115-683: The Miracle Worker refers to a broadcast, a play and various other adaptations of Helen Keller 's 1903 autobiography The Story of My Life . The first of these works was a 1957 Playhouse 90 broadcast written by William Gibson and starring Teresa Wright as Anne Sullivan and Patricia McCormack as Keller. Gibson adapted his teleplay for a 1959 Broadway production with Patty Duke as Keller and Anne Bancroft as Sullivan. The 1962 film also starred Bancroft and Duke. Subsequent television films were released in 1979 and in 2000 . The title originates in Mark Twain 's description of Sullivan as
230-438: A post mortem are usually a widespread inflammation of the pia mater and arachnoid layers of the meninges. Neutrophil granulocytes tend to have migrated to the cerebrospinal fluid and the base of the brain, along with cranial nerves and the spinal cord , may be surrounded with pus – as may the meningeal vessels. For some causes of meningitis, protection can be provided in the long term through vaccination , or in
345-550: A "miracle worker". He admired both women, and although his personal finances were problematic, he helped arrange the funding of Keller's Radcliffe College education by his friend, financier and industrialist Henry Huttleston Rogers . Helen Keller Helen Adams Keller (June 27, 1880 – June 1, 1968) was an American author, disability rights advocate, political activist and lecturer. Born in West Tuscumbia, Alabama , she lost her sight and her hearing after
460-537: A CSF leak. Meningitis is potentially life-threatening and has a high mortality rate if untreated; delay in treatment has been associated with a poorer outcome. Thus, treatment with wide-spectrum antibiotics should not be delayed while confirmatory tests are being conducted. If meningococcal disease is suspected in primary care, guidelines recommend that benzylpenicillin be administered before transfer to hospital. Intravenous fluids should be administered if hypotension (low blood pressure) or shock are present. It
575-421: A bout of illness when she was 19 months old. She then communicated primarily using home signs until the age of seven, when she met her first teacher and life-long companion Anne Sullivan . Sullivan taught Keller language, including reading and writing. After an education at both specialist and mainstream schools, Keller attended Radcliffe College of Harvard University and became the first deafblind person in
690-440: A breakthrough, when she realized that the motions her teacher was making on the palm of her hand, while running cool water over her other hand, symbolized the idea of "water". Writing in her autobiography, The Story of My Life , Keller recalled the moment: I stood still, my whole attention fixed upon the motions of her fingers. Suddenly I felt a misty consciousness as of something forgotten—a thrill of returning thought; and somehow
805-648: A captain in the Confederate Army . The family was part of the slaveholding elite before the American Civil War , but lost status later. Her mother was the daughter of Charles W. Adams , a Confederate general. Keller's paternal lineage was traced to Casper Keller, a native of Switzerland. One of Helen's Swiss ancestors was the first teacher for the deaf in Zürich . Keller reflected on this fact in her first autobiography, asserting that "there
920-427: A cause of meningitis in young children in those countries. In the countries in which the disease burden is highest, however, the vaccine is still too expensive. Similarly, immunization against mumps has led to a sharp fall in the number of cases of mumps meningitis, which prior to vaccination occurred in 15% of all cases of mumps. Meningococcus vaccines exist against groups A, B, C, W135 and Y. In countries where
1035-400: A coma as a result of coronary thrombosis . Keller and Thomson moved to Connecticut . They traveled worldwide and raised funds for the blind. Thomson had a stroke in 1957 from which she never fully recovered and died in 1960. Winnie Corbally, a nurse originally hired to care for Thomson in 1957, stayed on after Thomson's death and was Keller's companion for the rest of her life. The few own
1150-555: A couple of weeks before diagnosis. The most common fungal meningitis is cryptococcal meningitis due to Cryptococcus neoformans . In Africa, cryptococcal meningitis is now the most common cause of meningitis in multiple studies, and it accounts for 20–25% of AIDS-related deaths in Africa. Other less common pathogenic fungi which can cause meningitis include: Coccidioides immitis , Histoplasma capsulatum , Blastomyces dermatitidis , and Candida species. A parasitic worm
1265-400: A different role in children than in adults. Though the benefit of corticosteroids has been demonstrated in adults as well as in children from high-income countries, their use in children from low-income countries is not supported by the evidence; the reason for this discrepancy is not clear. Even in high-income countries, the benefit of corticosteroids is only seen when they are given prior to
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#17327916711381380-503: A favorite of the Japanese people. Keller met every U.S. president from Grover Cleveland to Lyndon B. Johnson and was friends with many famous figures, including Alexander Graham Bell , Charlie Chaplin and Mark Twain . Keller and Twain were both considered political radicals allied with leftist politics. Keller, who believed that the poor were "ground down by industrial oppression", wanted children born into poor families to have
1495-412: A glass is rolled over it) may also be present. The inflammation may be caused by infection with viruses , bacteria , fungi or parasites . Non-infectious causes include malignancy ( cancer ), subarachnoid hemorrhage , chronic inflammatory disease ( sarcoidosis ) and certain drugs . Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore,
1610-402: A group of bacteria that includes Treponema pallidum (the cause of syphilis ) and Borrelia burgdorferi (known for causing Lyme disease ), and may also result from cerebral malaria (malaria infecting the brain). The types of bacteria that cause bacterial meningitis vary according to the infected individual's age group. A head injury potentially allows nasal cavity bacteria to enter
1725-555: A higher likelihood of bacterial meningitis, as does a higher white blood cell count. If lactate levels are less than 35 mg/dl and the person has not previously received antibiotics then this may rule out bacterial meningitis. Various other specialized tests may be used to distinguish between different types of meningitis. A latex agglutination test may be positive in meningitis caused by Streptococcus pneumoniae , Neisseria meningitidis , Haemophilus influenzae , Escherichia coli and group B streptococci ; its routine use
