The present position regarding the treatment of tuberculous meningitis in children.

The present position regarding the treatment of tuberculous meningitis in childhood is that parents can be offered a go per cent. chance of complete recovery. This transformation is due to the introduction of streptomycin and isonicotinic acid hydrazide. Whereas streptomycin first changed a uniformly fatal disease to one with a mortality of 70 per cent., isoniazid has made it possible to press home the advantage so that 95 per cent. of early cases recover. A long distressing illness has become short. Treatment in the later stages can be continued at home. Tuberculous meningitis can now be considered in similar terms to pyogenic meningitis. This progress has been illustrated by the experience of Professor Debre1 who recently reviewed groups of children treated by different routines. I947-Short interrupted courses of streptomycin: 93 cases; 66 deaths; 29 per cent. survival. 1952-Streptomycin continuously for long periods. Intrathecal treatment for many months: 309 cases; I24 deaths; 6o per cent. survival. I952-54-Streptomycin as above + Para-amino salicylic acid + isoniazid: 220 cases; 39 deaths; 82.5 per cent. survival. Further analysis of the third seiies showed a survival rate of 95 per cent. in children over five years of age and 76 per cent. in children between two and five years. Infants still suffer a mortality of 35.5 per cent. Debre quotes other workers (Torres Gost; Ragazzini; Guisti and Cocchi; Choremis; and Fouquet) all of whom have achieved similar survival rates using isoniazid with streptomycin. Lorber2 quotes a survival rate of 95 per cent. of 20 children treated in Sheffield in 1954 and a rate of 85.5 per cent. of 69 children treated during 1952-54. In another paper Debre3 further demonstrates the improved results obtained by the use of isoniazid from the start of treatment. The survival rate in such cases was 96.3 per cent. compared with 8o per cent. in children for whom isoniazid was an addition to a primary course of streptomycin and PAS.