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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1934
[Report of the Medical Officer of Health for London County Council]
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AN ANALYSIS OF A SERIES OF CASES OF MENINGOCOCCAL MENINGITIS.
By J. C. Blake, M.B., B.S., D.P.H., M.R.C.S., Senior Assistant Medical
Officer, Eastern Hospital.
This small series comprises the cases under my charge at the Eastern hospital
during the period from March, 1932, to the date of writing this article.
Nineteen patients were treated. Statistics from so small a number of cases
cannot be of much significance, but they may be of value when added to those
published by other observers.
It is intended in this article to emphasise certain points in the treatment of
this disease.
The death-rate in this series was 36.8 per cent. The accompanying table
gives the rate in age groups. The oldest patient treated was 29 years of age.
T able I.
| Age. | Number of patients. | Deaths. | Death rate per cent. |
|---|---|---|---|
| 0-5 years | 6 | 2 | 33.3 |
| 5-20 „ | 7 | 1 | 14.3 |
| Over 20 years | 6 | 4 | 66.6 |
The following facts are also given in tabular form for the sake of brevity:—
T able II.
| Average duration of illness. | Average number of days illness prior to treatment. | Average total dosage of serum. | Bacteriological findings. | |||
|---|---|---|---|---|---|---|
| Group I. | Group II. | Meningococcus present, but not isolated. | ||||
| Recoveries | 63 days | 6 . 1 days | 120 c.c. | 2 cases | 2 cases | 8 cases |
| Deaths | 15 days | 3.3 days | 100 c.c. | nil | 4 cases | 3 cases |
From the above table it would appear that the length of illness prior to treatment
is not necessarily a factor of importance in prognosis. This depends more on
the type of disease, as borne out by the fact that five out of seven deaths had purpuric
or petechial rashes on admission to hospital, whereas only one of the recoveries
developed a rash during the course of the disease.
The percentage of group II infections is unusually high.
Complications.
Complications were not frequent if transient cranial nerve palsies are excluded.
They comprised two cases of unilateral facial paralysis, one of ptosis, also unilateral,
one external rectus palsy, and one of diplopia in which no weakness of external
ocular muscles could be detected. Two cases of nerve deafness were observed,
both occurring during the first week of the disease. One made a complete, the
other a partial, recovery. One child, aged four, had marked spastic ataxy which
improved slowly. There was one case of chronic hydrocephalus. Arthritis accompanying
serum sickness occurred in two cases.
Treatment.
The multivalent concentrated serum obtained from the Lister Institute was
used in all cases, and the majority responded rapidly to its use.
In the earlier cases, serum was given by the intramuscular and intrathecal routes
only, except in one instance. Latterly, all cases received serum intravenously in
addition. I am now convinced that every case should be given serum intravenously,
even though the septicæmic symptoms are slight. It is my practice to give at least
two intravenous injections at eight to twelve hours' interval. In cases with purpuric
rashes, and other symptoms of general infection, intravenous therapy must be more
prolonged.
(36)