THE TREATMENT OF EPIDEMIC CEREBRO-SPINAL MENINGITIS
BMJ (Clinical Research Edition)
L6 T1;AiJU1 ] EPIDEMIC CEREBRO-SPINAL ENIN ITIS. IFEB 27 I9rg cough and nio oetpe-toratl'on. Ani effective pneumothorax bas enablel tllis soldlier, wlho a few years ago Aas attacked with tuberculosis, to takve part in a campaigni for a mlontl niuider extL'einy ti'ving circuImstances, and it still finds hiiii in excellent liealtlh after such experioelce. At the fronit tuberculous soldiers are not found in thle linie of tlie Allies alone. Tlley are just as nuiuerouls, if nlot mtiore so, amilonlg
... tiore so, amilonlg tlle Geirmans. InI tlhe TiMC8 of Februiary 13tl' Ey6-Witness," whlo is at present withi 'General Head Quartelrs, in' describing operations at La Bassee, says: It lhas alreafly beenii miienitioned that some of the prisoners captured by uis latelyhav-e been of comparatively poor physique. In tOis coiinexioni it is interesting to note that during the last few dlays a dead Germana was founid having two metlical certi-ficate8 in hiis pocket statiln that lie was suffering from consuimption. They are hoth signed by a doctor and are accompanied by ani application from the father that his son should niot be senlt oni active service as he was suLfferinig from lung trouble. No doubt the conditions under whlichl tlhe present war is beinag carried on are muore lhygienic tlan in previous campaigns, but tlle plhysical lhardlslhips and the mental strain are greater. Tllere is little leisure, little clhance of physical repose unless whlen thlc men are in tlie trenches, and even then not always. Tlle interesting point is tllat men who are the subjects of tuberculosis hlave been able to undergo all tlle hardships of war, and that in the case of the Frenclh and Britisil soldiers whose cases I hiave detailed they lhave passed througll battle unscathed. A circumstance such as this, by robbinig tuberculosis of some of its terrors, ouglht to carry hope into the breast of many a tuberculous subject anid let himin feel that hiis day of isefulness has not yet come to a close, but that he is capable of undertaking outof-door employment even of a lharder nature than as a profession we lhave hlitherto been disposed to allow. This abilitv toencldure says mLuchl for the present treatment of pulmonary tuberculosis by sanatorium and thle open-air metlhod, and is also strong evidence in support of the treatmenit of suitable case,s by tlle production of artificial puieulmiotlhorax. REFERENcE,. IN vieW of tlle cases of cerebro-spinal fever oceurring in the army alnd the sporadic cases wlhich are cropping up in different parts of Englalnd, I tlhink it miiay not be out of place to draw attention to the verv goodl results obtained by Drs. Sllireore and Ross in thie treatment of this disease by soaiiiin in Britislh East Africa. As tllis paper, whiclh was published in tlhe Transaictons of t'he Society of Tropical Medicine and Hygiene (vol. vii, No. 2, December, 1913, p. 83), Ilmay Inot be readily available by all wlo niay. be called uponi to tireat cases of this mnalady, I will quote fully fL'm it lhere. So far as I cani discover in looking uip the literature of the treatment of epidoimic cerebro-spinal nmeniingitis, the first person to use soamin was Dr. T. Arniold Jolhnston, senior house-physician, Leicester Infirmary. In' thle BRITISH MEDICAL JOURN-AL (January. 22nid, 1910, p. 193) hie reported having injected soalmiin intravenously in 2 cases of cerebro-. spinal fever, olne of whicll was very severe, and both of which leclecred. He was led to adopt this line of treat. nent because of the favourable results reported by officers of tlle R.A.S.M.C. in sypllilis whllen this drug was uised, and also by others in tryp)anosomiasis (sleepitng sickness). At thle e'nd of hlis paper the author says: That the recoveries were enitirely (due to the remedy cannot be proved from such a limiited nlimber of cases. The (lisease certainlv was influeniced by the inijections, and toie result compares favourably withi the reportedl cases of serum treatment in cases of eqtual severity, as describeed in the papers of Robb, Currie. anld Macgregor. As a treatment it is not expensive and the techlnique is simiiple. Epidemics of cerebro-spinal fever are not uncommon in tropical Africa; they hiave been reported in West Africa (Goldl Coast), Egypt, tlle Anglo-Egyptian Suidan, anid in Britislh East Africa. A well-nmarked epidemuic