1840-488: A homestead, Ivy Green , that Helen's paternal grandfather had built decades earlier. She had four siblings: two full siblings, Mildred Campbell (Keller) Tyson and Phillip Brooks Keller; and two older half-brothers from her father's first marriage, James McDonald Keller and William Simpson Keller. Keller's father worked for many years as an editor of the Tuscumbia North Alabamian . He had served as
1955-435: A later stage to assess for complications of meningitis. In severe forms of meningitis, monitoring of blood electrolytes may be important; for example, hyponatremia is common in bacterial meningitis. The cause of hyponatremia, however, is controversial and may include dehydration, the inappropriate secretion of the antidiuretic hormone (SIADH), or overly aggressive intravenous fluid administration . A lumbar puncture
2070-671: A love affair, became secretly engaged, and defied her teacher and family by attempting an elopement with the man she loved." He was the fingerspelling socialist "Peter Fagan, a young Boston Herald reporter who was sent to Helen's home to act as her private secretary when lifelong companion, Anne, fell ill." At the time, her father had died and Sullivan was recovering in Lake Placid and Puerto Rico . Keller had moved with her mother in Montgomery, Alabama . Anne Sullivan died in 1936, with Keller holding her hand, after falling into
2185-659: A melodramatic, allegorical style. She was also the subject of the Academy Award -winning 1954 documentary Helen Keller in Her Story , narrated by her friend and noted theatrical actress Katharine Cornell . She was also profiled in The Story of Helen Keller , part of the Famous Americans series produced by Hearst Entertainment . Meningitis Meningitis is acute or chronic inflammation of
2300-589: A particular place and population. For instance, in the United Kingdom, empirical treatment consists of a third-generation cefalosporin such as cefotaxime or ceftriaxone . In the US, where resistance to cefalosporins is increasingly found in streptococci, addition of vancomycin to the initial treatment is recommended. Chloramphenicol , either alone or in combination with ampicillin , however, appears to work equally well. Empirical therapy may be chosen on
2415-584: A person has meningitis. The jolt accentuation test is not specific or sensitive enough to completely rule out meningitis. If someone is suspected of having meningitis, blood tests are performed for markers of inflammation (e.g. C-reactive protein , complete blood count ), as well as blood cultures . If a CT or MRI is required before LP, or if LP proves difficult, professional guidelines suggest that antibiotics should be administered first to prevent delay in treatment, especially if this may be longer than 30 minutes. Often, CT or MRI scans are performed at
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#17327916711382530-441: A person with meningitis has been. Viral meningitis is typically caused by enteroviruses , and is most commonly spread through fecal contamination. The risk of infection can be decreased by changing the behavior that led to transmission. Since the 1980s, many countries have included immunization against Haemophilus influenzae type B in their routine childhood vaccination schemes. This has practically eliminated this pathogen as
2645-470: A present. Keller initially struggled with lessons since she could not comprehend that every object had a word identifying it. When Sullivan was trying to teach Keller the word for "mug", Keller became so frustrated she broke the mug. Keller remembered how she soon began imitating Sullivan's hand gestures: "I did not know that I was spelling a word or even that words existed. I was simply making my fingers go in monkey-like imitation." The next month Keller made
2760-530: A talk with her own lips on "Happiness", and it will be remembered always as a piece of inspired teaching by those who heard it. Keller became a world-famous speaker and author. She was an advocate for people with disabilities , amid numerous other causes. She traveled to twenty-five different countries giving motivational speeches about Deaf people's conditions. She was a suffragist , pacifist , radical socialist, birth control supporter, and opponent of Woodrow Wilson . In 1915, she and George A. Kessler founded
2875-437: A temporary or long-term drainage device, such as a cerebral shunt . The osmotic therapy, glycerol , has an unclear effect on mortality but may decrease hearing problems. Empiric antibiotics (treatment without exact diagnosis) should be started immediately, even before the results of the lumbar puncture and CSF analysis are known. The choice of initial treatment depends largely on the kind of bacteria that cause meningitis in
2990-417: A total of 12 published books and several articles. One of her earliest pieces of writing, at age 11, was The Frost King (1891). There were allegations that this story had been plagiarized from The Frost Fairies by Margaret Canby. An investigation into the matter revealed that Keller may have experienced a case of cryptomnesia , which was that she had Canby's story read to her but forgot about it, while
3105-454: A type of meningoencephalitis where not only the meninges are affected but also the brain tissue . Meningitis may occur as the result of several non-infectious causes: spread of cancer to the meninges ( malignant or neoplastic meningitis ) and certain drugs (mainly non-steroidal anti-inflammatory drugs , antibiotics and intravenous immunoglobulins ). It may also be caused by several inflammatory conditions, such as sarcoidosis (which
3220-463: A vaccine) only elicit a weak response from the immune system , or cross-react with normal human proteins. Still, some countries ( New Zealand , Cuba , Norway and Chile ) have developed vaccines against local strains of group B meningococci; some have shown good results and are used in local immunization schedules. Two new vaccines, both approved in 2014, are effective against a wider range of group B meningococci strains. In Africa, until recently,
3335-430: Is "partially treated meningitis", where there are meningitis symptoms after receiving antibiotics (such as for presumptive sinusitis ). When this happens, CSF findings may resemble those of viral meningitis, but antibiotic treatment may need to be continued until there is definitive positive evidence of a viral cause (e.g. a positive enterovirus PCR). Meningitis can be diagnosed after death has occurred. The findings from
