1871, so far as shown by reports printed in the Report of the 
 State Board of Agriculture, the wheat crop was of excellent quality. 
 
 ' * Am. Jonr. Mel. Sci., July. 1^64, p. 90. 
 t Report Sec v y Ingham Co. Agr 1 ] Soc. in. Report of Sec*y of State B'd of Agriculture for the year lsfO. 
 
CEREBROSPINAL MENINGITIS. 179 
 
 For the year 1872, there is very little said in the Report, the following being 
 about all of consequence, and showing that it was of good quality in some 
 loc alities and not good in others. 
 
 *' c Afew showers before harvest time, 1872, just when the plant was in its 
 most susceptible condition to be most affected, caused rust. In consequence, 
 the crop was almost a failure; the quantity bein°' light, and quality but second 
 rate." * 
 
 "The spring [1872] opened very late, the summer was very hot, and after 
 the first of June, very dry/' 
 
 "The wheat crop was considerably more than an average in quantity, and 
 the quality was excellent/' f 
 
 But in the same Report I find a record of extraordinary meteorological con- 
 ditions during the winter of 1872-3, which may bear upon the subject of 
 the unusual prevalence of cerebro-spinal meningitis in this State, in December, 
 
 1872, and spring of 1873. 
 
 "The month of December [1872] was more than 8 deg. below the average 
 temperature of that month, J a fitting forerunner of the terribly cold winter of 
 
 1873. The period from December 22d to 25th will long be remembered as the 
 severest * cold spell' ever witnessed in our State. On the morning of the 21th 
 of December the thermometer stood at 32 deg. below zero. This extreme cold 
 was not confined to our State, but appears to have swept as a polar- wave from 
 Pembina in a southeasterly direction across Minnesota, Wisconsin, and Michi- 
 gan, thence easterly across Ontario and New York, and thence northeasterly 
 to Quebec. The damage to fruit trees and the suffering which it caused to all 
 classes will not soon be forgotten." || 
 
 Now although it is so difficult to obtain any reliable information regarding 
 the diseases of the cereals within late years, it happens that I have been able to 
 learn of a very remarkable blight of the wheat crop in Europe in 1804, — the 
 year preceding a well-recognized outbreak ef epidemic cerebro-spinal menin- 
 gitis in Europe. On page 13 of his work on the subject of this disease, Dr. 
 Stille says: "The first account of epidemic meningitis within the period we 
 have referred to was published in 1805, b}^ Vieusseux, who at once declared 
 that neither he nor any of his colleagues had ever seen a similar disease." 
 Although that outbreak began in Europe in 1805, it did not begin in this 
 country until the following year, at Medfield, Massachusetts. Of the quality 
 of the cereals in this country at that time I have found no mention, but, in 
 Loudon's Encyclopaedia of Plants, published in London, 1836, page 1048, one 
 may read that " the alarming state of the harvest of August, 1804, from what 
 is vulgarly called blight, induced Sir Joseph Banks to have some blighted 
 stalks of wheat examined under a powerful microscope, and drawings made 
 from them by Mr. Erancis Bauer. These were published in a pamphlet in 
 January, 1805." The figures of the fungi in the Encyclopaedia are copied 
 from this w r ork of Sir Joseph Banks. Whether or not the disease prevailed in 
 the immediate vicinity where the affected wheat was raised I have not been 
 able to learn. Dr. Meredith Clymer says : u In Prussia, Holland, Rhenish 
 
 * Twenty-third Annual Report of the Board of Management of the Genesee County Agr'l Society, in 
 "Report of Sec'y of Mich. State Board of Ariculture" for the year 1872, p. 135. 
 
 to. H. P. Sheldon, Secretary of Van Buren County Agr'l Society, in Report Soc'y State B'd of Ag., 1372, 
 p. 162. 
 
 % Prof. Kedzie has kept a thorough meteorological record at the College since 1S64. 
 
 I! Prof. R. C. Kedzie, in Report of SecV Mich. State Board of Agriculture for the year 1S72, p. 290. 
 
ISO STATE BOARD OF HEALTH—REPORT OP SECRETARY. 
 
 Germany, Bavaria, and Eastern France, there were occasional outbreaks of the 
 disease from 1805 to 1815." * 
 
 SOME POST-HOKTEM APPEAKAJSCES WHrCH NEED EXPLANATION. 
 
 Without attempting to deny that in some cases of this disease evidences of 
 inflammation of the meninges of the brain and spinal cord are found, it 
 nevertheless seems true that in a large proportion of the records of post- 
 mortem examinations no satisfactory evidence of this appears. Thus, in a case 
 reported to the College of Physicians of Philadelphia by Dr. Jewell in 1864, 
 and which appears to have been a well-marked case of this disease, the patient 
 died after an illness of 48 hours. Omitting references to other organs : " On 
 cutting through the scalp the blood flowed away more freely than usual, and it 
 was found that it was abnormally fluid within the veins. The vessels of the 
 dura mater were remarkably congested with fluid blood, very dark in color. 
 A yellow effusion existed in the subarachnoid space ; it proved to be of a serous 
 character, and to exist in the spinal canal also." f 
 
 Dr. Levick reported the case of a child that died on the first day of the dis- 
 ease where " On removing the calvaria a large ecchymosis was found under 
 the pericranium near the sagittal suture. The vessels of the dura mater were 
 filled with dark fluid blood, which could readily be pushed aside by the handle 
 of the scalpel. The substance of the brain and of the medulla oblongata was 
 natural in its appearance and consistence. There was no effusion in the ven- 
 tricle, and the most careful examination failed to detect the slightest evidence 
 of inflammatory exudation." J 
 
 In the American Journal of the Medical Sciences for October, 1865, page 
 509, is an abstract of Prof. Menderlich's observations on the epidemic in Ger- 
 many in 1864-5, wherein the following remarks occur: "It is particularly 
 worthy of remark that although many phenomena of this affection are expli- 
 cable by the lesions found in and about the nervous centres, yet many others 
 are present which cannot be referred to those lesions, which indeed are not 
 themselves uniformly proportioned in extent to the gravity of the symptoms. 
 Hence we must be convinced that cerebro-spinal meningitis is rather a con- 
 stitutional than a local disease, and one whose symptoms are not to be ex- 
 plained merely by a reference to its anatomical lesions alone." * * " It is 
 precisely the severest cases which hurry on without remission to a fatal close, 
 and in which the slightest anatomical alterations are discovered, or, indeed, 
 cannot be detected at all." * * "Oases occur in which it seems as if the life 
 of the body in all its parts perished by a sudden and deadly intoxication." 
 
