Studies of the Cerebrospinal Fluid Circulation in Tuberculous Meningits in Children: Part I. The Use of Penicillin as a Tracer Substance

Tuberculous Meningitis

“…Cathie (1950) regards the following signs as demanding a ventricular tap, namely increasing drowsiness, papilloedema, intractable vomiting or the occurrence of fits. (d)Pneumo‐encephalography. This is claimed by Lorber (1950 and 1951) to be the best way to visualize blocks within the cranium, and the method is well tolerated by sufferers from the disease. In a study of fifty‐eight children by this means, he was able not only to locate the site of blocks when these were present, but also to demonstrate ventricular dilatation.…”

“…In the event of a developing spinal block the lumbar‐cisternal protein ration is further raised and becomes greater than 2.5 to 1. There may also be significant differences in pressure (Lorber, 1950). (b)Penicillin and streptomycin levels in the cerebrospinal fluid may be used for detection of an incipient block, in which case there will be a concentration gradient between samples taken from different sites. (c)Clinical deterioration.…”

“…Unless a block to the cerebrospinal fluid circulation is present, lumbar injection of streptomycin will achieve complete mixing of cerebrospinal fluid and streptomycin within ten minutes (Lorber, 1950). For uncomplicated cases therefore any other route is unnecessary.…”