Epidemic Cerebrospinal Meningitis Research Articles

USE OF FLUORESCEIN INTRAVENOUSLY AS AN AID TO OPHTHALMIC DIAGNOSIS AND TREATMENT

Ehrlich 1 in 1882 described the formation of a vertical green line in the aqueous after intravenous or oral administration of fluorescein to rabbits. Since then a large amount of experimental work has been carried out, especialy in Germany, in an effort to explain the formation of this line. This has led to the use of fluorescein as an experimental medium for various types of research dealing with the production and circulation of the aqueous and the permeability of the capillaries of the eye. Before extensive clinical use can be made of this method, further experimental work will have to be done. Since fluorescein also appears in the spinal fluid, Bonar and Bailey 2 in 1930 reported its use as a diagnostic test for epidemic cerebrospinal meningitis. It has also been used for clinical and experimental work by urologists because it is excreted rapidly by the kidneys. Before taking up

XII Pathology of the Inner Ear in a Case of Deafness from Epidemic Cerebrospinal Meningitis

XII Pathology of the Inner Ear in a Case of Deafness from Epidemic Cerebrospinal Meningitis

HUMAN ENCEPHALITIS

During the first week in August 1938 an outbreak of equine encephalomyelitis causing the death of more than 200 horses occurred in southeastern Massachusetts and Rhode Island. August 12 a girl aged 12 years was referred to the Haynes Memorial Hospital with a diagnosis of epidemic cerebrospinal meningitis. On admission a provisional diagnosis of encephalitis was made. Seven hours after admission the patient suddenly died. At autopsy the diagnosis of encephalitis was confirmed. No virus studies were made on the brain. Seventeen days later, August 29, a boy aged 13 years was admitted from the same city, presenting much the same clinical picture. In view of the existing epidemic of equine encephalomyelitis in the same area, the spinal fluid obtained from the lumbar puncture was injected into mice but the results were inconclusive. Death occurred twenty hours after entry. Unfortunately permission for an autopsy was not granted. Similar cases continued

A bacteriological investigation of epidemic cerebrospinal meningitis in the Southern Sudan

A bacteriological investigation of epidemic cerebrospinal meningitis in the Southern Sudan

Epidemic cerebrospinal meningitis

In recent years, we have seen an increase in the incidence of epidemic cerebrospinal meningitis among the pediatric population; moreover, by now we have a fairly rich and diverse arsenal of therapeutic measures that needs to be evaluated and re-evaluated. This is why epidemic cerebrospinal meningitis is a frequent topic in the periodic medical literature.

Observations on vaccine therapy and out-vaccine therapy for epidemic cerebrospinal meningitis

There is no well-collected material on the incidence of epidemic cerebrospinal meningitis among children in the USSR. The most comprehensive monograph by Breitman is more than 20 years old. Judging by anecdotal evidence and the rather large number of papers on the subject, cases of the disease are widespread and frequent, and in recent years small epidemic outbreaks and sporadic cases have been occurring more and more frequently. Over a period of 30 years, according to Prof. Kisel, 80 cases of cerebrospinal meningitis have occurred in the former Olginsky Children's Hospital in Moscow. The clinic of infants of the 2nd M. G. W. (Frishman) counts 35 cases in a shorter period. Our material indicates a higher incidence of the disease in children specifically in recent years, with infants being affected more frequently.

ADVANCED MENINGOCOCCUS MENINGITIS

The introduction by Flexner, in 1907, of a curative serum for epidemic cerebrospinal meningitis has reduced the mortality under the most favorable conditions to a level now variously estimated at from 20 to 25 per cent. This relatively high death rate may be due to three factors: first, extreme virulence of the organism, producing a fulminating meningitis; second, an organism of different type from that used in preparing the antimeningococcus serum, and, third, late recognition of the disease. The latter is certainly the more common, since the fulminating type is rather rarely seen and the standard serums now on the market are polyvalent. The routine administration of antimeningococcus serum by lumbar puncture has given gratifying results only in early cases. In late cases in which treatment was by lumbar puncture, the mortality has been very high, and in those patients who survive, hydrocephalus and other serious sequelae are comparatively common.

