Treatment of Cerebrospinal Meningitis
Authors: W. J. Roche, C. J. McSweeney
Journal: BMJ (1939)

The limitations of serum in the treatment of cerebro spinal fever affecting the youngest age group of the popu lation have been known for many years. In their classical work on cerebrospinal fever Worster-Drought and Kennedy (1919) give the mortality for cases under 21 years as over 75 per cent., and the published statistics of other authors have in the main agreed with this figure. At Cork Street Hospital our case mortality in past years among this age group conformed to the accepted rates in spite of daily spinal drainage and intensive intrathecal serum therapy. A definite improvement followed the introduction of sulphanilamide, which since 1937 had been used as an adjuvant to intrathecal serum therapy, but still the ge,neral mortality rate for the cases was 57 per cent. Then last autumn came M & B 693. Its intro duction to Ireland happened to synchronize with the assumption by one of us (W. J. R.) of duty as resident medical officer at the hospital. We began to use M & B 693 at the same time as we decided to abandon the orthodox intrathecal route for serum administration. The results obtained showed a dramatic improvement. Not only did ten out of eleven consecutive cases recover (five of these patients being under 1 year of age, and all, except one, being infants or young children), but the clinical improvement in the individual cases was considerably speeded up and none of the successful cases developed any permanent disability. The case mortality in the under 1 year group was actually reduced from 78.26 per cent. among a series of forty-six cases treated by the  methods to 16.66 per cent. in a series of six cases treated by the new. A remarkable feature was the complete absence of hydrocephalus, which hitherto had been a very frequent occurrence in recovered cases of posterior basic meningitis. The one death in the series occurred quite suddenly from respiratory failure when the child seemed to be responding to treatment. This phenomenon of sudden respiratory failure during the acute stage of the disease is well attested. Worster-Drought and Kennedy (1919), quoting Fairley and Stewart, mention that it occurred no fewer than nineteen times in one series of cases. It is obvious that no method of treatment, however efficacious, can be expected to eliminate the risk of this chance happening. It has to be admitted that the series here reported as treated by the  new method  is very small as compared with the large number of cases treated by intrathecal serum. For this the time interval since the introduction of M & B 693 is alone responsible. In the seven months which have elapsed since that drug became available in Ireland all cases admitted to Cork Street Hospital have been treated with it and the intrathecal route of serum avoided (the  new method ). For nearly two years before October, 1938, all our cases received prontosil album and/or soluseptasine, with intrathecal serum fol lowing daily spinal drainage (the   method ). For the two years previous to that (1935 and 1936) the treatment was the same as the intermediate without ihe addition of sulphanilamide in any form (the old method '). No element of selection was observed at any stage: all the cases of confirmed cerebrospinal meningitis treated in the hospital since January 1, 1935, are included in this survey. One of us (W. J. R.) was personally responsible for the detailed treatment of all the cases in which the  new method  was used.