 On page 278 of the same journal for July, 1865, is an account of an autopsy 
 of a woman who died twelve hours after she had gone to bed apparently in her 
 usual health. It is reported by James J. Levick, M. D., one of the physicians 
 of Pennsylvania Hospital, as a case of "spotted fever without cerebro-spinal 
 meningitis." " On cutting through the scalp there was an escape of dark fluid 
 blood with which the vessels were turgid. A large ecchymosis was found on 
 the left temporal bone, and smaller ones on other parts of the cranium. The 
 meningeal vessels were filled with black blood. The most careful examination 
 failed to detect any evidence of inflammation either in the substance of the 
 drain or in its membranes. The spinal cord was removed in its entire length, 
 
 *Cerebro-Spinal Meningitis, p. 6. 
 
 t Am. Joar. Med. Sci., July, 1864, pp. 130, 131. 
 
 ; Am. Jour. Med. Sci., July, 1864, p. 136. 
 
CEREBROSPINAL MENINGITIS. 181 
 
 and was examined both by the unassisted eye and with the microscope. It 
 was of firm consistence, and in every way free from disease." 
 
 In Dr. Moreau Morris* article in the report of the Board of Health of New 
 York city for the year 1871, page 359, is an account of the post-mortem appear- 
 ances in a case that died eighteen hours after first attack. " The serous and 
 mucous coats of the stomach showed purpuric spots similar to those on the 
 body. It was also scattered, though less abundantly, over the peritoneal coat 
 of both large and small intestines. Lungs, heart, liver, and kidneys were 
 healthy. The blood was very fluid. The whole of the surface of the brain 
 was intensely congested, the veins and sinuses being gorged with very fluid 
 blood, though not entirely devoid of coagula. On section of the brain little 
 points of blood netted out everywhere. The ventricles were nearly dry. Con- 
 sistence of brain natural ; no exudations or purulent matter found." 
 
 It is to be regretted that the microscopical appearances of the blood-vessels 
 of the brain and spinal cord have not been generally recorded. If any such 
 records have been kept I have failed to find them. But from such records as 
 those just preceding, one would expect to find some such condition of the 
 smaller blood-vessels as described by Dr. Dickenson in tetanus, and quoted in 
 another part of this report. Prominent facts to be accounted for are the 
 ecchymoses, or extravasations of blood which seem to take place in various 
 parts of the body, and the engorgement of the veins and sinuses of the brain 
 with black blood. In the most severe cases, where death takes place most rap- 
 idly, these have been the most apparent causes of death. It is difficult to 
 see how blood can get outside of the vessels as it does in this disease except 
 one of two things is true. Either there must be some unusual rottenness of 
 the walls of the vessels, or they must be subjected to unusual strain. And 
 this even though the blood be rather more than usually fluid, for passive 
 hemorrhages are not common in this disease. It seems reasonable to conclude 
 that the ecchymotic spots and the venous engorgement of the brain are both 
 due to unusual blood-pressure in the vessels, and that this is due to general 
 muscular spasm, or tonic contraction. 
 
 CERTAIST FACTS IN ANATOMY WHICH MAT BEAR UPON" THE CAUSE OF THIS 
 
 DISEASE. 
 
 "The diameter of the capillaries varies in different tissues of the body, their 
 usual size being about one three-thousandths part of an inch. The smallest 
 are those of the brain, and the mucous membrane of the intestines; the 
 largest those of the skin and the marrow of the bones." * 
 
 This seems to have a bearing upon the view that in cerebro-spinal menin- 
 gitis there is primarily a starved condition of the cerebral tissue, through ex- 
 cessive contraction amounting to almost entire obliteration of the minute 
 blood-vessels. Such contraction has elsewhere been suggested as the cause of 
 the dry gangrene in one form of ergotism. The smallest capillaries being 
 those of the brain and mucous membrane of the intestines, we might expect 
 that the contraction of blood-vessels would be most serious in its effects upon 
 those tissues; more particularly in the brain for the reason that it would 
 suffer not only from small supply of blood, but also from impoverished blood, 
 because of the impoverished intestinal circulation interfering with digestion. 
 It will not answer, however, to assume without further proof that the tension 
 of the walls of the blood-vessels is the same in all parts of the body. There 
 
 * Gray'g Anatomy, p. S60. 
 
182 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 are other points to be considered before coming to a conclusion as to the rela- 
 tive quantity supplied to the brain under such circumstances, for the tendency 
 or power of contraction may be much greater in some parts than in others, in 
 which case extraordinary distention might result where the contraction of the 
 walls was least. 
 
 The fact that the largest capillaries are those of the skin, may have some 
 connection with the appearance of spots and ecchymoses in this disease. The 
 extent of tissue supplied by each capillary may also bear upon the subject of 
 death of parts. " In the liver and lung the interspaces are smaller than the 
 capillary vessels themselves. In the kidney, in the conjunctiva, and in the 
 cutis, the interspaces are from three to four times as large as the capillaries 
 which form them." * 
 
 Such contraction of muscular walls of blood-vessels as is believed to result 
 from the action of ergot and of cold would impede the general circulation, 
 and would tend to force the blood into situations where the vessels were least 
 supplied with muscular walls. 
 
 "Some arteries have extremely thin coats in proportion to their size; this is 
 especially the case in those situated in the cavity of the cranium and spinal 
 canal, the difference depending upon the greater thinness of the external and 
 middle coats." * * " Some arteries, as those in the cranium, are not in- 
 cluded in sheaths." * * Arteries are also provided with nerves; they are 
 derived chiefly from the sympathetic, but partly from the cerebro-spinal sys- 
 tem. * * " According to Kolliker, the majority of the arteries of the brain 
 and spinal cord, those of the choroid, of the placenta, as well as many arteries 
 of muscles, glands, and membranes, are uprovided with them." f 
 
 We have been examining the structure of arteries and capillaries ; conges- 
 tion of veins in certain parts would result from contraction of muscular walls 
 of blood-vessels. 
 
