History of the Concept of Tuberculous Meningitis

Abstract

More than a century separates the description of <i>“dropsy of the ventricles of the brain”</i> by Scottish physicians and Robert Koch’s identification of the causal agent of tuberculous meningitis in 1882. This article reviews the writings in Scotland and France that marked the history of the identification of this infectious entity. From John Paisley in 1734 to Robert Whytt in 1738, from Marcellin Chardel in 1799 and L.P. Collinet in 1802 to Isidore Bricheteau in 1814 and Jean-Louis Brachet in 1818, and then Victor Le Diberder in 1837 and Isidore Valleix in 1838, unknown and forgotten physicians outnumber the famous masters in bringing about the progress and knowledge that enabled this frequent and consistently fatal disease in the 19th century to be accurately diagnosed and in most cases cured in the 20th century.

Brain Tuberculosis: An Odyssey through Time to Understand This Pathology

“…In his descriptions, the death of the patient with brain TB occurred after a state of lethargy and prolonged fever. Furthermore, during the postmortem examinations of these patients, Willis observed inflammation of the meninges, dilation of the cerebral ventricles, and tuberculomas compressing the brain [ 32 , 33 ]. It seems that the connection between serous effusion and TB was made by Thomas Willis.…”

“…It seems that the connection between serous effusion and TB was made by Thomas Willis. In such cases, the most commonly proposed treatment was bloodletting [ 33 ].…”

“…In 1820, the French scientists Louis Martinet (1795–1875) and Alexandre Parent du Châtelet (1790–1835) presented a dissertation to the Royal French Academy of Sciences on the inflammation of the arachnoid membrane, stating that “tubercles, due to their development, may sometimes cause an inflammation of the arachnoid”. The two reached this conclusion after analyzing 140 cases, describing a new condition they called arachnitis , which they believed could be caused by various microbes that they were unable to identify at the time [ 33 , 50 ].…”

“…He also believed that death occurred as a result of tuberculous meningitis. Thus, in the 1830s–1840s, physicians reached an initial conclusion that dropsy of the ventricles occurred due to tuberculous infections of the central nervous system [ 33 ].…”

“…Laënnec was followed by Jean-Marc-Gaspard Itard (1774–1838), who, after studying the Greek and Arab authors who wrote about hydrocephalus, provided information about the natural progression of the disease and was one of the first authors to discuss its etiology: “more modern research on pathological anatomy, due in large part to Laënnec, has shown tuberculous granulations of the substance of the brain and cerebellum, in the layers of the optical nerves, and even in the thickness of the meninges”. He also described the performance of a chemical analysis of the abundant fluid present in the cerebral ventricular system, and his conclusion was that the effusion is not the disease itself but only its result [ 33 , 71 ]. Later, in 1865, the French physician Georges Simonis Empis (1824–1913) introduced the term la granulie (miliary TB), which represented a clinical–pathological syndrome characterized by fever, granular meningitis, and acute hydrocephalus [ 72 ].…”