Observations on three hundred cases of acute meningitis in infants and young children / L. Emmett Holt.

  • Holt, L. Emmett (Luther Emmett), 1855-1924.
Date:
1911
Catalogue details

Licence: In copyright

Credit: Observations on three hundred cases of acute meningitis in infants and young children / L. Emmett Holt. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    puncture, it is evident that tuberculous meningitis is very much more frequent than would appear from vital statistics of the country generally, or even those of New York City, and that a large number, probably the great majority of the cases put down as simple meningitis, and many of those recorded as cerebrospinal, are really tuberculous. COLON MENINGITIS Beginning with the smallest group I wish first to mention a case of meningitis due to a bacillus of the colon group which occurred in a baby only four weeks old. The child was admitted for an Erb’s palsy and malnutrition. The usual symptoms of meningitis developed: tempera- ture up to 103 F., leukocytosis of 13,000, general hyperesthesia and rigidity. A purulent fluid was drawn by lumbar puncture which showed a pure growth of a bacillus of the colon group. The illness lasted ten days. There were no symptoms pointing to visceral lesions elsewhere, but no autopsy could be obtained. In private practice I have seen one other case of meningitis in which the only growth from the cerebrospinal fluid was a bacillus of the colon group. This also occurred in an infant four weeks old, who had previously suffered, it was reported, from a urinary infection due to the colon bacillus. The child recovered from the acute symptoms, but developed a secondary hydrocephalus. INFLUENZA MENINGITIS Thus far four cases of meningitis due to the Bacillus influenza have been observed; all of which have occurred during the last year. Clinically this form resembles the meningococcus cases and it is only by lumbar puncture that a differential diagnosis can be made. These cases are not common. I have seen but one other in private practice. Dr. Flexner tells me that he has had a considerable number of fluids sent to him with clinical diagnosis of cerebrospinal meningitis which contained only the influenza organism. All these ended fatally, as well as those which have been personally seen. It is my belief that this is the almost invariable termination. In three of the four cases that have come under my observa- tion the B. influenza was obtained by cultures from the bronchial secre- tion during life, and in two, in which examinations were made, it was also obtained by culture from the nasopharynx. This would suggest the nasal mucosa as the port of entry. In three cases examined the organism was found in the blood. One recent case had some features of unusual interest. An infant of eight months was admitted to the hospital with an acute abscess of the left elbow. Cultures from the pus on ordinary media gave no growth; however, on blood-agar a pure growth of the B. influenza was obtained. The child shortly after developed acute men-