 "Muscular tissue is wanting in the veins: 1. Of the maternal parts of the 
 placenta. 2. In most of the cerebral veins, and sinuses of the dura mater. 
 8. In the veins of the retina.% ^. In the veins of the cancellous tissue of 
 bones. 5. In the venous spaces of the corpora cavernosa. The veins of the 
 above-mentioned parts have an internal epithelial lining, supported on one or 
 more layers of areolar tissue." 
 
 " Most veins are provided with valves, which serve to prevent the reflux of 
 the blood." * * " The cerebral and spinal veins, the veins of the cancel- 
 lated tissue of bone, the pulmonary veins, and the umbilical vein and its 
 branches, are also destitute of valves." || 
 
 ATTEMPT TO ACCOUNT FOR THE EXUDATION SOMETIMES FOUND. 
 
 If we accept the evidence which seems conclusive of the contraction- of 
 non-striated muscles through certain influences, such as cold, ergot, and sim- 
 ilar fungi, and bear in mind the pressure which under the action of such 
 agents, would be exerted upon the walls of blood-vessels not well supplied with 
 muscular tissue and not protected by valves, we may nave some conception of 
 the possibility of the effusion of serum, the exudation of fibrin, and the ex- 
 travasation of blood in such situations, which, it will be seen by the quotations 
 from Gray's Anatomy, are, more particularly, the brain and spinal cord. This 
 
 * Gray's Anatomy, p. 861. 
 t Gray's Anatomy, p. 860-1. 
 % ItaJics mine. . 
 Gray's Anatomy, p. 457. 
 
CEREBROSPINAL MENINGITIS. 1S3 
 
 must not be assumed as proof that iu this disease the exudation upon the 
 cerebro-spinal membranes is actually caused in this manner. It is offered as a 
 possible explanation, which must be verified or disproved by future investiga- 
 tion. In the same spirit we may offer an explanation of the softening 
 of the brain and spinal cord which is usually found in patients dead 
 from cerebro-spinal meningitis. Stille says: "The substance of the brain is 
 generally softened." He mentions the observations of numerous writers to 
 establish this point. "Softening of the spinal marrow appears to be less fre- 
 quent than that of the brain."* Nevertheless he mentions several cases, and 
 says: "Partial and superficial softening of the cervical portion we have seen 
 repeatedly."* Speaking of cerebral softening, Dr. Hammond says: "'Most 
 authors treat of it in direct connection with obliteration of the cerebral arter- 
 ies, but, although frequently due to this cause, it may be produced by others."f 
 Now if the general contraction of all blood-vessels well supplied with muscular 
 walls does not result in a great contraction of the vessels within the brain and 
 spinal cord, and in that manner, deprive the brain of its nutriment, there 
 seems to be good reason for believing that there would be congestion not only 
 of the thin-coated arteries of the brain and spinal canal, but also of "most of 
 the cerebral veins" in which Gray says " muscular tissue is wanting." Such a 
 condition of arterial and venous congestion would not be favorable to repair of 
 nervous tissue, and conjoined with a sluggish circulation, would go far toward 
 explaining the softening and disintegration of the brain and spinal cord, 
 especially as the blood would be impoverished because of the difficulty of get- 
 ting nutriment into it through vessels in such tonic contraction. 
 
 Some recent experiments on rabbits seem to show that in theui ergot causes 
 contraction of the vessels of the brain, as well as of other blood vessels. "Dr. 
 Max Schuler — Berl. Klin. Woclienschrift, Chicago Jour. Nervous Diseases, 
 Oct. 2, 1874, records some experiments," which, although not conclusive as to 
 the action of the substances named upon man are worthy of attention. ik He 
 found that after the continued application of large sinapisms the cerebral vas- 
 cularity was reduced." "Dr. Schuler, experimenting with nitrite of amyl, as 
 with mustard, was able to demonstrate the hitherto supposed action of this 
 drug, viz. : that it relaxed the cerebral vessels." " Dr. Schuler demonstrated that 
 injection of ergotine was followed by a powerful and continued vascular con- 
 traction at the place of injection, and in both the arteries and veins of the 
 pia mater." He found that "ergotine would contract the cerebral vessels when 
 they were dilated to their fullest extent. On the contrary, nitrite of amyl 
 would not dilate vessels contracted by ergotine." "He found that ergotine 
 would contract arterioles when the sympathetic nerve supplying those arteri- 
 oles was divided. Thus we have direct proof that ergotine acts on the mus- 
 cular fibre of the arteriole."]; 
 
 It may be remarked that, although ergot may cause contraction of the 
 blood-vessels of the brain, as also of all other blood-vessels having muscular 
 walls, including the heart, the contraction of those vessels having the least 
 muscular fibre must yield to the stronger contraction of those having the 
 greatest amount of muscular fibre, and as elsewhere pointed out, the muscular 
 walls of the arteries of the brain and spinal cord are thin, and the veins in 
 those parts have no valves. 
 
 * Stille on Epidemic Meningitis, p. 89. 
 
 t Diseases of the Nervous System, p. 137. 
 
 X Detroit Review of Medicine, February, 1ST5, p, 108. 
 
184 STATE BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 A careful study of the account of the experiments referred to above shows 
 that the immediate effects of these agents was different from the effects of their 
 continued influence. Immediately, and for a short time after the influence of 
 the mustard began, there was an alternation of contraction and dilation, result- 
 ing at last in a permanent contraction, under the full influence of the sub- 
 stance. In another part of this report, while endeavoring to account for the 
 two different sets of symptoms caused by ergoted grain, I suggested that per- 
 haps the so-called spasmodic ergotism resulted from alternate contraction and 
 dilation of the blood-vessels through the influence of food containing the fun- 
 gus, modified by varying conditions of heat and cold, position of the body in 
 sleep, etc. It will be remembered that the symptoms of spasmodic ergotism 
 are similar in many respect to those of cerebro-spinal meningitis. In connec- 
 tion with the experiments mentioned above, I recall the suggestion just referred 
 to for the purpose of studying the subject a little more closely since the state- 
 ment of certain facts which have been made to follow that part of the paper in 
 which the suggestion occurred. It may bow be studied in connection with the 
 question : Can some symptoms of meningitis be explained through 
 
 ALTERNATE CONTRACTION AND DILATION OF BLOOD VESSELS ? 
 