3450-431: Is a highly sensitive and specific test since only trace amounts of the infecting agent's DNA is required. It may identify bacteria in bacterial meningitis and may assist in distinguishing the various causes of viral meningitis ( enterovirus , herpes simplex virus 2 and mumps in those not vaccinated for this). Serology (identification of antibodies to viruses) may be useful in viral meningitis. If tuberculous meningitis
3565-460: Is done by positioning the person, usually lying on the side, applying local anesthetic , and inserting a needle into the dural sac (a sac around the spinal cord) to collect cerebrospinal fluid (CSF). When this has been achieved, the "opening pressure" of the CSF is measured using a manometer . The pressure is normally between 6 and 18 cm water (cmH 2 O); in bacterial meningitis the pressure
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3680-414: Is evidence of respiratory failure . If there are signs of raised intracranial pressure, measures to monitor the pressure may be taken; this would allow the optimization of the cerebral perfusion pressure and various treatments to decrease the intracranial pressure with medication (e.g. mannitol ). Seizures are treated with anticonvulsants . Hydrocephalus (obstructed flow of CSF) may require insertion of
3795-725: Is faithful to his ideals of right living. The Helen Keller Archives in New York are owned by the American Foundation for the Blind . Archival material of Helen Keller stored in New York was lost when the Twin Towers were destroyed in the September 11 attacks . Keller had a series of strokes in 1961 and spent the last years of her life at her home. On September 14, 1964, President Lyndon B. Johnson awarded her
3910-535: Is ground down by industrial oppression in order that the small remnant may live in ease. —Helen Keller, 1911 On January 22, 1916, Keller and Sullivan traveled to the small town of Menomonie in western Wisconsin to deliver a lecture at the Mabel Tainter Memorial Building . Details of her talk were provided in the weekly Dunn County News on January 22, 1916: A message of optimism, of hope, of good cheer, and of loving service
4025-403: Is meningitis caused by Mycobacterium tuberculosis , is more common in people from countries in which tuberculosis is endemic, but is also encountered in people with immune problems, such as AIDS . Recurrent bacterial meningitis may be caused by persisting anatomical defects, either congenital or acquired, or by disorders of the immune system . Anatomical defects allow continuity between
4140-423: Is no king who has not had a slave among his ancestors, and no slave who has not had a king among his". At 19 months old, Keller contracted an unknown illness described by doctors as "an acute congestion of the stomach and the brain". Contemporary doctors believe it may have been meningitis , caused by the bacterium Neisseria meningitidis (meningococcus), or possibly Haemophilus influenzae , which can cause
4255-406: Is normally above 40% of that in blood. In bacterial meningitis it is typically lower; the CSF glucose level is therefore divided by the blood glucose (CSF glucose to serum glucose ratio). A ratio ≤0.4 is indicative of bacterial meningitis; in the newborn, glucose levels in CSF are normally higher, and a ratio below 0.6 (60%) is therefore considered abnormal. High levels of lactate in CSF indicate
4370-423: Is not clear whether intravenous fluid should be given routinely or whether this should be restricted. Given that meningitis can cause a number of early severe complications, regular medical review is recommended to identify these complications early and to admit the person to an intensive care unit , if deemed necessary. Mechanical ventilation may be needed if the level of consciousness is very low, or if there
4485-462: Is not encouraged as it rarely leads to changes in treatment, but it may be used if other tests are not diagnostic. Similarly, the limulus lysate test may be positive in meningitis caused by Gram-negative bacteria, but it is of limited use unless other tests have been unhelpful. Polymerase chain reaction (PCR) is a technique used to amplify small traces of bacterial DNA in order to detect the presence of bacterial or viral DNA in cerebrospinal fluid; it
4600-552: Is often assumed to be the cause of eosinophilic meningitis when there is a predominance of eosinophils (a type of white blood cell) found in the cerebrospinal fluid. The most common parasites implicated are Angiostrongylus cantonensis , Gnathostoma spinigerum , Schistosoma , as well as the conditions cysticercosis , toxocariasis , baylisascariasis , paragonimiasis , and a number of rarer infections and noninfective conditions. Rarely, free-living parasitic amoebae can cause naegleriasis , also called amebic meningitis ,
4715-409: Is suspected, the sample is processed for Ziehl–Neelsen stain , which has a low sensitivity, and tuberculosis culture, which takes a long time to process; PCR is being used increasingly. Diagnosis of cryptococcal meningitis can be made at low cost using an India ink stain of the CSF; however, testing for cryptococcal antigen in blood or CSF is more sensitive. A diagnostic and therapeutic difficulty
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4830-520: Is then called neurosarcoidosis ), connective tissue disorders such as systemic lupus erythematosus , and certain forms of vasculitis (inflammatory conditions of the blood vessel wall), such as Behçet's disease . Epidermoid cysts and dermoid cysts may cause meningitis by releasing irritant matter into the subarachnoid space. Rarely, migraine may cause meningitis, but this diagnosis is usually only made when other causes have been eliminated. The meninges comprise three membranes that, together with
4945-462: Is thought to be caused by herpes simplex virus type 2 . There are a number of risk factors for fungal meningitis , including the use of immunosuppressants (such as after organ transplantation ), HIV/AIDS , and the loss of immunity associated with aging. It is uncommon in those with a normal immune system but has occurred with medication contamination . Symptom onset is typically more gradual, with headaches and fever being present for at least
