THE DIAGNOSIS AND TREATMENT OF MENINGITIS

Treatment of meningitis is no longer a question of the administration of antimeningococcal serum and awaiting results. Today there is at hand an ever expanding armamentarium of drugs effective on various bacteria, rickettsia and some of the larger viruses. The skillful use of these singly or in combination offers an excellent prognosis in most forms of bacterial meningitis. Tuberculous meningitis continues to present a poor outlook, but this has been improved with more intensive therapy. More effective agents are needed in the treatment of this disease.“Shotgun” therapy may be indicated in critically ill patients prior to accurate bacteriological diagnosis; it is more important that therapy should include an effective agent or combination of agents than to attempt to determine in advance the most potent form of specific therapy. Partially treated purulent meningitis may be confused with aseptic meningitis. There is at present no effective therapeutic agent for the viral meningitides, but the prognosis is favorable in most of these diseases without specific therapy.     

DIAGNOSIS AND TREATMENT OF JOINT TUBERCULOSIS

Tuberculosis of the joints is not a clinical oddity and a diagnosis of tuberculous infection must be considered in all joint lesions if diagnosis is to be made early. A history of insidious onset of pain, especially if accompanied by pulmonary symptoms or a history of contact with a tuberculous person, should alert the clinician to the possibility of this diagnosis. The tuberculin test, roentgenograms, culture of aspirated fluids and biopsy, by anthrotomy or punch, continue to be the standard procedures for establishing the diagnosis. The differential diagnosis must include the entire gamut of bone and joint disease.Chemotherapy combining streptomycin and dihydrostreptomycin with isonicotinic acid hydrazid and para-aminosalicylic acid is of extreme value in the eradication of draining sinuses and in the advancement of the ideal surgical date; but general physical and mental hygiene, rest and the prevention or correction of deformities is a continuing therapeutic necessity. Fusion of the affected area is advocated in almost all lesions although there is some hope that functioning joints may be preserved with early diagnosis, conservative surgical treatment and more efficient antibiotics. A postoperative regime similar to the preoperative treatment must be continued until the stabilization is firm or until there is no evidence of activity.