On the Treatment of Tubercular Meningitis. By 0. C. Gibbs,
M. D., of Lake Co., Ohio.
The time was, and at no very distant date, when all diseases
of the brain, occurring in children, accompanied with, or termi-
nating in, an effusion of fluid into the ventricles of that organ,
or between its investing membranes, were denominated Acute
Hydrocephalus. And perhaps it would not be too much to say
that diseases unaccompanied with that symptom, or without that
termination, have been thus classified, irrespective of their patho-
logical conditions.
D
Dr. Marshall Hall was perhaps the first who divided the so-
called acute hydrocephalus into the true and spurious disease,
established their non-identity, and proved the diversity of their
pathology. The distinction drawn has ever since been practi-
cally recognized by the profession.
Recently another division has been made in the disease usually
known as hydrocephalus. To whom the honor is due, is to me,
immaterial. Dr. West says, “ We are led to the conclusion that
inflammation of the brain occurs in early life under two different
conditions. It now and then comes on in previously healthy
children, but occurs much oftener in connection with the tuber-
culous cachexia, or as the result of tubercular deposit in the
brain or its membranes.” (Lectures on Diseases of Children,
p. 58.) But it would seem that lie has failed to take practical
advantage of the conclusion here expressed; for it appears to me
that the occurrence of hydrocephalus in the robust and healthy
must depend upon idiopathic meningeal or meningeo-cerebral in-
flammation ; in the scrofulous cachexia the inflammatory action
is caused by, and superadded to, the previously existing tuber-
cular disposition. The inflammatory action is usually sthenic in
the one case and asthenic in the other. Dr. West is by no means
alone in his conclusion, though perhaps he has more distinctly
stated it than another writer, whose opinions I have had an op-
portunity of examining. Dr. Watson says, « The grand predis-
posing cause of acute hydrocephalus is certainly the scrofulous
diathesis, and this is why we see the complaint run so often in
families; so that one child having died of that disease, affords
much ground for apprehending that others, belonging to the
same family, will become victims to it.” Yet upon the same
page he says : “I need not, I conceive, take any further pains
to convince you that the disease is essentially inflammatory. We
are inevitably led to that conclusion by the symptoms, which
nearly resemble those that occur when undoubted inflammation
lias arisen from injuries of the head; by the appearances on dis-
section, which are always such as inflammation may have pro-
duced,” &c. (Watson’s Lectures, p. 270 ) Dr. Condie, and
others, concur in the opinion expressed in the quotation from
Dr. West. Condie says, “Subacute meningitis occurs chiefly
in delicate, scrofulous children, especially in those distinguished
by great irritability of the brain and nervous system.” (Diseases
of Children, p. 385.) Again, (p. 390,) he says, “A strong pre-
disposition to the occurrence of chronic meningitis in the tuber-
cular form, which, in children, is by far the most frequent, is
manifestly hereditary or constitutional.” Yet Dr. Condie,
in my opinion, correctly denies the sweeping assertion of Dr.
Watson, in reference to the post mortem appearances; for he
says, “ Traces of inflammation in the membranes or substance of
the brain, or in other words increased vascularity, or thickening
of the membranes, and pseudo-membranes, or purulent effusion,
are by no means invariably detected in cases of chronic menin-
gitis.” (Diseases of Children, p. 390.) But admitting that the
products of inflammation were always present in the brain or
its membranes, in cases of death from tubercular meningitis, it
certainly would not prove the disease to be essentially and
primarily inflammatory; for who does not know, that in cases
of death from phthisis, the lungs contain the products of inflam-
mation as invariably as the membranes of the brain in tubercular
meningitis. Dr. Simon says, “ Tubercle, in itself, is clearly no
product of inflammation, but is apt to act as an irritant of sur-
rounding textures, and invite the addition of their inflammatory
exudations.” (Lectures on Pathology, p. 135.) Hence, we may
conclude the disease under consideration to be essentially tuber-
cular, and requiring, in part at least, remedies appropriate for
the scrofulous diathesis.
If the above views be correct, it would seem apparent that the
remedial means usually resorted to, bloodletting, purgatives,
mercurials, &c., are not those best adapted to subdue the disease.
In the country the disease is not of very frequent occurrence.
I have seen but four cases, in as many years of medical practice
and observation. In these four, one only proved fatal, and in that
case, convulsions, hemiplegia and loss of vision occurred before
medical advice was taken.
In the three cases of recovery, Iodide of Potassium was the
remedy depended upon.
The following case, condensed from my note book, is a fair
sample of the cases alluded to, and well illustrates the beneficial
effects of the iodine treatment.
August Uth, 1849. I was called to see a female child, aged
17 months. She was the fourth child of scrofulous parents; the
two immediately preceding having died of hydrocephalus, at the
ages respectively of 28 and 26 months. On the father’s side,
phthisis was a hereditary disease, on the mother’s asthma and
cancer. The child was decidedly scrofulous, and presented all the
usual symptoms of chronic meningitis in a marked degree. The
two preceding children had been treated by a very judicious
practitioner; the treatment made use of is unknown to me, but
bleeding from the temporal vein was the last resort.
I advised in this case tepid bathing daily; simple, easily digest-
ed, but nutritious articles of diet, (which last direction was not
attended to,) and such articles as seemed best adapted to remove
the derangement of the stomach and bowels to be temporarily
resorted to, intermitted and resumed as circumstances might
require. The following was ordered and persevered in, with one
intermission of two weeks, for about four months.
B Iodid. of Potassium gr. xvj.
Sacch. alb. pur.	jij.
Aquae	3i’j-
Mix; dose, a teaspoonful once a day, morning.
After two weeks, the patient began slowly to improve, and is
now, more than three years since, to all appearances, perfectly
well.
In one case, six months after apparent recovery, I was com-
pelled to return to the Iodide of Potassium, which again effected
an improvement that has since been permanent.
These cases are, of course, too few to establish the remedial
virtues of the Iodide of Potassium in tubercular meningitis ; but,
if this hastily penned article shall induce others, who have more
experience with the disease than myself, to give the remedy a
fair trial, and report the result, it will accomplish all I desire.
Perry, Lake Co., Ohio, February lstf, 1853.