5060-474: Is unlikely. Other problems can produce symptoms similar to those above, but from non-meningitic causes. This is called meningism or pseudomeningitis. Meningitis caused by the bacterium Neisseria meningitidis (known as "meningococcal meningitis") can be differentiated from meningitis with other causes by a rapidly spreading petechial rash , which may precede other symptoms. The rash consists of numerous small, irregular purple or red spots ("petechiae") on
5175-452: Is usually caused by viruses, but it may be due to bacterial infection that has already been partially treated, when bacteria disappear from the meninges, or when pathogens infect a space adjacent to the meninges (such as sinusitis ). Endocarditis (an infection of the heart valves which spreads small clusters of bacteria through the bloodstream) may cause aseptic meningitis. Aseptic meningitis may also result from infection with spirochetes ,
5290-482: Is usually elevated. In cryptococcal meningitis , intracranial pressure is markedly elevated. The initial appearance of the fluid may prove an indication of the nature of the infection: cloudy CSF indicates higher levels of protein, white and red blood cells and/or bacteria, and therefore may suggest bacterial meningitis. The CSF sample is examined for presence and types of white blood cells , red blood cells , protein content and glucose level. Gram staining of
5405-530: The Brooklyn Eagle wrote that her "mistakes sprung out of the manifest limitations of her development". Keller responded to that editor, referring to having met him before he knew of her political views: At that time the compliments he paid me were so generous that I blush to remember them. But now that I have come out for socialism he reminds me and the public that I am blind and deaf and especially liable to error. I must have shrunk in intelligence during
5520-955: The 1912 strike of textile workers in Lawrence, Massachusetts for instigating her support of socialism. Keller supported eugenics which had become popular with new understandings (as well as misapprehensions) of principles of biological inheritance. In 1915, she wrote in favor of refusing life-saving medical procedures to infants with severe mental impairments or physical deformities, saying that their lives were not worthwhile and they would likely become criminals. Keller also expressed concerns about human overpopulation . From 1946 to 1957 Keller visited 35 countries. In 1948 she went to New Zealand and visited deaf schools in Christchurch and Auckland . She met Deaf Society of Canterbury Life Member Patty Still in Christchurch. Keller wrote
5635-625: The Greek μῆνιγξ meninx , 'membrane', and the medical suffix -itis , 'inflammation'. In adults, the most common symptom of meningitis is a severe headache , occurring in almost 90% of cases of bacterial meningitis, followed by neck stiffness (the inability to flex the neck forward passively due to increased neck muscle tone and stiffness). The classic triad of diagnostic signs consists of neck stiffness, sudden high fever , and altered mental status ; however, all three features are present in only 44–46% of bacterial meningitis cases. If none of
5750-690: The Helen Keller International (HKI) organization. This organization is devoted to research in vision, health, and nutrition. In 1916, she sent money to the NAACP , as she was ashamed of the Southern un-Christian treatment of " colored people ". In 1920, Keller helped to found the American Civil Liberties Union (ACLU). She traveled to over 40 countries with Sullivan, making several trips to Japan and becoming
5865-726: The Presidential Medal of Freedom , one of the United States' two highest civilian honors. In 1965, she was elected to the National Women's Hall of Fame at the New York World's Fair . Keller devoted much of her later life to raising funds for the American Foundation for the Blind . She died in her sleep on June 1, 1968, at her home, Arcan Ridge, located in Easton, Connecticut , at the age of 87. A service
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#17327916711385980-703: The Tadoma method, which means using her fingers to feel the lips and throat of the speaker. She became proficient at using braille and using fingerspelling to communicate. Shortly before World War I, with the assistance of the Zoellner Quartet , she determined that by placing her fingertips on a resonant tabletop she could experience music played close by. Anne Sullivan stayed as a companion to Helen Keller long after she taught her. Sullivan married John Macy in 1905, and her health started failing around 1914. Polly Thomson (February 20, 1885 – March 21, 1960)
6095-760: The Wright-Humason School for the Deaf , and to learn from Sarah Fuller at the Horace Mann School for the Deaf . In 1896, they returned to Massachusetts, and Keller entered The Cambridge School for Young Ladies before gaining admittance, in 1900, to Radcliffe College of Harvard University , where she lived in Briggs Hall, South House . Her admirer, Mark Twain , had introduced her to Standard Oil magnate Henry Huttleston Rogers , who, with his wife Abbie, paid for her education. In 1904, at
6210-402: The cerebrospinal fluid , enclose and protect the brain and spinal cord (the central nervous system ). The pia mater is a delicate impermeable membrane that firmly adheres to the surface of the brain, following all the minor contours. The arachnoid mater (so named because of its spider-web-like appearance) is a loosely fitting sac on top of the pia mater. The subarachnoid space separates
6325-423: The choroid plexus . Meningitis occurs in 25% of newborns with bloodstream infections due to group B streptococci ; this phenomenon is much less common in adults. Direct contamination of the cerebrospinal fluid may arise from indwelling devices, skull fractures, or infections of the nasopharynx or the nasal sinuses that have formed a tract with the subarachnoid space (see above); occasionally, congenital defects of
6440-714: The dura mater can be identified. The large-scale inflammation that occurs in the subarachnoid space during meningitis is not a direct result of bacterial infection but can rather largely be attributed to the response of the immune system to the entry of bacteria into the central nervous system . When components of the bacterial cell membrane are identified by the immune cells of the brain ( astrocytes and microglia ), they respond by releasing large amounts of cytokines , hormone-like mediators that recruit other immune cells and stimulate other tissues to participate in an immune response. The blood–brain barrier becomes more permeable, leading to "vasogenic" cerebral edema (swelling of
