Cerebro-Spinal Meningitis

Kai Tiaki : the journal of the nurses of New Zealand, Volume VIII, Issue 4, 1 October 1915, Page 189

Cerebro-Spinal Meningitis

Lecture fay Captain Garfield Crawford to the Nursing Staff, New Zealand Military Base Hospital, Trentham, 17th August, 1915

In his opening remarks the lecturer stated that the subject of Cere bro- Spinal - Meningitis was indeed a very important one, aiid that it was impossible for him to deal with it fully during the short time at his disposal. He would, however, endeavour to put before his audience the most interesting aspects of the diesase. Definition : Cerebro-Spinal-Meningitis is a disease caused by a certain organism or germ called Diplococcus Intracellularis Meningitidis, which disease is characterized by inflammation of the membranes of the brain and spine. Causation : Diplococcus Intracellularis Meningitidis. This is the germ which causes the disease. It is "D !: shaped, occurs m pairs and found most commonly within the cells which form part of the cerebro-spinal fluid. These germs are found m the cerebro-spinal fluid, m the throat, back of the nose, stomach and intestines, tissues of the brain and m the blood. Predisposing Causes : (1) Climate : — The disease occurs chiefly m the winter months. (2) Overcrowding : — ln France thirtynine epidemics out of fifty occurred m barracks. (3) Youth : — Seventy-five per cent, of cases occur m people under twenty years of age, though, of course, m the Service, the age average is necessarily higher. (4) Exertion and Fatigue : — Many cases occur after patient has been subjected to severe exertion or fatigue. (5) Injury to the Head :— ln many cases some recent injury to the head has been sustained. . Means of Infection : Cerebro-Spinal-Meningitis is seldom spread by direct infection, but nearly always by means of 11 carriers," i.e., by a third person, who,

strange to say, does not, as a rule, become affected by the disease, but is the means of carrying it to someone else. As an example of this the lecturer quoted an instance where five men were working m a dock-yard on a certain ship, from the bold of which pure cultures of the germ were obtained. Not one of these men became affected with Cerebro-Spinal-Meningi-tis, but they all (i canied n it from the hold of the ship to their children, seventy-five per cent, of whom died. How the Germs Get into the Blood : (1 ) The germs get into the blood either from the back of the throat, or from the intestines. (2) From excoriation of the skin, by scratch, or mosquito bites, etc. Having got into the blood the system generally shows signs of infection, but more particularly the membranes of the spinal cord and brain. Period of Incubation : Period indefinite — usually from two to ten days. Sometimes the period is of shorter duration, and, again, cases have been recorded where there has been an interval of from three to four weeks, or even longer, before the patient has shewn symptoms of the disease. Symptoms : (1) Invasion : Suddenness of attack ; often preceded by a headache, feverishness, feeling of nausea and vomiting. Tenderness and stiffness m back of neck. Epistaxis. Patient often becomes unconscious. (2) Acute Stage : The acute stage of the disease may last only for a few hours, or for two or three weeks. The longer the patient remains m this condition, the worse the prognosis. The patient becomes flushed, usually lies on his side, coiled ur> m bed with bedclothes drawn over him, and resents being moved. Eyes usually, closed, intol-

