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Landmark perspective: The impact of penicillin on the treatment of meningitis.

Meningitis Before Penicillin Meningococcal meningitis, or cerebrospinal fever, as the disease was once called, has been registered in the medical literature as a serious health problem for almost 200 years. Since its first description in 1805 by Vieusseaux, 1 many catastrophic epidemic outbreaks and numerous sporadic cases have been recorded. The tendency of the disease to occur in closed populations, where person-to-person spread is favored and high nasopharyngeal carrier rates are observed, has magnified the hysteria over the disease. High attack rates have been observed in military recruit camps, colleges, and similar populations. 2 Before specific anti-infectious treatment became available, the reported mortality from the disease ranged between 30% and 90%, with the highest case fatality rates observed in very young children and in adults older than 40 years. 3 Treatment before the antibiotic era was based on two principles. Initially, drainage of CSF by repeated lumbar punctures was performed