Meningitis and Its Impact On Our History
Meningitis is an infection that affects the meninges, which are the delicate membranes that surround the brain and spinal cord. There are 3 types of this disease: bacterial, viral and fungal. The one that will be focused on specifically will be the bacterial type, due to a personal experience with this deadly disease, as my grandfather met a unexpected and tragic fate with meningitis. With bacterial meningitis, the bacteria is spread through droplet transmission- which usually comes from the sinuses, ears or throat and then after that it spreads to the blood and eventually the brain. The three most common meningitis causing bacterias are: Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Listeria monocytogenes. This disease is mostly spread from person to person by sneezing and coughing by an infected person, and some bacterias are even spread through contaminated food. Some people even carry the bacteria and spread the disease to others without even being sick. However, in our history, there wasn’t much awareness about meningitis, it’s warning signs and ways to prevent it.
This lethal disease dates far back, to pre-Renaissance and even ancient times, as it was even spoken about by Hippocrates, the father of Western medicine, in his Corpus Hippocraticum as one of the infectious diseases of that time. Thomas Willis first described meningitis as an epidemic in 1961, as an “inflammation of the meninges with a continual fever.” The old time name for meningitis is “brain fever” or cerebrospinal disease, as it is a disease that causes swelling of the brain which consequently causes an intense fever that is hard to get under the control. Along with these symptoms, a person infected with meningitis would experience flu-like symptoms, nuchal rigidity(stiff neck), altered mental status, photophobia and phonophobia. The disease advances very fast and it would not be very long that someone would last being untreated. With meningitis in its full destructive and developed state, it would cause dizziness, seizing(due to brain swelling), convulsions and vomiting. As many people do not even understand that they are sick due to the usuality of the symptoms, they spread their sickness mostly through coughing and sneezing, which saliva and droplets of this bacteria would be transferred. The first ever recorded epidemic outbreak of the disease took place in Geneva, Switzerland in 1805 by Gaspard Vieusseux. In our history, many people went undiagnosed or misdiagnosed, because there wasn’t a name for the disease yet and for the most part it was mistaken for typhus and other diseases that were coexistent and widespread at this time. The thing that made people realize that this disease was different from the other diseases was that it was something that caused mental distortion or “meningism”. For most of the other diseases, this was not a symptom and that is how it was differentiated. Another thing that helped people determine the disease in the late 1800’s was the understanding of the symptoms as interpreted Vladimir Kernig and Jozef Brudzinski, in which the patients would not be able to straighten their leg when their hip is flexed to 90 degrees(Kernig) and that a patient’s hips and knees will flex when their neck is flexed(Brudzinski). Thus, these signs were called Kernig’s sign and Brudzinski sign. Back then, people never really did understand what caused the disease and how to treat the disease, but there was a cluster trend and as it spread quickly, it affected many people in a short amount of time, within close distances of the other.
Advancing vastly and quickly, as it does in today’s time, two doctors noted the first case in the United States. The severest pandemic in the history of the New York City, started in the early months of 1904 and continued through 1905. During 1904 there were 1,083 deaths and a death rate of 4.6; during 1905, 1,511 deaths and a death rate of 6.3. Despite the rapid advancement, the bacteria that caused the disease was not discovered until 1886, with the rise of bacteriology,. N. meningitidis was discovered by Austrian bacteriologist, Anton Weichselbaum, in patients exhibiting the many serious symptoms of meningitis. He did this through a collection of cerebrospinal fluid through a lumbar puncture or commonly called a spinal tap. This made sense because most of the issue resided in the spine and the inability to flex properly, as the bacteria are attacking the meninges. The early 1990’s was a time-period in which about 80% of those who were infected with the bacteria would fall to their demise. On the other hand, the first attempt at dwindling the evolvement of the disease blossomed in 1913, when the very first and only anti-meningococcal serum was created and cut down the mortality rate of this disease to almost half that it was before. Simon Flexner, who was the director of the Rockefeller Institute for Medical Research, is mostly credited with this after studying and observing how horses actually can be used to generate antibodies against meningitis causing bacteria and the further advancements of the antiserum. This was a great triumph for public health and this ended up being the first of many, in the field of fighting meningitis. After this, it was learned that antibiotics such as penicillin and corticosteroids can be used to treat the disease, and many vaccinations were formed.
Now, in North America, it is rare to contract meningitis but there is still at 9-12% mortality rate, even with effective treatments. The most major outbreak was in 2012 when contaminated steroid medication was shipped nationwide and killed 36 people, with about 500 cases reported. Problem areas are not very specific but can be linked to areas that are dry and warm, with dusty winds- a great description of what is the Sub-Saharan part of Africa, which beholds the “meningitis belt.” This stretches from Senegal to Ethiopia and is prone to large outbreaks due to these environmental conditions which can damage membranes in the throat and lungs, making people more vulnerable to the disease. Even more so, it seems that meningitis is linked to large groups of people all together- which includes travelers, students moving to and living closely on college campuses, military recruiters and trainees, and the Hajj pilgrimage. Due to large epidemics from these situations, it is now a requirement and a public health measure for people to have the meningitis vaccination in order to partake in many of these activities.
As can be seen, meningitis is something that is very serious and not to be taken lightly. Although it is rare to contract the disease today, this was not always the case. This also does not take away the fact that when contracting this disease, there are high chances that it will be life-threatening or fatal. We have much to thank for the individuals who contributed to our public health system by working so hard to figure out what the disease was and how to treat it.