 The probable result of such changes may perhaps be better stated in the 
 form of propositions, as follows : 
 
 1. The brain and spinal cord are normally surrounded by a fluid. 
 
 2. The cranium and spinal canal are rigid, and their contents are of nearly 
 uniform bulk. 
 
 3. When the blood-vessels of the brain and spinal cord are greatly contracted, 
 the extra space thus left within the cranium and spinal canal is probably 
 filled by an extra quantity of fluid. 
 
 4. Under such conditions, if the blood-vessels are suddenly dilated, there will 
 be pressure upon the brain and spinal cord. 
 
 Some of the prominent symptoms of this disease would be accounted for 
 through compression of the spinal cord and brain. In another part of this 
 paper, while speaking of cold and changes in temperature, it was remarked that 
 some of the prominent symptoms of this disease would be accounted for by 
 irritation of the pneumogastric and spinal accessory nerves near their origin 
 within the spinal canal. If the foregoing propositions are correct, we should 
 have the conditions for mechanical irritation through pressure upon the nerv- 
 ous substance wherever there was sudden dilation following extreme contrac- 
 tion of the blood-vessels of any considerable portion of the brain and spinal 
 cord ; and it seems reasonable to conclude that the pressure would be most 
 severe in its effects at the points of dilation. Other things equal, this dilation 
 would be great where there was least normal stimulation of vaso-motor nerves, 
 and greatest where there was entire suspension of function of such nerves, 
 through division or complete reaction from previous over-excitation. Prof. 
 Flint says that "the local circulations are regulated in accordance with im- 
 pressions made on sensory nerves,"* etc. I have elsewhere called attention to 
 the fact that, under ordinary circumstances, cold is not allowed to strike the 
 body except in the air passages. During the inspiration of cold air the blood 
 which goes to the lungs must lose heat rapidly. We have seen that cold is one 
 of the most important agents in causing contraction of muscular tissue. Can 
 there be any doubt that it has a powerful influence upon the nerves distributed 
 
 * Physiology, p. 489. 
 
CEREBRO-SPINAL MENINGITIS. 185 
 
 to the lungs and heart ? If it has, then such sudden changes as that from 
 breathing the cold external air of winter to breathing that of a warm room 
 should cause a corresponding change in the "local circulation" of that part of 
 the brain and spinal cord from whence those nerves are derived. Under ordi- 
 nary circumstances this causes, at the most, only some giddiness ; but through 
 the excessive influence of ergot, or a fungus having similar properties of pow- 
 erfully influencing the contraction of blood-vessels, it may be possible for the 
 added influence of cold to produce extraordinary contraction, and this to be 
 followed by an equally extraordinary dilation of the blood-vessels, because of 
 almost complete paralysis of the nerves so exposed when they are again brought 
 under the relaxing influence of heat. The nerves of the face and air passages 
 would be most exposed to cold, and, therefore, to reaction therefrom. There 
 may be some relation of cause and effect between these facts,* and the symptoms 
 of giddiness, nausea and vomiting, dilation of pupils, tetanoid contractions of 
 muscles of the neck, etc., so frequently found in cerebro-spinal meningitis. 
 
 There is reason to believe that cases of cerebro-spinal meningitis and tetanus 
 are sometimes confounded. There are cases of meningitis on record which if 
 there had chanced to have been a previous wound might, consistently, 
 have been reported as tetanus. The question arises whether tetanus is not a 
 similar form of disease which is usually caused in great part by physical pain. 
 Let us study the action of pain. Under the influence of severe pain there is 
 usually a marked contraction of voluntary muscles. There is what is called a 
 "straining of every nerve/' The whole muscular system is in a state of un- 
 usual tensiou. In health, the circulation in the veins is largely carried on by 
 the alternations of pressure and relaxation which the muscles exert upon 
 them during ordinary healthful conditions, the valves in the veins preventing 
 the blood from flowing from the heart. Given a state of continuous unusual 
 muscular tension, such as sometimes results from wounds, there would be a 
 corresponding tension in those blood-vessels least compressed by muscles. 
 Those in the cranium and spinal canal are the ones, as previously remarked. 
 Fortunately facts have been recorded which bear directly upon this subject. 
 The microscopical appearances of the spinal cord in tetanus are described by 
 Dr. Dickenson: "The blood-vessels appear to be, if not the flrst, at least an 
 early seat of change. Distended with blood, not only to their uttermost nat- 
 ural capacity, but dilated to many times their proper width, and crammed 
 with blood corpuscles so as to look like solid cylinders, their condition gave 
 evidence of an altogether abnormal relation between the pressure of the blood 
 and the resistance of the walls. Either blood had been propelled into them 
 with supernatural force, or what is more likely [?], the tension of their coats 
 had been lessened by a change in their innervation. The overcharge of the 
 vessels led to the escape of their contents. In some cases blood corpuscles 
 were extruded. More often only the fluid portion of the blood traversed the 
 wall, to appear as the translucent structureless material which played so prom- 
 inent a part in the destruction of the cord." * * "At the same time a cer- 
 tain amount of disintegration of the nervous elements had taken place, where 
 the exudation came into contact with them, such as might result if, as sug- 
 gested by Mr. Lockhart Clarke, the exudation had a solvent action upon the 
 tissue. It is probable that the tendency to disintegration in the nervous mat- 
 ter may have been enhanced by the unnatural state of the blood-vessels, and 
 the consequent imperfect nutrition of the cord." f 
 
 * Another point to be borne in mind is the v^so-motor centre, supposed to be in the medulla oblongata. 
 1 Am. Jour. Med. Sci., April, 1869, p. 4G9. 
 
