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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    During the last five years lumbar puncture has been performed about one thousand times. After simple lumbar puncture no accidents have occurred; there have been no alarming symptoms, and no case of infec- tion. However, in a single instance in which repeated injections were made in a case of cerebrospinal meningitis for the injection of Flexner’s serum, secondary infection did occur, in spite of routine aseptic precau- tions. This is a warning which should be heeded. In another child suffering from cerebrospinal meningitis an alarming collapse followed the injection of 35 c.c. of serum. The fluid was warmed and the injection made in the usual manner, but the child came near dying and was rescued only after the most strenuous efforts. Aside from these two cases my experience has been without special incident. Too much, therefore, can hardly be said in favor of a systematic resort to lumbar puncture as a means of diagnosis in cases of meningitis; but it is a procedure requiring considerable skill and necessitating as strict asepsis as any surgical operation. SIMPLE MENINGITIS Before passing to a consideration of the different groups of cases which have been enumerated, I should like to say a word concerning “simple meningitis,” a term formerly much used and one which still figures largely in vital statistics. In most such reports three forms of meningitis are given: tuberculous, cerebrospinal and simple. Some give only tuberculous as a separate class, combining cerebrospinal and simple. In the U. S. Census Beport of the registration area for 1908 there are mentioned 71,229 deaths from meningitis in the five years 1904-1908; 25 per cent, of these are classed as cerebrospinal; 26 per cent, as tuberculous, and 49 per cent, as “simple or unqualified.” In this same report, of 6,902 cases of meningitis occurring in the first three years of life in the year 1908, 32 per cent, are classed as tuberculous. In the New York City report for 1908 there are recorded in children during the first three years of life, 819 deaths from meningitis, divided as follows: Tuberculous 448 or 55 per cent. Cerebrospinal 188 or 23 per cent. Simple 183 or 22 per cent. Previous to the period here considered the diagnosis of “simple menin- gitis” appears in the hospital records in twenty-three cases. It was at that time our custom to contrast such cases with those which were tuberculous. At present the group “non-tuberculous” meningitis has been pretty well differentiated. The term “simple meningitis” has no longer any significance and should be dropped. There is not the slightest doubt that the largest proportion of cases so classified belong in the tuber- culous group. From experience in the hospital, where careful differential diagnosis of the different forms of meningitis has been possible by lumbar