Before undertaking a more detailed consideration of our patients who suffered from staphylococcic infection of the meninges, we have presented a review of staphylococcic meningitis 1 as reported in the literature. We were able to find records of 48 acceptable examples of recovery from this disease, a number sufficiently small to indicate the malignant nature of this localization of staphylococcic infection. We plan to discuss now the patients with staphylococcic meningitis for whom we have been privileged to furnish bacteriophage service, including in this discussion not only those who had a recognized invasion of the blood stream, so as to belong in our series of 500 patients with staphylococcemia,2 but also patients suffering from meningitis without adequate evidence of staphylococcemia and hence omitted from the series with sepsis. The patients included in this series with staphylococcemia will be designated by their appropriate serial numbers. In the present paper we purpose to present the records of 10 patients who recovered from meningitis and of 1 additional patient who apparently recovered from meningitis and was discharged from the hospital but succumbed later to an abscess of the brain. The case histories of some of these patients have already been recorded in the literature, and some of them will be found not wholly acceptable as examples of diffuse inflammation of the leptomeninges. Each of them, however, may teach a lesson in regard to the difficult problem of staphylococcic meningitis.
Staphylococcic meningitis is a disease of such malignancy that every carefully observed case terminating in recovery should be fully reported to aid in the care of future victims of this malady. We intend to present the records of a considerable number of patients who have suffered from this disease, including several who survived. These are patients who have received our bacteriophage service during the last ten years. Before proceeding to the discussion of our own experience in this field we purpose to undertake a review of the more significant recorded observations from the time when drying of the spinal marrow and accumulation of bile were regarded as the causes of spasms and paralysis, through the period when purulent exudate in the membranous coverings of the brain and cord was recognized as a feature of these disorders and the later period, when the infectious activity of specific microbes came to be appreciated in the causation, to the modern era, in which precise recognition of the etiologic agent, be it spirochete, mycobacterium, neisseria, streptococcus, staphylococcus or filtrable virus, supplies the most significant evidence on which to base prognosis and therapy.Throughout the review an attempt will be made to focus the attention on staphylococcic meningitis, more or less definitely recognizable as such, and in the later years to give attention particularly to the examples of recovery.The signs and symptoms of meningitis can be recognized only with difficulty in the descriptive writings of Hippocrates, where passages which may relate to meningitis are obscured by association with descrip¬ tions of signs which are obviously unrelated, such as the following:The third form of consumption. In this form the patient's spinal marrow becomes full of blood and bile. Likewise he wastes away also from the hollow veins,
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