PUNCTURE OF THE CISTERNA MAGNA

Since Wegeforth, Ayer and Essick,1in the early part of 1919, worked out the anatomic relationships of the cisterna cerebellomedullaris, and Ayer,2in 1920, made his first report of the clinical use of puncture of the cisterna magna, this procedure has grown of increasing importance from the diagnostic as well as the therapeutic point of view. One cannot help but feel that this operation has not reached the internists, pediatricians and general practitioners for whom it should be of the greatest clinical importance in the early treatment of diseases, especially epidemic cerebrospinal meningitis. The main drawback is that it has been considered a procedure for specialists. This fact limited its employment to a comparatively small group, mainly neurologists and neuropsychiatrists who have made careful studies of the cadaver as emphasized by Ayer in all his reports. However, with the extension of graduate courses and demonstration clinics, knowledge of

THE SKIN LESIONS IN MENINGOCOCCUS SEPTICEMIA

The skin lesions in acute infectious diseases are among the important and most easily determined clinical findings. Their cause, in some instances, has been explained on the basis of the presence of toxic substances, and in other instances it has been shown positively to be due to the presence of microorganisms. The hemorrhagic, purpuric and petechial lesions belong especially to this latter group. The demonstration of typhoid bacilli in the "rose spots," of streptococci in the skin lesions associated with streptococcus septicemia and subacute bacterial endocarditis, of tubercle bacilli in the petechiae or tuberculids seen in acute miliary tuberculosis, are the most striking examples of this type of etiology. The meningococcemia preceding or associated with acute epidemic cerebrospinal meningitis is manifest in some cases by the appearance of skin lesions of a petechial or purpuric nature. This characteristic has gained the terms "spotted fever," "black fever" and "petechial fever" for

EXPERIMENTAL VESTIBULAR TREMORS, WITH ANALOGOUS CLINICAL CASES

Since the memorable work of Flourens in 1824, experiments on pigeons have contributed greatly to our knowledge of the anatomy and physiology of the static labyrinth. During the epidemic of 1918 and 1919, I treated a number of cases of epidemic cerebrospinal meningitis, in some of which postmeningitic symptoms were noted. Since my observations did not seem to be explained by the generally accepted views concerning the physiology of the membranous labyrinth, I have approached the problem experimentally during the past year and a half. In this work I have noted, not only the coarse head and eye nystagmus found by so many investigators, but also a fine tremor which I have designated vestibular tremor. It will suffice for the scope of this paper if I call attention to the anatomic landmarks of the apparatus, the saccule, the utricle, and the three semicircular canals, the tubulated enlargements

Epidemic Cerebro-spinal Meningitis associated with Acute Suppuration of the Middle Ear

Epidemic Cerebro-spinal Meningitis associated with Acute Suppuration of the Middle Ear

MADRID

<h3>Address by Neumann on the Pathology of the Ear</h3> At a joint session of the Madrid Medical Society and the Spanish Society of Otologists, Professor Neumann of Vienna delivered an address on general and anatomic pathology of the internal ear, especially the labyrinth. He pointed out that arteriosclerosis may act either diffusely by causing a general intoxication or locally on the vestibular nerve. He also presented pathologic specimens from cases of arteriosclerosis in which tinnitus has been the initial complaint. Tinnitus resulting from change of posture is characteristic of arteriosclerosis, ringing in the ears in the neuroses appearing usually when the patient is tired. In another specimen, there was enormous dilatation of the saccule as the result of retention of secretion through inflammation and ossification of the septum. These conditions indicate a low grade inflammation, as severe labyrinthitis would cause destruction instead of ossification. The organism of epidemic cerebrospinal meningitis

INTRAVENTRICULAR AND SUBDURAL SERUM TREATMENT OF MENINGOCOCCUS MENINGITIS IN INFANCY

The treatment of meningococcus or epidemic cerebrospinal meningitis in infants, especially in the hospital class of patients, has not been entirely satisfactory. The mortality rate and the incidence of sequels, even with careful serum treatment, are too high. The results obtained at the Infants' Hospital in a series of cases treated by lumbar puncture before the use of serum did not differ materially from a series treated later with serum. In other words, for some reason, serum has not proved so helpful in the treatment of hospital infants as has been expected. Why this should be so has been a subject for consideration with us for several years that we might find a reason and hence improve the treatment. It seems to us that two factors are responsible for a high rate of mortality and sequels in infancy. The patients are seen late or are admitted to the hospital after

Anomalies in patients, who suffered from epidemic cerebro-spinal meningitis

Anomalies in patients, who suffered from epidemic cerebro-spinal meningitis

EXTRAMENINGEAL MENINGOCOCCUS INFECTIONS

The meningeal picture resulting from meningococcus infection has so fixed the attention of clinicians and pathologists that the possibilities of extrameningeal infection by the organism have had scant notice. This has resulted in a general failure to recognize the fundamental nature of the disease as a meningococcus septicemia, which has in turn had important consequences in the fields of diagnosis and treatment. The reason for this is not obscure. The premeningitic stage of the disease, which, up to the present, has been called epidemic cerebrospinal meningitis, is ordinarily not impressive enough to be of serious concern to the family physician, and is rarely, if ever, seen by the hospital physician or the consultant. Meningococcus infections apart from meningitis are practically unrecognized in civil life. The local meningeal involvement and the symptoms arising therefrom have been the criteria of diagnosis. To this the skill and care required to cause the organism