6555-546: The pneumococcal conjugate vaccine (PCV), which is active against seven common serotypes of this pathogen, significantly reduces the incidence of pneumococcal meningitis. The pneumococcal polysaccharide vaccine , which covers 23 strains, is only administered to certain groups (e.g. those who have had a splenectomy , the surgical removal of the spleen); it does not elicit a significant immune response in all recipients, e.g. small children. Childhood vaccination with Bacillus Calmette-Guérin has been reported to significantly reduce
6670-405: The sensitivity of these tests is limited. They do, however, have very good specificity for meningitis: the signs rarely occur in other diseases. Another test, known as the "jolt accentuation maneuver" helps determine whether meningitis is present in those reporting fever and headache. A person is asked to rapidly rotate the head horizontally; if this does not make the headache worse, meningitis
6785-890: The Christian theologian and mystic who gave a spiritual interpretation of the teachings of the Bible and who claimed that the Second Coming of Jesus Christ had already taken place. Keller described the core of her belief in these words: But in Swedenborg's teaching it [Divine Providence] is shown to be the government of God's Love and Wisdom and the creation of uses. Since His Life cannot be less in one being than another, or His Love manifested less fully in one thing than another, His Providence must needs be universal ... He has provided religion of some kind everywhere, and it does not matter to what race or creed anyone belongs if he
6900-475: The IWW between 1916 and 1918. In Why I Became an IWW , Keller explained that her motivation for activism came in part from her concern about blindness and other disabilities: I was appointed on a commission to investigate the conditions of the blind. For the first time I, who had thought blindness a misfortune beyond human control, found that too much of it was traceable to wrong industrial conditions, often caused by
7015-584: The Kellers to Alexander Graham Bell , who was working with deaf children at the time. Bell advised them to contact the Perkins Institute for the Blind , the school where Bridgman had been educated. It was then located in South Boston . Michael Anagnos, the school's director, asked Anne Sullivan , a 20-year-old alumna of the school who was visually impaired, to become Keller's instructor. It was
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#17327916711387130-617: The United States to earn a Bachelor of Arts degree. Keller was also a prolific author, writing 14 books and hundreds of speeches and essays on topics ranging from animals to Mahatma Gandhi . Keller campaigned for those with disabilities and for women's suffrage , labor rights , and world peace . In 1909, she joined the Socialist Party of America (SPA). She was a founding member of the American Civil Liberties Union (ACLU). Keller's autobiography, The Story of My Life (1903), publicized her education and life with Sullivan. It
7245-586: The age of 24, Keller graduated as a member of Phi Beta Kappa from Radcliffe, becoming the first deafblind person to earn a Bachelor of Arts degree. She maintained a correspondence with the Austrian philosopher and pedagogue Wilhelm Jerusalem , who was one of the first to discover her literary talent. Determined to communicate with others as conventionally as possible, Keller learned to speak and spent much of her life giving speeches and lectures on aspects of her life. She learned to "hear" people's speech using
7360-610: The age of seven, Keller had more than 60 home signs to communicate with her family, and could distinguish people by the vibration of their footsteps. In 1886, Keller's mother, inspired by an account in Charles Dickens ' American Notes of the successful education of Laura Bridgman , a deaf and blind woman, dispatched the young Keller and her father to consult physician J. Julian Chisholm, an eye, ear, nose and throat specialist in Baltimore , for advice. Chisholm referred
7475-526: The approach for prevention and control of meningococcal epidemics was based on early detection of the disease and emergency reactive mass vaccination of the population at risk with bivalent A/C or trivalent A/C/W135 polysaccharide vaccines, though the introduction of MenAfriVac (meningococcus group A vaccine) has demonstrated effectiveness in young people and has been described as a model for product development partnerships in resource-limited settings. Routine vaccination against Streptococcus pneumoniae with
7590-418: The arachnoid and pia mater membranes and is filled with cerebrospinal fluid. The outermost membrane, the dura mater , is a thick durable membrane, which is attached to both the arachnoid membrane and the skull. In bacterial meningitis, bacteria reach the meninges by one of two main routes: through the bloodstream (hematogenous spread) or through direct contact between the meninges and either the nasal cavity or
7705-472: The basis of the person's age, whether the infection was preceded by a head injury , whether the person has undergone recent neurosurgery and whether or not a cerebral shunt is present. In young children and those over 50 years of age, as well as those who are immunocompromised, the addition of ampicillin is recommended to cover Listeria monocytogenes . Once the Gram stain results become available, and
7820-405: The beginning of a nearly 50-year-long relationship Sullivan developed with Keller as her governess and later her companion . Sullivan arrived at Keller's house on March 5, 1887, a day Keller would forever remember as "my soul's birthday". Sullivan immediately began to teach Helen to communicate by spelling words into her hand, beginning with "d-o-l-l" for the doll that she had brought Keller as
7935-472: The brain (tumor or abscess) or the intracranial pressure (ICP) is elevated, as it may lead to brain herniation . If someone is at risk for either a mass or raised ICP (recent head injury, a known immune system problem, localizing neurological signs, or evidence on examination of a raised ICP), a CT or MRI scan is recommended prior to the lumbar puncture. This applies in 45% of all adult cases. There are no physical tests that can rule out or determine if
8050-494: The brain due to fluid leakage from blood vessels). Large numbers of white blood cells enter the CSF, causing inflammation of the meninges and leading to "interstitial" edema (swelling due to fluid between the cells). In addition, the walls of the blood vessels themselves become inflamed (cerebral vasculitis), which leads to decreased blood flow and a third type of edema, "cytotoxic" edema . The three forms of cerebral edema all lead to increased intracranial pressure ; together with
