1919 Journal of the American Medical Association  
It has long been known that in the course of an epidemic cerebrospinal meningitis an obstructive hydrocephalus may develop, either acutely at the height of the disease, or as a sequel after the subsidence of the acute symptoms. This was observed clinically and verified by necropsy as far back as 1865, when Ziemssen and Hess1 published the first reports. These observations were confirmed by Hart2 and Heubner.3 The cases were all fatal, and the main interest in the subject was from the pathologic
more » ... from the pathologic standpoint. Not until 1907, when Koplik4 revived the discussion of the question, was there any suggestion that direct therapy might be efficacious. He made the symptoms pointing to internal hydrocephalus, namely, headache, vomiting, unconsciousness and convulsions, and Macewen's sign, the indications for the treatment of the meningitis by repeated lumbar puncture to drain the ventricles. His cases were all in children, and he laid stress on the remitting type of the symptoms when this complication developed. The following year, Cushing and Sladen5 reported a successful case of intraventricular injection of antimeningitis serum in a child of 6 months in which Diplococcus intracellularis was found in the ventricu¬ lar fluid, but not by lumbar puncture. They also refer to a case of puncture of the lateral ventricles by Sowers in an adult with great improvement for eight days. The choked disks and headaches subsided, consciousness was regained, and the temperature returned to normal ; but the patient died suddenly and unexpectedly, and postmortem examination revealed a thick membrane closing the outlets of the ventricu¬ lar fluid in the neighborhood of the fourth ventricle. The lateral ventricles were distended and contained a purulent fluid, while the ependyma showed a granular inflammation. They suggest that in certain other instances of ventricular obstruction in the acute stages of the disease, even in adults, ventricular puncture might be advisable, and if organisms are present in the ventricular fluid, serum might be administered directly into the ventricles. Fischer,6 in 1910, reported a similar case with recovery, and likewise emphasized the intraventricular injection of the antimeningitis
doi:10.1001/jama.1919.02610040010003 fatcat:exziwtiplzcx7kyhi3hmdhipvi