The treatment of tuberculous meningitis

Conclusions

Any review of the treatment of tuberculous meningitis by streptomycin at this stage must be depressing. Human memory is so short that we forget the inevitable and speedy deaths of the years before 1947 and concentrate on the disappointing failures of treatment with streptomycin after 8 or 10 or 14 months of apparent response. It is far too early yet to assess the place of this rather toxic drug in therapeutics. Our limited experience suggests that intrathecal therapy is necessary for at least 6 weeks if even 20 per cent. of the cases are to survive. The great majority of cases survive for long periods, and this feature must also be put to the credit side of streptomycin.

Over a year ago, in another place, I said, in trying to evaluate streptomycin as an effective weapon against this condition, that it was only the “end of the beginning”. I feel the same now. We want not a drug which cures 20 per cent. of cases, and leaves a quarter of them deaf after a year or more of treatment, but a preparation of much higher potency and of lower toxicity. At any rate, one individual who has had to treat several hundred cases of tuberculous meningitis during a quarter of a century is glad to be afforded the privilege of placing before this assembly of tuberculosis experts some account of 19 surviving cases treated in one hospital during the last two years.