The influenza bacillus has, during the past few years, been repeatedly identified as the cause of purulent meningitis. Though the frequent marked participation of the central nervous system in the clinical picture of influenza had long before been noticed, Slavik (IS99, Heubner's Clinic, in the case of a ninc-months-old boy with influenza) was the first to identify, infra vitam, microscopically and culturally on blood-culture media, Pfeiffer's bacillus in the cerebrospinal fluid. While Slavik's case ended fatally, Lange (NUL Ganghofner's Pediatric Clinic, Prague) reported a recovery in a case of suppurative influenza cerebrospinal nieningitis in a boy nine years of age. The short course of the disease, which began rather insidiously, is very remarkable. About ten (lays after the symptoms had appeared there followed, immediately after eight c.c. of purulent fluid was evacuated. by lumbar puncture, reduction of fever and cure of all ineningeal symptoms. It is questionable whether, as Lange surmises, the removal of this small amount of fluid, assisted the cure. Sinee then fourteen additional cases have been reported. These include a second recovery (in a nine months boy), which Mya reports in conjunction with other eases: and which CiteCia (Archivio ItaHallo, 1903) fully describes. In this case also the lumbar puncture was employed; to be specific, three times with the evacuation of 35, 50 and 2(1 c.c. of purulent, fluid. Mya, no doubt justly, ascribes the recovery more to the breast nourishment, which was continued through out the disease, than to the lumbar puncture. In Mya's case of recovery there remained crossed paresis of the left facial nerve and of the right extremities.
It seems remarkable that several of the bacteriologically proved eases of influenza meningitis, exhibited other diseases, for instance otitis and pulmonary trouble, due to Pfeiffer's bacillus. In cultures obtained from these foci as well a.s from the mcningeal exudate, which is constantly described as thick and purulent, there existed in some eases, besides influenza bacilli, diplo- and monococci and short delicate threads, which probably are to be regarded to some extent at least not as mixed infeetions but as division forms and involution forms of the influenza bacillus.
Filially it should be noted that Mya's three cases all occurred in the spring of 1902, w-hen an epidemic of inflammations caused by Pfeiffer's bacillus prevailed in Florence. On the other hand, during the preceding deeade, no analogous ease was observed among numerous eases of meningitis which had been examined bacteriologically. This epidemie appearance certainly tnerits further study.
With the exception of a few microorganisms not well known and some of which have not yet been found in children (Stadelmann), we have non. mentioned the chief topics in the bacterial etiology of diffuse purulent leptomeningitis.
From what has been said the prognosis also is apparent.
Treatment.—The therapy is as yet hopeless. Neither depleting by purgatives, nor reducing the blood supply of the skull, especially in the region of the mastoid process, nor counterirritation of the scalp by irritating ointments (inunetions with ung. tartari stibiati, P.G.), nor the local application of cold, cause tangible curative effects. The value of repeated lumbar punctures is likewise problematic, although a priori it seems rational to evacuate as much as possible of the pus and, by reducing intracranial pressure, to improve circulation and absorhtion. As the example of influenza meningitis has demonstrated, in many cases free employment of the puncture fails, while in one ease (Langer) the withdrawal of a minimal amount of purulent fluid seems to have ushered in the improvement.
Major operations on the skull come into question only when primary pus foci in the vicinity of the meninges can be exposed and thereby eonstant or intermittent reinfection of the pia rnater obviated. This holds good therefore especially in otogenous purulent meningitis.
When the diagnosis of purulent meningitis is established by all know-n methods, our efforts must be confined to the alleviation of the most distressing symptoms, which terrify the beholders. Chloral in large doses-0.5-1.0 Gm. (7-14 gr.) for an infant—in elystnas, and morphine appear to us better than baths, etc. Nothing remains to be done but to strive for euthanasia.