VENTRICULAR DRAINAGE BY PUNCTURE OF THE CORPUS CALLOSUM

It has long been known that in the course of an epidemic cerebrospinal meningitis an obstructive hydrocephalus may develop, either acutely at the height of the disease, or as a sequel after the subsidence of the acute symptoms. This was observed clinically and verified by necropsy as far back as 1865, when Ziemssen and Hess1published the first reports. These observations were confirmed by Hart2and Heubner.3The cases were all fatal, and the main interest in the subject was from the pathologic standpoint. Not until 1907, when Koplik4revived the discussion of the question, was there any suggestion that direct therapy might be efficacious. He made the symptoms pointing to internal hydrocephalus, namely, headache, vomiting, unconsciousness and convulsions, and Macewen's sign, the indications for the treatment of the meningitis by repeated lumbar puncture to drain the ventricles. His cases were all in children, and he

EPIDEMIC CEREBROSPINAL MENINGITIS AS OBSERVED AT GENERAL HOSPITAL NO. 6, FORT McPHERSON, GA., WINTER OF 1917 AND 1918

This report includes cases of epidemic cerebrospinal meningitis at General Hospital No. 6, Fort McPherson, Georgia, from Oct. 1, 1917, to May 1, 1918, a period of seven months. Ten patients were treated and the diagnosis was confirmed in every case by the presence of the meningococcus in the spinal fluid. Methods Employed in Care of Meningitis Cases. —Meningitis patients were isolated in single rooms. Clothing, bed clothes, dishes, bedpans and urinals were sterilized. Throat cultures were taken from convalescent patients every four days until three negative cultures were obtained, and from physicians, nurses and attendants, every four days during their contact with patients. If a positive culture was obtained in a patient he was treated with a spray of dichloramin-T in chlorcosane. Physicians, nurses and attendants received this spray routinely every four hours. Prophylactic Measures —The following prophylactic measures were employed immediately on the diagnosis of meningitis being made:

CERTAIN RESIDUALS OF EPIDEMIC CEREBROSPINAL MENINGITIS OBSERVED IN THE ARMY

In the period from December, 1917, to February, 1918, a number of cases of epidemic cerebrospinal meningitis developed at Camp Beauregard, La. The patients were treated with specific serum administered both intravenously and intraspinally, and a number of them made uneventful recoveries from the infection. After a four or five weeks' period of convalescence in the base hospital at the camp they were as a rule granted a sixty days' furlough at home. On return from their furlough some of the men were found still to have certain residuals owing to which they were unable to go back to duty. Others did go back to duty but were found within a few days to be unable to perform it. All such patients were therefore readmitted to the base hospital. After a further period of from five to eight weeks' treatment and rest in the hospital they were still not in

EARLY DIAGNOSIS AND INTRAVENOUS SERUM TREATMENT OF EPIDEMIC CEREBROSPINAL MENINGITIS

In large cantonment hospitals where clinical material can be controlled by military methods, where acute disease in large volume may be studied in its earliest as well as its later stages, where necropsy study is possible and where elaborate laboratory equipment is often lacking and the medical officer thrown in consequence on his own resources, bedside observation may well add to the store of medical knowledge. At the base hospital, Camp Jackson, S. C., attention has been focused on epidemic cerebrospinal meningitis. More than 270 cases of this disease have been studied with the result that a more definite idea of its general character has been established, methods of diagnosis of value have been brought into use, and a more successful treatment has been carried out. This paper is based on the study of the first 265 cases of meningococcus infection observed from November, 1917, to June, 1918. Some of

THE INTRAVENOUS SERUM TREATMENT OF EPIDEMIC CEREBROSPINAL MENINGITIS

The meningeal aspect of meningococcus infections has usurped such a prominent place in the commonly accepted ideas of the nature of epidemic cerebrospinal meningitis, that important facts have been kept in the background. The very name of the disease and the causative agent have given undue prominence to a single manifestation of a condition that in our opinion is very much more than a cerebrospinal meningitis. This is by no means a new idea. Others have from time to time expressed the opinion that meningococcus infections are primarily septic in nature and that meningitis is a secondary complication. So far as we are aware, however, this conception has not been adopted as a practical working basis for diagnosis or treatment. Such prominence has been given the meningitis that the preminingitic stage of meningococcus sepsis has been for practical purposes disregarded. It is our view that in a recognition of this