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Meningococcus meningitis.

Case 108. (Eschbach and Lacaze, November, 1915.)

During his eleven months captivity at Grafenwöhr, Eschbach and Lacaze had the opportunity of observing the case of a soldier, 24, who sustained a shell-wound in the left lung and was made prisoner August 20, 1914, at Chateau Salins. He got well of his wound, but February 16, 1915, began to cry out and was restless in the night. He was found on the straw muttering words among which only the word, “Head, head,” could be distinguished. He was irresponsive, possibly deaf. Suddenly he had a convulsive crisis and whenever touched he would have jactitations and cry out. Otherwise, he was calm and stuporous. The pupils were widely dilated. In short, he showed a mental confusion associated with paroxysmal excitement due to cerebral and cutaneous hyperesthesia. The first symptoms had occurred the morning before, when he leaned his head against a wall and complained.

Lumbar puncture yielded intra- and extracellular meningococci. The patient was isolated. In the afternoon he became less agitated, kept his eyes closed, mumbled, repeated gestures, would spit in his hands, rub his hands together, rub his neck, shoulders and body, or else he would pass his hands over his forehead and through his hair. Occasionally he would seize the straw and draw it to him with all his strength. Once when asked, “What is your name?” he said, “Not true. Not true.” Hallucinations appeared to have been added to the situation. The neck was a little stiff to forced flexion. Temperature 37.8. Lumbar puncture under chloroform anesthesia; antimeningococcus serum was injected. Next day quieter; able to get up and walk. Slept, mumbled less, was able to answer simple questions, desired to urinate and finally succeeded.

February 19, no mental disorder. Headache and lassitude. Neck stiff, Kernig’s sign marked. Lumbar puncture yielded a fluid now puriform; antimeningococcus serum injected. February 20, lifting the head produced opisthotonos. Labial herpes. The fluid yielded, besides meningococci, also endothelial cells. Serum injected. February 21, fibrin in fluid; serum injected. February 22, no head symptoms. Herpes more intense, involving also arms. Tongue coated. Temperature 37.5, evening 38.3. February 23, meningococci and lymphocytes in fluid. February 24, left knee swollen. Serum injected; puncture fluid showed meningococci and polynucleosis. Fluid from knee showed polynuclear cells without organisms. February 25, patient reached evening temperature of 39.5; serum injected. A few meningococci, altered polynuclear leucocytes. February 26, patient rigid, tongue coated, serum injection. Rare meningococci, degenerated polynuclear leucocytes. February 27, rigidity decreased, evening temperature 37.7. February 28, Kernig’s sign absent. Herpes dry. Serum injection. Fluid clear; lymphocytes and polynuclear cells; no meningococci. March 6, painful inguinal gland on the left side. March 7, epididymitis left (mumps two years before, with headache two weeks and double orchitis). March 9, serum eruption. March 17, epididymitis practically absent. Lymph node painful. Later data impossible to get, except that there was apparently an arthritis of the hip and a sacral decubitus with eventual recovery.