The late sequelae of pneumococcal meningitis.

Before the advent of effective chemotherapy, pneumococcal meningitis was not only a fatal disease, but one that ran its full course with great rapidity. Cases invariably came to necropsy within 10 days of the onset of the illness and usually very much sooner (Cairns and Russell, 1946). Although sulphonamides alone had little effect on the ultimate mortality the infection was often partially suppressed and the speed of the disease slowed down. When, however, penicillin became available the prognosis was revolutionized. In 1943 a trial of penicillin in the treatment of pneumococcal meningitis was initiated at Oxford by the late Sir Hugh Cairns: the value of penicillin was quickly established (Cairns, Duthie, Lewin, and Smith, 1944) and by combining it with sulphonamides the mortality was reduced to the order of 10% (Smith, 1951). Moreover, in certain unsuccessful cases death only occurred after illness lasting weeks or months. In parallel with this modification of the clinical picture the necropsy findings also altered, and particularly those with regard to the vascular changes (Cairns and Russell, 1946). In 1944, at a time when the limits to what might be achieved with chemotherapy were still unknown, a child was admitted to the Radcliffe Infirmary, Oxford, who had already been ill with pneumococcal meningitis for some weeks and had developed the syndrome of posterior basic meningitis of infants (Gee and Barlow, 1878). After a long and difficult illness the infection was eradicated and the obstructive element in the hydrocephalus relieved. This was one of the few cases in which useful recovery was not achieved (Smith, Duthie, and Cairns, 1946), and the child survived as an idiot until 1955. We consider that this case merits a full description since, in our experience, it is unique both in regard to the survival period and the necropsy findings, which latter exemplify the end-result of a disease process that has hitherto been studied only in the active stage.