erant to light, with pink, steamy conjunctivae. He. frequently moans and calls out. Mania . and delirium are often ptesent. Headache is intense, usually at back cf head, but sometimes confined to frontal region. Infection, m latter case, has then spread up through nose. Rash appears on third or fourth day, and varies m character . Commonest type of rash occurring at Trentham is the purpuric or port wine (spotted^ rash. Scattered over various parts of body, usually commencing on uppe:: arms, and spreading to lower limbs and body ; size varying from typhoid spot to an area the size of a hazel nut ; m most serious cases rash more extensive and, m fatal cases, has been the size of a large orange or even larger. Herpes is present m thirty per cent, of cases, usually on upper lip, and, m some cases, it was present on left ear. Broncho-pneumonia often sets m. Kernig's sign nearly always present. Incontinence of urine and faeces common. Termination by death may ba very rapid, sometimes m two, three or four days. These are the chief symptoms m the acute stage The end of the acute stage is either death or chronic stage. Chronic Stage : May last from three to four months, or longer. Emaciation (though greedy for food, loss of flesh is appalling). This is due to the upsetting of the nervous digestive centre. Temperature irregular- — for three or four days more or less normal, then suddenly may rise to 102 or more. Mental condition varies, sometimes the disease leaves mental weakness. Vomiting very troublesome at times, and is not a good, symptom when it comes to prognosis. Contraction of muscles of the face, risus sardonicus is often present. Convalescence usually very slow, with common tendency to re]apse. Kernig's sign the last to go. Whole duration of Disease m NonFatal Casks : This varies accoi cling to the severity of cases from thiee weeks to three or four months, or even longer. Complications: . (1) Broncho-pneumonia, often fatal (as m case " G "). (2) Deafness: duo to inflammation .or affection of the auditory nerve ;":. . (as m case "W."). (3) Eye : Ulceration, with possible loss of sight, (as m case " P "), (4) Trophic sores : usually on lower

limbs or back (as m cases " P " or:"W"), (5) of joints which may result m formation of pus (as m case "D"). (6) Relapse : already referred to, (as m casts " R " and " M "). (7) Paralysis — of different muscles, e.g., of face, arms, legs (as m cases " D " and "M"). Mortality of Disease : This varies according to virulence of attack. Fifty per cent., since treatment by serum and vaccine has come into vogue, is not a high estimate. Prognosis or Outlook : Is worse the more abrupt or severe the onset. Persistent vomiting m the chronic stage is a bad sign, as are also continued drowsiness and relapses Treatment of Cases : (1) History : The lecturer dealt with one or two special points. It is highly important that all information regarding the patient be obtained as soon as possible — the history of case, from patient himself (if able to give it) or from relatives, or those who brought him m; his next of kin and their address, the. exact hut or tent from which he came, also his regiment. ' . (2). Isolation : Nurse -in-charge to insist on observation of rules for isolation. Practically the same as are enforced at Trentham — -the wearing of mask, overalls, noiseless slippers ; - use of nasal douche and gargling of throat by nurses and orderlies, and also the taking of .formamint tabloids. (3) General : Mouth, teeth, nose, throat and eyes must be thoroughly cleansed at regular intervals throughout the day. The tongue must be kept thoroughly clean. Skin bathed and washed twice daily, special care being taken with regard to the back to guard against bed sores. Care with regard to urine and motions. Sanitary precautions must be strictly enforced with regard to all excreta. The lecturer particularly referred to care m direct application of hot water bottles, as the skin is very sensitive and can easily be. injured. (4) Serum and Vaccine Treatment : (a) The Serum used is obtained from an originally healthy animal, usually a horse, which has been gradually poisoned with the meningitis poison and then bled. The scrum is collected from the blood, and put up m sterilised bottles. This serum, is then

injected, after lumbar puncture, directly into the spinal -canal, and its action depends on the fact that it endeavours to break up the germs of meningitis and thereby destroy or kill them. _ (b) Vaccine is obtained from the patient himself. The meningitis germ having been isolated from the patient's nose or throat, or from his cerebro-spinal fluid, is grown upon a suitable medium and , emulsified into vaccine ; these vaccines are then, m certain doses, injected subcutaneously into the patient, and their action depends upon the fact that they help to. strengthen the patient's . blood m its fight with the meningitis poison. (5) Lumbar Puncture : Lumbar -puncture is, m almos + all cases, essential, and always

when the pressure signs are present. (The lecturer here showed three bottles containing fluid, taken by means of recent lumbar puncture of- three separate cases. He explained the method used, and showed needles employed. The needles are inserted bebetween 4th and sth lumbar vertebrae. After the fluid is taken away the serum is injected. Before this injection is performed the spinal canal is often washed out with saline. In no case must more serum be injected than the amount of cerebro-spinal fluid withdrawn. (6) Electricity and Massage : It is advisable to tone up the muscles of the patient by means of massage and electricity. If paralysis is threatening, the treatment is very helpful. ■ „