8165-484: The broad type of bacterial cause is known, it may be possible to change the antibiotics to those likely to deal with the presumed group of pathogens. The results of the CSF culture generally take longer to become available (24–48 hours). Once they do, empiric therapy may be switched to specific antibiotic therapy targeted to the specific causative organism and its sensitivities to antibiotics. For an antibiotic to be effective in meningitis it must not only be active against
8280-737: The cause of meningitis may be the skin signs of hand, foot and mouth disease and genital herpes , both of which are associated with various forms of viral meningitis. Additional problems may occur in the early stage of the illness. These may require specific treatment, and sometimes indicate severe illness or worse prognosis. The infection may trigger sepsis , a systemic inflammatory response syndrome of falling blood pressure , fast heart rate , high or abnormally low temperature, and rapid breathing . Very low blood pressure may occur at an early stage, especially but not exclusively in meningococcal meningitis; this may lead to insufficient blood supply to other organs. Disseminated intravascular coagulation ,
8395-470: The commencement of dexamethasone or a similar corticosteroid just before the first dose of antibiotics is given, and continued for four days. Given that most of the benefit of the treatment is confined to those with pneumococcal meningitis, some guidelines suggest that dexamethasone be discontinued if another cause for meningitis is identified. The likely mechanism is suppression of overactive inflammation. Additional treatment with corticosteroids have
8510-878: The condition is classified as a medical emergency . A lumbar puncture , in which a needle is inserted into the spinal canal to collect a sample of cerebrospinal fluid (CSF), can diagnose or exclude meningitis. Some forms of meningitis are preventable by immunization with the meningococcal , mumps , pneumococcal , and Hib vaccines . Giving antibiotics to people with significant exposure to certain types of meningitis may also be useful for preventing transmission. The first treatment in acute meningitis consists of promptly giving antibiotics and sometimes antiviral drugs . Corticosteroids can be used to prevent complications from excessive inflammation. Meningitis can lead to serious long-term consequences such as deafness , epilepsy , hydrocephalus , or cognitive deficits , especially if not treated quickly. In 2019, meningitis
8625-424: The condition, but does not protect against future infections. Resistance to rifampicin has been noted to increase after use, which has caused some to recommend considering other agents. While antibiotics are frequently used in an attempt to prevent meningitis in those with a basilar skull fracture there is not enough evidence to determine whether this is beneficial or harmful. This applies to those with or without
8740-423: The early stages of meningitis (in 30% of cases) and do not necessarily indicate an underlying cause. Seizures may result from increased pressure and from areas of inflammation in the brain tissue. Focal seizures (seizures that involve one limb or part of the body), persistent seizures, late-onset seizures and those that are difficult to control with medication indicate a poorer long-term outcome. Inflammation of
8855-527: The effects of war; in addition, she supported causes that opposed military intervention . She had speech therapy to have her voice understood better by the public. When the Rockefeller-owned press refused to print her articles, she protested until her work was finally published. She supported Socialist Party candidate Eugene V. Debs in each of his campaigns for the presidency. Before reading Progress and Poverty by Henry George , Helen Keller
8970-406: The excessive activation of blood clotting , may obstruct blood flow to organs and paradoxically increase the bleeding risk. Gangrene of limbs can occur in meningococcal disease . Severe meningococcal and pneumococcal infections may result in hemorrhaging of the adrenal glands , leading to Waterhouse-Friderichsen syndrome , which is often fatal. The brain tissue may swell , pressure inside
9085-520: The external environment and the nervous system . The most common cause of recurrent meningitis is a skull fracture , particularly fractures that affect the base of the skull or extend towards the sinuses and petrous pyramids . Approximately 59% of recurrent meningitis cases are due to such anatomical abnormalities, 36% are due to immune deficiencies (such as complement deficiency , which predisposes especially to recurrent meningococcal meningitis), and 5% are due to ongoing infections in areas adjacent to
9200-480: The eyes of every newborn baby with a disinfectant solution. At the time, only a fraction of doctors and midwives were doing this. Thanks to Keller's advocacy, this commonsense public health measure was swiftly and widely adopted. Keller wrote The World I Live In in 1908, giving readers an insight into how she felt about the world. Out of the Dark , a series of essays on socialism, was published in 1913. When Keller
9315-670: The formation of blood clots in the veins ( cerebral venous thrombosis ), may all lead to weakness, loss of sensation, or abnormal movement or function of the part of the body supplied by the affected area of the brain. Meningitis is typically caused by an infection . Most infections are due to viruses , and others due to bacteria , fungi , and parasites . Mostly the parasites are parasitic worms , but can also rarely include parasitic amoebae . Meningitis may also result from various non-infectious causes. The term aseptic meningitis refers to cases of meningitis in which no bacterial infection can be demonstrated. This type of meningitis
9430-470: The head and neck area, such as otitis media or mastoiditis , can lead to meningitis in a small proportion of people. Recipients of cochlear implants for hearing loss are more at risk for pneumococcal meningitis. In rare cases, Enterococcus spp. can be responsible for meningitis, both community and hospital-acquired, usually as a secondary result of trauma or surgery, or due to intestinal diseases (e.g., strongyloidiasis). Tuberculous meningitis , which
9545-437: The lowered blood pressure often encountered in sepsis , this means that it is harder for blood to enter the brain; consequently brain cells are deprived of oxygen and undergo apoptosis ( programmed cell death ). Administration of antibiotics may initially worsen the process outlined above, by increasing the amount of bacterial cell membrane products released through the destruction of bacteria. Particular treatments, such as
