MENINGITIS, (Epidemic).
light has been thrown on the spread of this epidemic disease by a culture of the coccus from swabs taken from persons lately in contact with a victim; these carriers, though in good health, nevertheless harbour the germ of the disease in their naso-pharynx; these carriers may also convey the micrococcus to other carriers who have not been in contact with a person suffering from the disease. Both these kinds of carriers as well as patients in the acute and convalescing stages of the malady spread the disease amongst the members of the community. By the serum test the potentiality of a carrier may be determined, and by the use of antiseptic sprays, Chlorinated Soda, Zinc Sulphate, Carbolic Acid, &c., an attempt should be made to sterilise his throat after he has been isolated. Vaccine methods of dealing with the carrier's infective powers cannot yet be said to have proved successful.
The treatment of a patient suffering from the disease is to be conducted upon the lines laid down for the management of simple basic meningitis. Rest in a darkened room, with the head elevated and ice applied to the shaven scalp, arc clearly indicated. The cerebral symptoms—cephalalgia, restlessness, insomnia, &c.—call for palliatives as Bromides, Antipyrine, and an occasional dose of Chloral or Trional. Leeching behind the ears or over the occiput may be employed; mustard to the nucha or the application of the ice-bag to the spine may afford relief to the acute spinal symptoms. Blistering over occiput or nucha should never be employed owing to the danger of sloughing. Morphia, though generally contra-indicated in other forms of meningitis, may be safely employed to relieve violent spinal pain, and is especially indicated hypodermically, when the vomiting is uncontrollable by other methods. Fever should be reduced by con tinuous cold sponging, or in the case of children by tepid bathing.
No antiseptic drug possesses any specific action upon the growth and development of the Diplococcus. The only hope lies in Lumbar Puncture, which should be immediately resorted to, and after about 3o c.c. of fluid has been drawn off the same amount of Flexner's polyvalent serum should be injected by gravity. The injection should be repeated in 6 or S hours
if the spinal fluid has been noticed to be turbid; a dose every day or every second day for 6 or 7 times may be necessary in severe cases if the turbidity returns. Mild cases will be met by r or 2 injections. Acute examples of the disease terminate sometimes in a few hours, and will probably prove invulnerable to the serum, but when possible they should have the advantage which the serum alone holds forth.
Some authorities rely upon lumbar puncture alone repeated every day till the fluid loses all traces of turbidity. There is also difference of opinion about the relative values of the different sera, but Robb, who has had much experience in two epidemics, insists upon the great superiority of Flexner's. The theory of the necessity of an autogenous serum is certainly true, but before such can be prepared the patient is beyond the reach of treatment, as the time element is a vital factor in every case. Halahan after puncture washes out the spinal canal with per cent. Carbolic Solution before injecting the serum.
Vaccine treatment by living and sterilised cultures has yet to be proved of any real value; most of the cases hitherto so treated have also been subjected to repeated tappings.
The suggestion of tilting up the foot of the bed so that the patient's cerebral vessels become congested (a modified Bier's Method) has been tried; it is useless unless combined with puncture and serum treatment.
Where acquired hydrocephalus has commenced to manifest its presence through blocking of the communications between the interior of the ventricles and the posterior lymph cistern. lumbar puncture cannot be expected to exert any but the most temporary relief. At this period, after the cessation of fever and toxwmia, a trial of Mercury and Iodides is clearly indicated, and as in the hydrocephalus which follows simple basic meningitis, when these agents fail, resort to drainage of the ventricles as described under Hydrocephalus should be gravely considered.