186 STATE BOARD OF HEALTH—REPORT OF SECRETARY. 
 
 An attempt to study and explain the cause of tetanus was not the primary 
 object of this report. But it has been found necessary to study this and otber 
 allied affections in order to appreciate the evidence as to the cause of cerebro- 
 spinal meningitis. Prof. Gross says: "The term tetanus is a generic one, 
 employed to denote a, peculiar affection of the nerves, characterized by violent 
 contraction of the voluntary muscles, with irregular intervals of partial, 
 though seldom of complete, relaxation."* 
 
 The several species of tetanus are: trismus, or locked jaw; opisthotonos, 
 when the body is bent backward ; emprosthotonos, when it is bent forward ; 
 pleuroiJiotonos, when it is drawn to one side; trismus nascentium* or infantile 
 tetanus, a few days after birth. Trismus and opisthotonos are frequently 
 prominent phenomena in cerebro-spinai meningitis, and there is no reason to 
 believe that these species of tetanus are then caused in a very different 
 manner than when they follow a wound. Not a very large proportion of all 
 wounds are followed by tetanus; something more than an ordinary wound is 
 therefore needed. Prof. Gross says: "The fact is, in persons of a nervous, 
 irritable temperament, any injury, however trifling or insignificant in itself, 
 may readily induce the disease, especially in hot and damp states of the atmos- 
 phere, or during sudden transitions from heat to cold. Exposure to cold 
 draughts, by which the body is suddenly chilled, is, under such circumstances, 
 extremely liable to provoke an attack. The effect of cold air, when permitted 
 to play directly upon the body, is well illustrated by an occurrence that took 
 place after the battle of Ticonderoga in 1758. The wounded were exposed 
 the whole night after the action, in open boats, upon Lake George, and the 
 consequence was that nine of them died of locked jaw/'f 
 
 The combined influence of cold, pain, fear, or unusual nervous susceptibility, 
 is probably sufficient to cause such muscular tension as to force the blood into 
 the feebly resisting blood-vessels of the brain and spinal cord, and to produce 
 the condition described by Dr. Dickenson quoted above. When we remember 
 the "extremely thin coats" of the arteries of the brain and spinal cord, it 
 seems evident that the direct action of any agent, such as ergot, that undoubt- 
 edly produces marked contraction of the blood-vessels, would be toward the 
 production of just such a condition of the brain and spinal cord as is described 
 above, as found in tetanus. To deny this seems to me like denying that 
 "motion occurs in the direction of least resistance." It seems reasonable to 
 conclude that the use of ergot in food or medicine would tend toward the pro- 
 duction of tetanus. Seeking the cause of tetanus is also seeking the cause of 
 part of the phenomena of cerebro-spinai meningitis. But in this last men- 
 tioned disease there are additional phenomena which it has been thought were 
 best explained by the influence of some " blood-poison." It should be borne 
 in mind, however, that while in tetanus caused by a wound in connection with 
 cold, the spinal congestion is caused in great part by the extraordinary tonicity 
 of the voluntary muscles combined with the unusual contraction of the vessels 
 of the surface of the body, in the spinal congestion which I suppose to be, 
 under certain circumstances, caused by ergot and subtances having similar 
 action upon involuntary muscular fibre, we may have the same influence of 
 cold combined with it; but, whether it is or not, there is probably a general 
 contraction of all blood-vessels having- muscular coats, and this results in de- 
 ranging digestion, assimilation, and especially interferes with the removal of 
 
 * Gross 1 Surgery, Vol. I , p. 771. 
 t Grose' Sar£ery, Vol. I., p. 772. 
 
CEREBROSPINAL MENINGITIS. 18? 
 
 effete matter from the system. In cerebrospinal meningitis there is frequently 
 suppression of the urine. The bowels are sometimes constipated. 
 
 If the foregoing is a true view of tetanus and the action of ergot, we have 
 in ergot of rye, wheat, and perhaps other fnngi, something capable of act- 
 ing toward the production of tetanus, and, in addition, of so interfering with 
 digestion and excretion as to produce a depraved condition of the blood* suf- 
 ficient to account for the leading symptoms, if not for all the symptoms of 
 cerebro-spinal meningitis. If these views are correct, the reason is plain why 
 cold alone, a wound alone, or both together, do not cause all the phenomena 
 of epidemic meningitis, for the production of which something is required 
 which shall add the influence of those poisonous matters which in health are 
 rapidly excreted from the body. They may enable us to see why when the 
 disease occurs without the influence of cold some of the symptoms have been 
 mistaken for typhus, — a disease due to animal poison in the system. They 
 explain the reason why this disease is more frequent in cold weather, when the 
 contraction of the blood-vessels of the surface is great through the influence 
 of cold alone. They explain how the tension which occurs in fear, which is 
 recognized as a factor in the causation of the disease, is capable of producing 
 such an effect. They may throw some light upon other affections, as, for in- 
 stance, tetanus, hydrophobia, cholera, intermittent fever, puerperal convulsions, 
 and hysteria. 
 
 In order to prove that a disease is caused by a given substance or substances, 
 agency or agencies, it is necessary to prove that the alleged cause is capable of 
 producing the phenomena manifested by the disease, that it is present and 
 acting whenever such disease occurs, and in order to fix upon one thing or 
 agency alone, it must appear that no other known agency or substance capable 
 of producing such phenomena is present and acting. 
 
 With more labor than will probably be realized by most persons who read 
 the results, I have endeavored to collect all the evidence which was readily 
 accessible to me relative to a number of substances and agencies, and to group 
 it in such manner as that it should bear upon one of the three essential points 
 just mentioned, and have its proper value in sustaining or breaking down the 
 idea that each particular substance or agent was a cause of this disease. The 
 results of several such groupings do not appear in this report, being considered 
 of minor importance. That so much prominence is given to the subjects of 
 cold and certain fungi, is because they seemed to be "true causes;" and, as re- 
 gards the latter, a large amount of evidence has been given for the reason that 
 it was believed that even then it would not by many be accepted as a prom- 
 inent cause of the disease. 
 
 In some cases an effort has been made to show that it is not impossible that 
 certain agencies and substances may cause the disease in question, and to offer 
 a rational explanation of a possible method. This has been done partly for the 
 purpose of removing obstacles to a complete and thorough collection of the 
 evidence on the subject; for so long as people could "not understand how an 
 excessive amount of ozone could possibly cause any such disease ;" or " see no 
 possible connection between cold and this disease," and conclude that "of 
 course it is impossible that the disease could have been caused by that article 
 of food," *— while we are so frequently met with such views as these, it is ex- 
 ceedingly difficult to collect any reliable evidence upon the subject. 
 
 More evidence seems desirable as to whether food containing ergot, or a 
 
 * Referring to flour made from smut wheat, " Providence Journal," R. I., Aug. 27th, 1874. 
 