9660-400: The lungs is typically treated for six months, those with tuberculous meningitis are typically treated for a year or longer. Fluid given intravenously are an essential part of treatment of bacterial meningitis. There is no difference in terms of mortality or acute severe neurological complications in children given a maintenance regimen over restricted-fluid regimen, but evidence is in favor of
9775-591: The maintenance regimen in terms of emergence of chronic severe neurological complications. Additional treatment with corticosteroids (usually dexamethasone ) has shown some benefits, such as a reduction of hearing loss , and better short term neurological outcomes in adolescents and adults from high-income countries with low rates of HIV. Some research has found reduced rates of death while other research has not. They also appear to be beneficial in those with tuberculosis meningitis, at least in those who are HIV negative. Professional guidelines therefore recommend
9890-417: The many because they possess the means of livelihood of all ... The country is governed for the richest, for the corporations, the bankers, the land speculators, and for the exploiters of labor. The majority of mankind are working people. So long as their fair demands—the ownership and control of their livelihoods—are set at naught, we can have neither men's rights nor women's rights. The majority of mankind
10005-421: The memory remained in her subconscious. At age 22, Keller published her autobiography, The Story of My Life (1903), with help from Sullivan and Sullivan's husband, John Macy. It recounts the story of her life up to age 21 and was written during her time in college. In an article Keller wrote in 1907, she brought to public attention the fact that many cases of childhood blindness could be prevented by washing
10120-427: The meningeal space. Similarly, devices in the brain and meninges, such as cerebral shunts , extraventricular drains or Ommaya reservoirs , carry an increased risk of meningitis. In these cases, people are more likely to be infected with Staphylococci , Pseudomonas , and other Gram-negative bacteria . These pathogens are also associated with meningitis in people with an impaired immune system . An infection in
10235-415: The meninges may lead to abnormalities of the cranial nerves , a group of nerves arising from the brain stem that supply the head and neck area and which control, among other functions, eye movement, facial muscles, and hearing. Visual symptoms and hearing loss may persist after an episode of meningitis. Inflammation of the brain ( encephalitis ) or its blood vessels ( cerebral vasculitis ), as well as
10350-439: The meninges. Viruses that cause meningitis include enteroviruses , herpes simplex virus (generally type 2, which produces most genital sores; less commonly type 1), varicella zoster virus (known for causing chickenpox and shingles ), mumps virus , HIV , LCMV , Arboviruses (acquired from a mosquito or other insect), and the influenza virus . Mollaret's meningitis is a chronic recurrent form of herpes meningitis; it
10465-600: The mystery of language was revealed to me. I knew then that w-a-t-e-r meant the wonderful cool something that was flowing over my hand. The living word awakened my soul, gave it light, hope, set it free! Keller quickly demanded that Sullivan sign the names of all the other familiar objects in her world. In May 1888, Keller started attending the Perkins Institute for the Blind. In 1893, Keller, along with Sullivan, attended William Wade House and Finishing School. In 1894, Keller and Sullivan moved to New York to attend
10580-495: The organism in 70–85% of cases) but results can take up to 48 hours to become available. The type of white blood cell predominantly present (see table) indicates whether meningitis is bacterial (usually neutrophil-predominant) or viral (usually lymphocyte-predominant), although at the beginning of the disease this is not always a reliable indicator. Less commonly, eosinophils predominate, suggesting parasitic or fungal etiology, among others. The concentration of glucose in CSF
10695-467: The pathogenic bacterium but also reach the meninges in adequate quantities; some antibiotics have inadequate penetrance and therefore have little use in meningitis. Most of the antibiotics used in meningitis have not been tested directly on people with meningitis in clinical trials . Rather, the relevant knowledge has mostly derived from laboratory studies in rabbits . Tuberculous meningitis requires prolonged treatment with antibiotics. While tuberculosis of
10810-458: The presence of positive Kernig's sign or Brudziński sign . Kernig's sign is assessed with the person lying supine , with the hip and knee flexed to 90 degrees. In a person with a positive Kernig's sign, pain limits passive extension of the knee. A positive Brudzinski's sign occurs when flexion of the neck causes involuntary flexion of the knee and hip. Although Kernig's sign and Brudzinski's sign are both commonly used to screen for meningitis,
10925-518: The protective membranes covering the brain and spinal cord , collectively called the meninges . The most common symptoms are fever , intense headache , vomiting and neck stiffness and occasionally photophobia . Other symptoms include confusion or altered consciousness , nausea , and an inability to tolerate light or loud noises . Young children often exhibit only nonspecific symptoms , such as irritability, drowsiness, or poor feeding. A non-blanching rash (a rash that does not fade when
11040-420: The rate of tuberculous meningitis, but its waning effectiveness in adulthood has prompted a search for a better vaccine. Short-term antibiotic prophylaxis is another method of prevention, particularly of meningococcal meningitis. In cases of meningococcal meningitis, preventative treatment in close contacts with antibiotics (e.g. rifampicin , ciprofloxacin or ceftriaxone ) can reduce their risk of contracting
11155-431: The same opportunities to succeed that she had enjoyed. She wrote, "I owed my success partly to the advantages of my birth and environment. I have learned that the power to rise is not within the reach of everyone." In 1909 Keller became a member of the Socialist Party ; she actively campaigned and wrote in support of the working class from 1909 to 1921. Many of her speeches and writings were about women's right to vote and
