Non-tuberculous meningitis.

of such a degree of hydrocephalus that there seems to be scarcely aiy brain substance left. In many cases of tuberculous meningitis streptomycin seems to maintain the condition of the patient when treatment was commenced, but little subsequent improvement is seen. Such experiences support the case for the inclusion of some adjuvant antibacterial agent with the streptomycin, in the hope that a synergistic action such as is seen with sulphonamide and penicillin might be found. Finally, it must be realized that the streptomycin treatment of tuberculous meningitis cannot be lightly undertaken. Apart from full laboratory facilities for controlling the clinical pathology of a case much extra nursing is required, continuous medical supervision is necessary, and from the patient's point of view there will be a course of intramuscular injections lasting for six months or more, apart from intrathecal and general supporting treatment. Only the fullest and continuing co-operation of everybody concerned can give streptomycin treatment the fair trial it deserves, and even in the most successful cases with apparent cure, prolonged subsequent observation is necessary owing to the possibility of relapse.