1S8 STATS BOARD OF HEALTH— REPORT OF SECRETARY. 
 
 fungus having similar properties, has been used in communities where the dis- 
 ease has prevailed as an epidemic, and whether the particular persons who have 
 had the disease ate of such food. Reference has been made to an unsuccessful 
 effort to learn the conditions existing and the source and nature of the food 
 supply at the Reform School in this State at the time the disease prevailed 
 there in 1863-5. A communication was also addressed to the U. S. Minister 
 at Paris, France, asking if it were possible to learn the nature of the crops in 
 localities from which the French army were supplied in those years when it 
 suffered so severely from this terrible disease. The reply of the secretary of 
 the legation was as follows: "The French government has at length replied 
 to my request for the information you wanted about smut in wheat. They re- 
 gret that the long lapse of time since the dates referred to, prevents both the 
 Minister of War, and the Minister of Agriculture, to whom application was 
 made, from being able to answer your questions." But unless more attention 
 is paid to such subjects in France than in the United States the lapse of time 
 was a matter of no consequence, and no better result would have been reached 
 if the inquiry had related to the year last past. The general prevalence of the 
 disease throughout the United States during the year 1872 prompted a letter 
 of inquiry to the Hon. Frederick Watts, Commissioner of Agriculture. The 
 essential part of his reply was as follows : " The reports made to this Depart- 
 ment do not mention smut in wheat in such detail as to enable us to state, 
 with any approach to accuracy, the proportion of wheat so affected in any 
 locality — nor even whether there was more or less of smut than usual in wheat, 
 or other grain, in 1871/' Until this time there seems to have been no demand 
 for any such information. I made extraordinary efforts to obtain it for the 
 reason that if it could be obtained in connection with past epidemics we need 
 not go groping after this knowledge through numerous epidemics in the future. 
 When the next epidemic comes it is to be hoped that the agriculturists will 
 contribute to its study more definite knowledge respecting the disease, or ab- 
 sence of disease, affecting the principal crops which furnish us with food. 
 But if they do not, it is possible that the chemists may give us the information 
 sought. In the U. S. Dispensatory, on page 369 of the twelfth edition, is the 
 following: 
 
 TEST FOR ERGOT 12* ELOUE. 
 
 " The odor of ergot is no doubt owing to the liberation of its volatile alka- 
 loid, probably in consequence of a slow decomposition of the native salt. A 
 method of detecting ergot in a mixed powder, rye flour, for example, is thus 
 afforded. If, on the addition of solution of potassa, the odor of ergot is per- 
 ceived, its presence is sufficiently proved." 
 
 Since investigating the subject, I have had no opportunity of applying this 
 test to flour known to have been actually used for food by a person suffering 
 from this disease. Such a test applied to two samples of flour obtained from 
 the Petersburg mill at the time of my visit, yielded negative or at least unsatis- 
 factory results, as did also a similar test of two other suspected samples. 
 
 Microscopical examination of the flour has been suggested, and it may be 
 possible that the mature spores of Tilletia Caries, the "bunt" of the English, 
 and the kind of "smut" of this country which is found in wheat after it is 
 threshed, may be found in flour made from such wheat, but I have never found 
 any. It ctaes not seem probable, however, that ergot of rye can be readily de- 
 tected microscopically, for it contains nothing which is so very peculiar and 
 
CEREBROSPINAL MENINGITIS. 189 
 
 striking as to be easily identified in that manner, and if there is a real "ergot 
 of wheat" it is probable that the same remark will apply to that. 
 
 In order to prove that this disease is caused mainly by any particular poison, 
 it would be necessary to show that no other known poison capable of producing 
 the disease is present and acting. 
 
 There are very many poisons which produce symptoms similar to those of 
 cerebro-spinal meningitis, even to some of ike, post-mortem appearances; but 
 in the results of most of these poisons there are certain points which dis- 
 tinguish the particular poison. Thus, in poisoning by strychnine there is 
 trismus and opisthotonos, but there is also more violent tetanic action of most 
 of the muscles of the body ; there is no headache, nor, as a rule, vomiting ; the 
 post-mortem appearances include spinal congestion, but do not include evi- 
 dences of inflammation, at least not in cases of rapid poisoning with large 
 doses. In any search for a special poison capable of being the main cause 
 of this disease, many such poisons can be thrown out as not present and act- 
 ing. This is true of strychnia, of such fungi as might be mistaken for the 
 edible mushrooms, and because of the prevalence of the disease in cold weather, 
 of all poisons affecting green foods, except possibly such poisonous roots as 
 may be mistaken for edible roots and preserved in cellars. There is one ex- 
 ception of the class last mentioned, but it is not one that appears to be capable 
 of accounting for epidemics of this disease: In Taylor's Prin. and Prac. of 
 Med. Juris, it is stated that persons have been poisoned by taking the roots of 
 Monkshood (Aconitum Napellus) for those of horse-radish, these having been 
 dug after the leaves had fallen. Horse-radish is frequently used at the season 
 of the year when this disease prevails, but although the symptoms of poison- 
 ing by aconite are in some respects similar to those of the disease in question, 
 there is no probability of its being the cause, for in this country the plant is 
 not a very common one, and cases of the disease often occur in many different 
 families at about the same time, and whatever external poison, if any, be found 
 to cause the disease, it must evidently be one which, although having its dis- 
 tribution somewhat limited to certain localities, is so common to all classes of 
 people in each locality as to have eluded observation up to this time. Oases of 
 poisoning by mushrooms, by poisonous roots, by shell-fish, and even by cheese, 
 are, probably, as a rule, detected, for the reason that not all the members of a 
 family use such articles of food. The very fact that the cause of cerebro-spinal 
 meningitis has not been discovered, is good evidence that it is not connected 
 with any of the secondary articles of food. If connected with the food, the 
 probabilities are greatly in favor of its being found in connection with the 
 flour, for no other article of food is usually so distributed as to account for the 
 distribution of the disease. Of all the poisons likely to be present in the flour, 
 the one which is known to produce symptoms most like those of this disease is 
 the fungus known as ergot. Other fungi are known to be poisonous, and are 
 frequently found in articles of food prepared from the cereals. 
 
