Acute purulent meningitis in infancy and childhood with special reference to late manifestations
Galloway, William Hugh
In 1951 Trolle stated that the general impression in Infectious Diseases' Hospitals was that practically all the patients were discharged mentally normal. He went on to say that there had been some disagreement as to whether this was so or whether cerebrospinal meningitis might have left lasting mental sequelae. Alexander (1952) reported that because of the widespread policy of using antibiotics for fevers of all causes and the growing tendency to use more than one therapeutic agent, pyogenic meningeal infections were seldom fatal. On the other hand, more children with cerebral damage were surviving. Nelson (1959) wrote, "The decrease in mortality from purulent meningitis has been attended with a significant increase in permanent and serious neurological and mental sequelae. The reduction in them is one of the problems of the moment." The purpose of this thesis is to see how a series of children in the North-East of Scotland suffering from purulent meningitis have fared, It is generally accepted that the mortality from all forms of purulent meningitis has fallen considerably since the pre-sulphonamide period. This may be due to earlier diagnosis and the institution of therapy with newer antibiotics and other chemotherapeutic agents. Despite this happier outlook as to life and death, recent reports have shown that, although the grosser neurological defects are fewer, a considerable number of children are left with evidence of brain damage such as emotional instability, impaired memory, undue restlessness and inability to concentrate (Trolle, 1951)• Because of these sequelae many children have been rendered ineducable at ordinary schools. It was decided to see how the children in the present series had fared, and what sequelae they showed. Were they due to their illness entirely, or were there other factors such as environment and heredity playing a part? One way to tackle the problem was to ask specific questions as to his scholastic attainment where the patient was of school age. The school he attended was contacted and the schoolmaster was asked to report if the child was in a class for his own age and if progress was being maintained. A comment on his behaviour was requested and also whether there was any evidence of deafness. By asking these simple questions, it was thought that this would overcome the necessity of having to interview and assess all members of a family. This would have been very difficult to do, first because a large part of this study is retrospective, and second with the normal movement of families, contact with many would have been difficult. In an agricultural area like the North-East of Scotland* many families make many moves* thus making follow-up difficult. The majority of the pre-school children have been seen personally, but in some instances the opinion of the family doctor has been obtained regarding the child's mental and physical status.