Abstract
During the latter part of August, 1936, and the first week of September, we treated successfully with sulfanilamide what appears to be the first critically studied case on record of streptococcal meningitis. Our second case, one of highest severity, was treated in December. It also recovered. The spinal fluid in each was characterized by a remarkable bacteriostatic effect of the drug, manifesting itself in the first case in 72 hours, and in the second in 48 hours.
In the latter case there were 3,000 white cells per cmm., of, spinal fluid, and 8 chains of streptococci per high-power field. One loop of spinal fluid yielded countless numbers of colonies on a blood agar plate; yet after 48 hours' treatment, seeding of ½ cc, of spinal fluid under the same conditions gave no growth, even after 5 days' incubation at 37°C.
When contrasted with the normal serum of a healthy adult, the following results obtain: Both fluids were seeded with 100 streptococci and incubated at 37° for 24 hours. No growth was obtained from the spinal fluid, while the serum showed slightly over 1,000 colonies. A complete clinical report 1 of these cases has been in press for some months.
In a case of brain abscess 2 with a Type V pneumococcus, which was successfully treated, a question arose with the surgeon relative to the accessibility of the spinal fluid to the drug, which was administered paraspinally. A quantitative test for sulfanilamide, devised by one of us (Bambas), proved to be essentially the same as the one later reported by Fuller, 3 except that H acid (1-amino-8-naphthol-3.6-disulfonic acid) was used as the coupling compound.
In 72 hours the patient had received 10 cc. of Prontosil in 2 doses of 5 cc. each, and a total of 40 grains of sulfanilamide in 5 doses. The concentration of the drug in the ventricular fluid was 1:25.000, or 4 mg. per 100 cc. of fluid.
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