 Among the various poisons which are capable of producing symptoms some- 
 what similar to those of this disease is one which has been found in the food. 
 On page 397, Vol. I., Taylor's Prin. and Practice of Medical Jurisprudence, 
 the author says: "In January, 1854, Dr. Kingsley of Roscrea furnished me 
 with the particulars of some cases in which several families, including about 
 thirty persons, suffered severely from the effects of bread containing, by acci- 
 dental admixture, the flour of darnel seeds." The symptoms exhibited, as 
 described by Dr. Kingsley, were of a form of intoxication. There was giddi- 
 
190 STATE BOARD OF HEALTH-REPORT OF SECRETARY. 
 
 ness, tremblings of the arms and legs, impaired vision, coldness of the hands 
 and feet, great prostration, and in some cases vomiting, burning heat in month 
 and throat, confusion in head, and small and irregular pulse. There is no 
 mention of lock-jaw or other tetanoid symptoms, as in cerebro-spinal menin- 
 gitis, and the patients were convalescent on the following day, whereas in the 
 disease in question convalescence is usually protracted. It is possible, however, 
 that in small and long-continued doses the flour of the seeds of the bearded 
 darnel may be capable of producing a form of poisoning similar to or even 
 identical with cerebro-spinal meningitis. Inasmuch as it is certainly a danger- 
 ous poison, the characters of the plant should be well known to farmers in 
 order that it may not, through ignorance of its dangerous qualities, be allowed 
 to increase and eventually cause wide-spread poisoning by its admixture with 
 the flour which enters into the constitution of so many of the ordinary articles 
 of food. The botanical name of the bearded darnel is Lolium Temulenlum. 
 In Gray's Manual of Botany it is located in "Grain-fields, Massachusetts, and 
 Penn: rare, — Grain noxious; almost the only such instance among grasses." 
 It is an annual plant, " adventive from Europe." In a note the author remarks 
 that "I here rank with the adventive plants those which De Oandolle terms 
 plants cultivated without or against man's will."* As it has come across the 
 ocean it seems probable that, unless effort is made to prevent it, it may spread 
 still more easily throughout our own country. 
 
 There is one article which is now almost as widely distributed, and that is 
 the potato. It will be referred to again in another place. Some of the phe- 
 nomena of this disease might be accounted for if it could be shown that 
 arsenic was so distributed as to be taken into the system, by persons through- 
 out whole communities. I know of no evidence that the paris green, used to 
 destroy potato-bugs, enters into the potatoes, or that it has ever been found in 
 drinking-water from wells in the vicinity of its use; and this disease occurred 
 long before its use for that purpose. Arsenical pigments have been in use for 
 a long period of time, however, and are very largely distributed in dwellings, 
 more especially on wall-papers and window-shades, but the effects of arsenic in 
 that form are known, and do not correspond very closely with this disease, 
 wherein the attack is quite frequently sudden. 
 
 Phosphorus is a very violent poison, even in minute doses, and its effects are 
 sufficiently similar to the phenomena of this disease to demand thorough ex- 
 amination. In combination with other elements, it is found in many, if not in 
 most, articles of food. If it shall appear that it is ever taken into the system 
 in any such combination as will liberate it in a poisonous form, it will be 
 worthy of serious attention. It is a component of nervous tissue, and, in 
 health, it is excreted in considerable quantity, especially in the urine. It may 
 be worthy of consideration in this connection that in cerebro-spinal menin- 
 gitis there is frequently, if not generally, a scanty flow of urine, and it is pos- 
 sible that some of the secondary phenomena of the disease are due to the 
 retention in the system of some of the combinations of phosphorus. 
 
 In a late medical periodical received while the first part of this report is 
 passing through the press, I find a paragraph which bears upon this subject, 
 and quote it with the remark that the statement needs confirmation : 
 
 "Professor Levi of the University of Pisa has just made known, as the re- 
 sult of numerous analytical and experimental researches, that the physiolog- 
 
 * Page vrn. 
 
CEREBRO-SPINAL MENINGITIS. 191 
 
 ical, therapeutical, and obstetric properties of ergot of rye are dne to the 
 presence of phosphoric acid, which it contains in abundance, much more than 
 to its organic principles (like ergotin, ecbalin, etc.), to which until now had 
 been exclusively ascribed all the various actions of the substance."* 
 
 Those who have read this report thus far will have seen that the view which 
 seems most reasonable to the writer of this report is that the disease in ques- 
 tion is a tetanoid fever tending to cerebro-spinal meningitis if sufficiently pro- 
 longed; that it is caused by substances and agencies which cause excessive 
 general muscular contraction, and which thereby produce excessive pressure 
 throughout the blood-vessels of the body, causing, among other derangements, 
 those blood-vessels to yield which are least well-supplied with strong muscular 
 walls. This conclusion having reference more to a mechanism than to any par- 
 ticular poison or substance, it is not essential to exclude any substance or agent 
 as a possible cause, but it is desirable to have evidence as to the possibility of 
 producing such pathological conditions through such methods. After the greater 
 part of this report and the conclusions at the close of it were written, and 
 some part of it printed, the writer has fortunately been able to examine, some- 
 what hastily, the late work of Dr. H. C. Wood, of Philadelphia, on Therapeut- 
 ics, and has inserted in different parts of this reports a few quotations. It 
 seems that many observers have concluded that ergot must cause a rise of 
 arterial pressure, and many experiments have confirmed this view. Dr. Wood 
 says : "Seemingly the most elaborate and thorough examination yet made as 
 to the action of ergot upon the blood-vessels, as evinced by its influence on 
 arterial pressure, is that of P. Eberty (Inaug. Dissert., Halle, 1873)." * * * 
 "He finds that the arterial pressure rises directly and enormously after the in- 
 jection of ergotin. This rise, which he acknowledges to be chiefly due to the 
 contraction of the vessels, occurs in the veins as well as in the arteries, and in 
 the frog as well as in the dog and the rabbit." * * "Until further studies 
 are made, no positive opinion can be arrived at as to whether ergotic vaso- 
 motor spasm is peripheric or centric, but the probabilities seem to be very 
 strong in favor of the latter origin." * * "The rise of arterial pressure 
 produced by ergot, and the existence of vaso-motor spasm, must, I think, be 
 considered as proven facts; yet Haudelin is stated to have found that the 
 arterial pressure falls after the exhibition of the poison. Brown-Sequard has 
 insisted (Archives de Physiologie, 1870, t. III., p. 434) that in ergotic poisoning 
 there are two periods: first, vaso-motor spasm; second, vaso-motor paralysis. 
 It is very possible that he is correct, and that Haudelin's results were simply 
 due to bis having used such enormous doses of ergot as at once to overpower 
 the vaso-motor apparatus"! 
 
