PNEUMOCOCCAL MENINGITIS SINCE THE INTRODUCTION OF M. & B. 693

Targeting the complement system in bacterial meningitis

“…Before the invention of antibiotics when bacterial meningitis was almost universally fatal, patients were even occasionally (and sometimes successfully) treated with intrathecally administered serum or complement to make-up for the lack of CSF bactericidal activity (M’Kenzie and Martin, 1908; Finland et al , 1938; Coleman, 1940; Domingo et al , 2019). The adjuvant use of intrathecal serum or complement in patients treated with antibacterial sulphonamides in the late 1930 to 1940s did, not, however, seem to beneficially affect the disease course and may have led to increased mortality in meningococcal meningitis patients [17% (374/2139) versus 9% (482/5221)] (Coleman, 1940; Domingo et al , 2019). Studies in the 1910–1940s that identified complement activity in the CSF of a small proportion of cases with acute inflammatory conditions thought it was the sole result of extravasation of complement components from the blood related to increased blood–CSF barrier permeability (Kolmer et al , 1918; Fothergill, 1935).…”

Royal Society of Medicine—Sections of Otology and Laryngology

“…Subsequent dosage depends on clinical progress and evidence of blood infection. The value of antipneumococcic serum as an accessory to chemotherapy in pneumococcal meningitis is doubtful (Coleman, 1940), but with a mortality of 35 per cent, with sulphapyridine treatment, cases should at least be given the chance of any benefit from specific serum. It is possible that future results with the more diffusible rabbit's serum given both intravenously and intrathecally in combination with adequate sulphapyridine dosage may improve this somewhat dismal outlook.…”