H. influenzae meningitis.

Tie treatment of influenzal meningitis, particularly in a young child, was usually unsuccessful before the introduction of the sulphonamides, serum, and antibiotics. These agents have altered the prognosis, but the choice of one or more of them is not easy, nor is the success attending each invariably predictable. Tlis uncertainty of therapeutic response is much greater in cases which are diagnosed late or have received inadequate treatment. Alexander (1947) says that the sulphonamides, serum, and streptomycin, used singly, are all effective agents in certain circumstances. She concludes, however, that except in special institutions all of them are indicated simultaneously in a severe case, paricularly as residual cerebral damage may be less after such combined treatment. Alexander found that sulphonamide and antiserum were equally effective in protecting mice, but that together they exerted a pronounced synergistic action; she also found sulphadiazine, sulphathiazole, and sulphamerazine of approximately equal efficacy, although she employed mainly the first. Streptomycin was found to be the most potent agent against H. influenzae, though not adequate alone in the most severe infections; its use is limited by its toxicity and by the readiness with which the organism becomes drug-fast (Lancet, 1948). She found penicillin relatively ineffective at concentrations usually attained. It is not totally ineffective, however, and the supply of streptomycin and antiserum is so precarious in this country that penicillin is usually employed here. Gordon and Zinemann (1945) pointed out that many strains of H. infle are relatively sensitive to large doses of penicillin. Successful results have been obtained by this means by Forgacs et al. (1945) in one out of two cases, McIntosh and Drysdale (1945), Drysdale et al. (1946), and Gerrard (1947) in single cases, and by Gottlieb and Forsyth (1947) in three out of four cases. Thomson et al. (1947) used sulphonamides with penicillin intramuscularly and intrathecally with three cures out of four. Unlike Alexander, they found no close relationship between the clinical response to a drug and the in vitro sensitivity of the organism to that drug. 205 The case here reported ran a long course, and was treated with every available drug, with ultimate success. We believe that in this case the administration of anti-influenzal rabbit serum was the deciding factor in bringing about recovery. The findings in the cerebrospinal fluid showed a remarkable difference after the antiserum, which fortifies our belief that recovery thereafter was not coincidental.