Menincococcus Meningitis

treatment, results, cerebrospinal, baths and normal

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On afteount of the excessive sensitiveness of the patient, cooling baths cannot as a rule be employed, and careful packs or similar procedure must be substituted for them. On the other hand warm, or rather hot baths, since their reconuuendation by Aufrecht, have established their right to a place in the treatment of cerebrospinal meningitis. They should be given at 40° 0. (104° F.) and continued ten minutes or long after this. The skin should be flushed and should undergo a long sweat in an immediately succeeding pack.

Their mode of action has not yet been satisfactorily explained and their reckless employment for all patients is not justified. At least the first of such baths in every case should be given under the physician's observation of the pulse, respiration. etc. The sante precaution is certainly requisite in the similarly dangerous piloearpine treatment.

Lumbar puncture, to the diagnostic value of which we have already referred, has been frequently employed and recommended for diagnostic purposes. It is conceivable and experience confirms the fact that aspiration of an amount of fluid sufficiently large to secure normal pressure, may temporarily alleviate headache and other symptoms related to increased intracranial pressure. It is probable also that thereby the itttracranial circulation may be tnade more nearly normal and more favorable for resorbtion of the exudate. Nevertheless it remains questionable whether this effect is not of much too transitory a nature to produce a tangible improvement, even if the puncture is repeated frequently, i.e., at intervals of one or a few days. Clinical

observation and statistics do not prove conclusively the permanent curative effect of this treatment or even the possibility of preventing a secondary hydrocephalus. On the other hand the operation may be regarded aS so safe that it should always be employed as a palliative.

The unsatisfactory curative effects of simple lumbar puncture have led to supplementing it by irrigating the spinal canal with sterile normal salt solution or the injection of antiseptics. Both procedures have their advocates. Franca, after aspirating; c.c. of cerebrospinal fluid, injected 3-9 c.c. of a 1 per cent. lysol solution into the spinal canal and repeated this treatment sometimes daily. His good results have not been confirmed by other observers.

Likewise discouraging results have as yet been obtained by incising the dura after lumbar puncture—as Quincke already did—and by more radical operations, e.g., trephining the skull or incising the membrana obturatoria posterior. These methmLs were tried excluAvely in older pat le n ts.

It should be briefly noted that the internal medical treatment of cerebrospinal meningitis with sodium iodide and hexarnethylenamine has as yet accomplished no results above criticism.

Flexner recommends the spinal injection of a bacteriolytic serum obtained from many strains of the meningococcus. The results ShOW a larger percentage of recoveries than by any other treatment. Of 1500 CRACS treated with the serum in many countries 75 per cent. recovered,

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