MENINGITIS, Acute Cerebral, of Childhood.
Confining this title to the simple non-suppurative inflammation of the pia-arachnoid involving chiefly the base of the brain, which is synonymous with Posterior Basic Occlusive Meningitis, the treatment indicated is that common to all forms of cerebral leptomeningitis.
Absolute rest in a cool, darkened and thickly carpeted room shut off from noise and all source of vibrations is essential. The child may be nursed on the lap with the head kept slightly elevated, when rest in bed is not tolerated. An ice-cap or Leiter's tubes should be continuously applied to the scalp.
Diet is of more importance in the management of this type of cerebral meningitis than in the other varieties, since the affection often runs a chronic course, and the maintenance of life may ultimately depend upon the successful administration of food from the onset. Hence small quantities of diluted milk or suitable infant food should be assiduously administered at short intervals, and resort to early rectal feeding may be required if the stomach is irritable, but soups or animal food in any form should be prohibited.
A smart purge, r gr. Calomel or 2 grs. Hyd. cum Creta given in a tea spoonful of Syrup of Senna, may be administered in order to thoroughly evacuate the bowels.
The treatment must he mainly symptomatic; cephalalgia and restless ness may be relieved by Bromides, with r or 2 grs. Antipyrine added to each dose. Leeching of the temples and a mustard poultice to the nucha often afford considerable relief.
Vomiting may be controlled by rectal feeding and a sinapism over the epigastric region; though the latter agent is more suitable for the relief of vomiting of gastric origin, it occasionally answers in cerebral irritation, High temperature must be treated by patient tepid or cold sponging, and sleeplessness which does not yield to bromides should be relieved 1; a small dose of Chloral.
Lumbar puncture is a valuable agent for the relief of most of the urgent head symptoms, but it is more clearly indicated in the later stages when accumulation of effused inflammatory products is causing increased cere bral pressure.
Though simple acute basic meningitis is widely accepted as being a sporadic form of epidemic cerebro-spinal meningitis, and due to the presence of the Diplococcus intracellularis, information is still lacking of the value of intraspinal injections of Flexner's serum in the simple type.
In the opinion of the writer the serum should always have a fair trial in every sporadic case where the diagnosis of tubercle can be excluded, especially as it cannot do harm if the cerebro-spinal fluid be first permitted to drain away through the needle before injection.
As the accumulation of the inflammatory fluid in the cerebral ventricles leads to their distension owing to blocking of the iter and the openings from the fourth ventricles, hydrocephalus is liable to supervene. Lumbar puncture is clearly indicated at this stage, though its effects are usually but temporary.
Incision of the tympanic membrane on both sides sometimes affords marked relief to pressure symptoms, and it should always be resorted to where there is any otitis present.
Mercury unquestionably is of great value in aiding the absorption of the effused liquid, but it must be pushed by inunction till its physiological effects show themselves. This should be resorted to in every case of simple meningitis. The writer has so many times witnessed most striking recoveries from full doses of the metal by the skin after profound coma had almost obliterated all hope of improvement that he believes it to he unjustifiable to abandon the patient to his fate without resorting to vigorous treatment by this drug.
Iodides may be employed alone or in conjunction with mercurial treat ment.
Where chronic hydrocephalus follows and the case does not yield to lumbar puncture, the measures discussed under Hydrocephalus must be followed.
The term chronic meningitis is sometimes applied to the cases of simple basic meningitis which run a slow course of months, and these are identical with those somewhat rare examples of cerebrospinal meningitis where the same obstructive factors are at work in inducing acquired hydrocephalus by obliterating the passages between the ventricles and the posterior lymph cistern. The only treatment from which any permanent benefit can be expected after the failure of mercury and iodides lies in the drainage of the ventricles.
The acute idiopathic internal hydrocephalus of Quinche, being due to a chronic inflammatory condition of the lining membrane of the ventricle with serous accumulation and no blocking of the iter, yields to lumbar puncture in conjunction with mercurial treatment.