Size and Visibility of the Filterable or Virus Bodies
Authors: A. C. Coles
Journal: BMJ (1941)

OUAL507Case 24.-This patient appears to have died of a complication of the unconscious state, possibly due to inhalation of infected material, rather than from the meningitis itself.Cdse 31 acquired a particularly lethal and rare complication- suppurative pericarditis.There were no deaths among those who were seen during the first week of illness and who remained free from serious secondary infections of the viscera.For these reasons more than for the simple statistical fact of a low mortality rate on a limited series of cases, I feel justified in believing that sulphonamide E.O.S. has a pronounced curative action in this disease.Very diverse figuires have been published by other observers using different remedial agents.This diversity is readily understood by anyone who has worked among these patients.The mortality rate is affected greatly by so many factors other than that of the cheniotherapeutic potency of the drug employed..It varies with the epidemic, locality, age distribution, the speed with which the diagnosis is made, the amount of medical attention which can be focused on each patient, and, above all, with the per- fection of the nursing care available.Superb nursing skill is required by delirious, comatose, or semiconscious patients.I know that I have been particularly fortunate in my house-physicians and nurses.The figures given below furnish a suitable basis for comparison.Epidemic 19 14-17 (pre-sulphonamide): 5,306 cases; mortality 65% These national figures were analysed by H. D. Rolleston (1919), who found in them evidence of a dwindling mor- tality as serum treatment came into more general use.Present epidemic, first quarter, 1940 (sulphonamides widely used): 4,388 civilian cases; mortality 23.7% Irndividual groups of smaller numbers but more unified medical control have yielded better results: 120 cases observed personally by Banks (1940) (sulphapyridine or other sulphonamides used in all cases): Mortality 10% 154 cases at Wrexham (Lancet, 1940) (various doctors) (sulphonamides widely used): Mortality 12.3%,' The mortality in the present series treated with sulphon- amide E.O.S.-34 cases (9 %)-is therefore closely in accord with the current figures.Summary A new sulphonamide of low toxicity and full chemothera- peutic activity in acute cerebrospinal meningitis is described.Less critical clinical data lead one to expect that it will be equally effective in combating infections due to B. coli and haemolytic streptococci.More extended clinical observations will probably reveal other fields of utility.In animals it controls acute infections due to Str. pyogenes and pneumococcus Type III, and chronic urinary infection by B. typhosus and B. paratyphosus A. Its low toxicity has been investigated by experiment on mice.The rarity with which in therapeutic dosage it provokes unpleasant side-effects in man has been demonstrated by a clinical survey of 130 cases.It seldom causes vomiting, and malaise attributable to the drug is inconspicuous.It is hydrolysed in the body with the liberation of sulphanil- amide in situ, and is excreted in forms which are far more soluble than those following the administration of sulpha- pyridine or sulphathiazole.It possesses the convenient property of ready solubility in water.Neutral and almost tasteless pharmaceutical solutions can easily be prepared for administra- tion by mouth, rectum, or vein.