A Survey of Recent Developments in the Treatment of Pneumococcal Meningitis.

Doctors cure few diseases. When even an occasional patient begins to recover from a disease which previously carried 100% mortality, an impressive advance has been made, and when, later, such patients are actually expected to recover, then medicine may claim a triumph. This has happened with regard to pneumococcal meningitis. Pneumococcal meningitis is not common, and no large series of cases have been described in Great Britain except those of Cairns and his co-workers at Oxford (Cairns et al., 1944; Smith et al., 1946). These particular reports were not fully representative of the general run of cases for at least two reasons; first, the great majority of these patients were adults, many being members of the armed forces, and secondly the treatment was carried out by a highly skilled team with the finest possible neurosurgical skill constantly at hand. For this reason, and bearing in mind that single cases are still being published, it was considered of interest to collect and analyse case records from different hospitals over the period of modern chemotherapy, tacing the changes in mortality rates as different agents were used, and then attempting to assess the present therapeutic value of penicillin and the most judicious method of its employment. For this purpose the records for the 11 years 1938-1948 of four large hospitals in Birmingham have been used. Several of the more recent cases have been seen personally. Before reviewing the Birmingham cases