MENINGITIS, Cerebral (Purulent).
The treatment is in the first place that of the primary condition causing it. Wounds of the scalp, injuries and disease of the cranial bones, ery sipelas of the face and scalp, admit of easy access of the pus-forming organisms through the veins of the diploe. General infective processes as typhoid fever, pneumonia and smallpox, ulcerative endocarditis, pyxmia, &c., may bring the pyogenic microbes to the meninges through the blood-stream. But the great proportion of cases of purulent meningitis is caused by otitis media, caries of the petrous bone, sinus phlebitis, disease of the mastoid cells, nasal fossa= or naso-pharynx, frontal sinus or orbit, in which cases the infective meningeal inflammation is liable to be complicated by cerebral abscess.
From the consideration of the above causes the solution of the problem of prevention is obvious. Free evacuation of all purulent collections in connection with the scalp, bones, car, frontal sinuses and orbit should be promptly executed. Trephining of the mastoid cells and incision of the tympanic membrane will secure immunity when practised early. The rigid disinfection of all scalp wounds and the establishment of efficient drainage once pus has shown its presence is essential, and this is equally imperative in erysipelas when the signs indicate that suppuration beneath the aponcurosis has supervened.
Once the meninges have become involved the treatment must be mainly symptomatic and carried out on the lines indicated in the other types of acute cerebral meningitis.
A smart cathartic—Calomel followed by a saline or .1 min. Croton Oil— should be administered. The patient should be placed in bed with the head elevated, and ice applied to the shaven scalp and leeches applied behind the ears. Fever, cephalalgia, vomiting, delirium, restlessness, in somnia, &c., are to be treated by agents employed on recognised principles.
The presence of any of the primary causes above enumerated should be carefully sought for and promptly dealt with if this has been previously overlooked. Depressed hone should be elevated or removed and subdural abscesses evacuated by trephining. Mastoid trephining or gouging, in cision of the tympanum, and the surgical procedures detailed under Ear )iseascs are to he carried out when the signs indicate otitis media. When localising symptoms are present the methods of opening the skull for the relief of cerebral abscess or sinus phlebitis are clearly indicated.
Lumbar punk Lure may be resorted to in all cases where the cerebral pressure is high, and the spinal fluid may be allowed to flow till the rate of its exit through the needle demonstrates that the pressure has been reduced to the normal, and the operation may be repeated from time to time with advantage. Where lumbar puncture fails to relieve the high cerebral pressure, some surgeons recommend even in the absence of localising symptoms that the vault of the cranium should be trephined and the Jura mater freely incised, as has been done with temporary advantage in rapidly growing cerebral tumours to reduce the tension.
Mercurialisation by inunction should be resorted to in all cases where operative procedures are not indicated, in order to give the comatose patient any benefit which may possibly be obtained by hastening the absorption of effused fluid outside the cerebrum or in the interior of the ventricles. Occasionally life may he saved by this procedure.
Autogenous Vaccine may be tried in cases running a slow course un influenced by surgical measures.