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
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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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    ingitis and died from the disease. The cerebrospinal fluid during life and the cultures from the meningeal exudate at autopsy showed a pure growth of the B. influenza. MENINGITIS FROM PYOGENIC ORGANISMS The common pyogenic organisms, streptococcus and staphylococcus, have been very infrequently found by me as the cause of meningitis. They were present in but ten cases. In one other a streptococcus infection complicated a tuberculous case. It is rather striking that six of the ten cases occurred in newly-born children, and that in five the meningitis was secondary to spina bifida. In one it followed an operation on a hydrocephalus, and in only two cases did it occur under conditions resembling a primary inflammation. In one case, in an infant three months old, the autopsy showed encephalitis as well, and the streptococcus was also found in the heart’s blood and lungs. Clinically this form of meningitis was characterized by severe general and local symptoms and a rather rapid development, with always an unfavorable termination. Since so much has been made in medical liter- ature of the association of otitis media and mastoiditis with acute menin- gitis, my experience on this point may possess some interest. I saw meningitis develop but once after otitis or its complications. This patient was a baby fifteen months old who had had a double mastoid operation done in Europe. Dressings had not been changed from the time the child had sailed until she was admitted to the hospital, a period of nearly two weeks. At that time they were very foul and the wound in bad condition, and the child desperately ill. Symptoms of acute meningitis developed and the child died in the course of a few days. The autopsy, however, showed the meningitis to be a tuberculous one. A caie- ful examination showed no connection whatever between the mastoid lesion and the one in the meninges. My experience leads me to question whether the dangers of meningitis from cases of otitis or mastoiditis are as great as they have been represented. I have always in the hospital wards many cases of acute otitis and a moderate number of these patients develop mastoid complications. However, on by no means all of them is the mastoid operation done. I am, therefore, led to the opinion that so far as patients of this age, chiefly under two years, are concerned, menin- gitis from a neglect to perform the mastoid operation is one of the rarest occurrences. MENINGOCOCCUS MENINGITIS It is not my purpose to enter minutely into a study of the twenty-four sporadic cases of cerebrospinal meningitis which have occurred since the great epidemic nearly five years ago. The number is too small to admit of any generalizations. Fourteen children received serum treatment, of