 The argument from successful treatment is one difficult to apply to this sub- 
 ject, for the reason that no treatment has been attended with much success. 
 The same is true of tetanus. The following, from Dr. H. 0. Wood's late work 
 on Therapeutics, may serve as a starting-point, if the view proposed in this 
 report as to the mechanism of the production of cerebro-spinal meningitis and 
 of tetanus is deemed worthy of examination. On page 30*^, speaking of nitrite 
 of amyl, Dr. Wood says: "Its physiological action would indicate that it 
 should be of service in all cases of spasm of the capillaries, of the bronchial 
 tubes, and of the muscular system generally." On the page following, for 
 quite other reasons, however, he suggests its use in tetanus, and says : " It has 
 
 ♦Medical and Surgical Reporter, Pnila. Feb. 20, ISTa, p. 158. 
 1- ^Materia Medica azid Toxicology, p. 463— 4. 
 
132 STATE BOARD OF HEALTH—REPORT OF SECRETARY. 
 
 been used, so far as I know, in only two cases (London Lancet, 1871), both of 
 which recovered, one with the amyl salt alone, and the other with it and 
 chloral." 
 
 It may be added that in cerebro-spinal meningitis hot baths and hot applica- 
 tions to the surface have been frequently recommended as useful, especially in 
 the beginning of the disease. 
 
 It was hardly to have been expected that in this first attempt it would be 
 possible for the writer to demonstrate the cause of this disease which has been 
 the subject of more or less study for a century. If he has succeeded in con- 
 tributing in any degree to the advancement of our knowledge of its cause, or in 
 clearing the ground and laying out work which shall advance it, the labor will 
 be well repaid. 
 
 What are some of the questions believed to have been now or previously an- 
 swered, and what are those to which answers are still wanted ? It is probable 
 that this would elicit a different reply from different persons. Answering only 
 for myself, I conclude that : 1. There does not seem to be sufficient evidence 
 to prove that the disease is contagious, in the ordinary sense of the term. 2. I 
 am not satisfied that it has a general atmospheric cause. 3. It does not seem 
 probable that epidemics of this disease are caused by over-crowding, imperfect 
 ventilation, bad drainage or sewerage, or by any of the ordinary unsanitary con- 
 ditions acting alone, although the death-rate may undoubtedly be increased 
 thereby when the disease occurs under such conditions. 4. Observations are 
 much needed to show what relation, if any, exists between the presence of ozone 
 in the atmosphere and the prevalence of this disease, as also between extreme 
 dryness of the atmosphere and this disease. 5. The exact constitution of the 
 drinking water should be ascertained ; and any evidence going to show that it 
 is materially changed in winter or spring might bear upon the study of the 
 cause of this disease. 6. An important question remains to be studied as to 
 what relation, if any, exists between this disease and those plants which yield 
 solanine, more particularly the common potato. An, epidemic of a disease 
 manifesting many symptoms common to the one in question, was attributed to 
 poisonous exhalations from amass of decomposing potatoes collected at a starch 
 factory. Cases of poisoning by sprouted potatoes are on record. This disease 
 frequently occurs in spring, at which season potatoes have frequently under- 
 gone one or the other of these changes referred to above. 7. Another subject 
 which deserves study in connection with this disease, is the possibility of the 
 introduction into or the retention in the system of an injurious amount of 
 phosphorus or some of its combinations, as that substance is poisonous in ex- 
 ceedingly small quantities, and some of the phenomena attendant thereon are 
 suggestive of this disease. Possibly this may be accounted for by the fact of 
 the retention of urine, and of other excretions, in this disease, and therefore of 
 the phosphates which in health are rapidly excreted. 8. It is not probable that 
 epidemic cerebro-spinal meningitis is entirely due to a single cause; and as a 
 rule at the present time it is only wide-spread when several causes acting in the 
 same general direction are equally wide-spread and combine to render it epi- 
 demic. 9. To specify the prominent causes, I conclude that, as regards season 
 of year, which has been known to have some close relation to this disease, it is 
 probable that cold and reaction therefrom are the principal controlling elements, 
 and that cold is one of the causes of this disease. As regards ergot, smut, and 
 all fungi which cause great contraction of non-striated muscles, they are prob- 
 ably capable of being prominent causes of this disease, and further evidence is 
 
OEREBRO-SPINAL MENINGITIS. 193 
 
 very desirable as to the precise changes which they induce in the human body and 
 which appear post-mortem, in order to enable us to determine the above propo- 
 sition, as also whether epidemics of this disease usually owe their violence in 
 great degree to the presence of such substances in the food. 10. Fear is doubt- 
 less capable of contributing to its causation ; as is also, physical pain, mental 
 anxiety, and, perhaps, undue mental labor. 11. The recumbent position of the 
 body, as in sleep (and perhaps the condition of sleep), favors the production of 
 the disease, so far as relates to general congestion of the brain and spinal cord, 
 for the reason that whereas in the upright position the force of gravity favors 
 the return of venous blood from the brain and spinal cord, in lying down the 
 force of gravity does not act to prevent excessive pressure upon the blood ves- 
 sels throughout the body from forcing the blood into the veins of the brain and 
 spinal cord, which are not provided with valves ; and, the muscular coats of the 
 cerebro-spinal arteries being thin, there is then a tendency toward their undue 
 distension. 
 
 To summarize and state in general terms the conclusions reached, — it is 
 extremely probable, but not yet proved, that any substance or agency which 
 causes unusual contraction of the non-striated muscular tissue throughout the 
 body is capable of being a prominent cause, and any substance, agent, bodily 
 position, condition, sensation, or emotion, which tends to produce general 
 muscular tension, or otherwise to force unduly the blood into the blood-vessels 
 of the brain and spinal cord, is capable of contributing to the production of 
 this disease. 
 
 Note. — As the writer has been directed to continue this investigation, he will be duly 
 grateful for any material evidence relating to the subject which it may be convenient for 
 any person to place in his possession. 
 
 Errata : On page 134, the reference mark after " ill-ventilation" should be a star, and 
 after the word "poison " a dagger. On page 137, line 21, read 35.6 instead of 356, and in 
 line 22 read 101.9 instead of 1019. On page 142, line 22, read Schonleinii instead of 
 Schonleinu. On page 165, tenth line from bottom, read " flexure of forearm on arm. " 
 

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