occurring in the last-namied cololny in 1913, Shircore and Ross were enabled to study the dlisease carefully and also to try on a larle scale the effects of different lines of treatnent. Tllree lmletlhods wvere adopted: (1) Soamin, (2) serunm, (3) lumabar pulncture. Here again the authors were lcd to try soamiiin becauise of its value in trypanosolmliasis, alnd also becau'se at fiist iio scruaml wa's available. Out of a total numuber of admissions to lhospital of 143, 127 were treated with tlhe drtug (though this is not stated, I believe it w-as iiijected intraniuscularly), 37 of tllese being malignant cases, or cases on the tlhird, fourth, or' fifthi day of the disease. Tlhose dying witliin 60 hours, thiat is, a little over two days after admission, are excluded; they never regained consciousness, and tlhougll in some a marked reaction to tlle soamin took place, death always occurred. Such cases the authors believe are beyond anly known line of treatmiient. Excluding the above, tlheln, the remainiing cases nulm-nbered 90, and of these 56 were discharged cured, wllile 34 died; this gives a percentage of 62.22 of recoveries. Clinically improvemnent in the symptolms was seen after tlhe injections, and researches on tlle cerebro-spinal fluid slhowed that tlhe meninhgococci were reduced or eveni, in some instances, disappeared. As regards the use of serum, tli's ivas fouund to be disappointing, and after thle value of soamin was demonstrated it was given up. Whhen one of thle authors unfortunately contracted tlle disease limnself tlhe question of administering serum was not even considered by his colleagues; the soaluin treatmient was adopted and hie recovered. Lu-mbar punctuLre was found useful in relieving lheadache and restlessness, ahld tlhe a'uthors' thought it miglt help the action of the soamin. Tllese restults lhave been confirmed bv Dr. Gilks, wlho also treated somiie cases of the disea'se in the same epidemic.1 Eihlit cases amonigst Europeans were treated, witlh only one deatlh. Treatmiient was in every case by intramuscular inijection of soamin, xWlich vas usuallv admilnistered in 5-grain doses on eachl of the first two days after commlencement, followed by 3-grailns on-the fourth day; wlhile, if irregular temperature persisted, boecasio'nal further doses were given. No bad effects occurred fronm the use of the drug. Thovgh .the diagnosis of all this series of cases reported by Gilks was not confirmxed. bacteriologically, yet there is no doubt from thle clinical signs that they were examples of the disease. An anialysis of this work wvould seem, thlen. to slhow that soamin has a distinctly beneficial effect upoil epidemic cerebro-spinal meniingitis, and, sucll being the.case, ali extended trial of it in cases now occurring mighlt, it is to be hoped, give results of considerable value. As soainin is a purer preparation than atoxyl its use is to be advocated. In the small doses giveni over tile short period indicate(d by Dr. Gilks, alid in those now often emiiployed in liuimian cases of trvpanosomliasis, there is apparently n'o danger, o0tic neuritis anid lesions of tllis niature only occurring whlien, large doses of the drtlg are given over prolonged periods. As regards the metlhod of administration, intramuscular. injections seemii fo act quite well, but perhiaps intravenous injection luay ultimately prove -to be better.. -A trial Onl large numilbers of cases would be required to decide this point. REFEISRENCE. East Africa Protecto-ate, AnLnal MAedtical Rleport for the year ending December 31st, 1913, p. 90. DR. SCUDDER, of Bostoln, Mass., writes in the Bosto)n Medical atnd Strgical -Joti-nat (Febrtuary 4th) oln time significanice of x-ray examliniation following operation for. congenital pyloric tumLour. Posterior gastro-eniterostollmy does lnot ensu-re the disappearance of the tumour, and in tlhree authentic cases the tumour discoveredI at tllc operation was detected within nine mlonths after a plastic operation. He collecte(d twenty-six cases in wlhichl x-ray examinations were miiade duringi the after-treatmnent. The tun-mour did not vanlis, or at least the pylorus r( in Lined obstructed, whlile time stomla was thec only exit bor the bism:uthl mIeal froml th)e sstomlach. He thinks thlat theo tumnour itself anld time changes in the mluco.sa explain thec obstruction in all1 cases, and that the hypothesis of pyloric spasm mu1st bve set aside.