11270-421: The same symptoms but is less likely because of its 97% juvenile mortality rate at that time. She was able to recover from her illness, but was left permanently blind and deaf, as she recalled in her autobiography, "at sea in a dense fog". At that time, Keller was able to communicate somewhat with Martha Washington, who was two years older and the daughter of the family cook, and understood the girl's signs; by
11385-420: The sample may demonstrate bacteria in bacterial meningitis, but absence of bacteria does not exclude bacterial meningitis as they are only seen in 60% of cases; this figure is reduced by a further 20% if antibiotics were administered before the sample was taken. Gram staining is also less reliable in particular infections such as listeriosis . Microbiological culture of the sample is more sensitive (it identifies
11500-423: The selfishness and greed of employers. And the social evil contributed its share. I found that poverty drove women to a life of shame that ended in blindness. The last sentence refers to prostitution and syphilis , the former a "life of shame" that women used to support themselves, which contributed to their contracting syphilis. Untreated, it was a leading cause of blindness. In the same interview, Keller also cited
11615-405: The short term with antibiotics . Some behavioral measures may also be effective. Bacterial and viral meningitis are contagious, but neither is as contagious as the common cold or flu . Both can be transmitted through droplets of respiratory secretions during close contact such as kissing, sneezing or coughing on someone, but bacterial meningitis cannot be spread by only breathing the air where
11730-417: The skin. In most cases, meningitis follows invasion of the bloodstream by organisms that live on mucosal surfaces such as the nasal cavity . This is often in turn preceded by viral infections, which break down the normal barrier provided by the mucosal surfaces. Once bacteria have entered the bloodstream, they enter the subarachnoid space in places where the blood–brain barrier is vulnerable – such as
11845-404: The skull may increase and the swollen brain may herniate through the skull base. This may be noticed by a decreasing level of consciousness , loss of the pupillary light reflex , and abnormal posturing . The inflammation of the brain tissue may also obstruct the normal flow of CSF around the brain ( hydrocephalus ). Seizures may occur for various reasons; in children, seizures are common in
11960-675: The three signs are present, acute meningitis is extremely unlikely. Other signs commonly associated with meningitis include photophobia (intolerance to bright light) and phonophobia (intolerance to loud noises). Small children often do not exhibit the aforementioned symptoms, and may only be irritable and look unwell. The fontanelle (the soft spot on the top of a baby's head) can bulge in infants aged up to 6 months. Other features that distinguish meningitis from less severe illnesses in young children are leg pain, cold extremities, and an abnormal skin color . Neck stiffness occurs in 70% of bacterial meningitis in adults. Other signs include
12075-451: The trunk, lower extremities , mucous membranes, conjunctiva, and (occasionally) the palms of the hands or soles of the feet. The rash is typically non-blanching ; the redness does not disappear when pressed with a finger or a glass tumbler. Although this rash is not necessarily present in meningococcal meningitis, it is relatively specific for the disease; it does, however, occasionally occur in meningitis due to other bacteria. Other clues on
12190-406: The use of corticosteroids , are aimed at dampening the immune system's response to this phenomenon. Diagnosing meningitis as promptly as possible can improve outcomes. There are no specific signs or symptoms that can indicate meningitis, and a lumbar puncture (spinal tap) to examine the cerebrospinal fluid is recommended for diagnosis. Lumbar puncture is contraindicated if there is a mass in
12305-494: The vaccine for meningococcus group C was introduced, cases caused by this pathogen have decreased substantially. A quadrivalent vaccine now exists, which combines four vaccines with the exception of B; immunization with this ACW135Y vaccine is now a visa requirement for taking part in Hajj . Development of a vaccine against group B meningococci has proved much more difficult, as its surface proteins (which would normally be used to make
12420-593: The years since I met him. ... Oh, ridiculous Brooklyn Eagle ! Socially blind and deaf, it defends an intolerable system, a system that is the cause of much of the physical blindness and deafness which we are trying to prevent. In 1912, Keller joined the Industrial Workers of the World (the IWW, known as the Wobblies), saying that parliamentary socialism was "sinking in the political bog". She wrote for
12535-550: Was adapted as a play by William Gibson , later adapted as a film under the same title, The Miracle Worker . Her birthplace has been designated and preserved as a National Historic Landmark . Since 1954 it has been operated as a house museum and sponsors an annual " Helen Keller Day ". Keller was born on June 27, 1880, in Tuscumbia, Alabama , the daughter of Arthur Henley Keller (1836–1896), and Catherine Everett (Adams) Keller (1856–1921), known as "Kate". Her family lived on
12650-502: Was already a socialist who believed that Georgism was a good step in the right direction. She later wrote of finding "in Henry George's philosophy a rare beauty and power of inspiration, and a splendid faith in the essential nobility of human nature". Keller claimed that newspaper columnists who had praised her courage and intelligence before she expressed her socialist views now called attention to her disabilities. The editor of
12765-420: Was brought to Menomonie Saturday—a message that will linger long with those fortunate enough to have received it. This message came with the visit of Helen Keller and her teacher, Mrs. John Macy, and both had a hand in imparting it Saturday evening to a splendid audience that filled The Memorial. The wonderful girl who has so brilliantly triumphed over the triple afflictions of blindness, dumbness and deafness, gave
12880-439: Was diagnosed in about 7.7 million people worldwide, of whom 236,000 died, down from 433,000 deaths in 1990. With appropriate treatment, the risk of death in bacterial meningitis is less than 15%. Outbreaks of bacterial meningitis occur between December and June each year in an area of sub-Saharan Africa known as the meningitis belt . Smaller outbreaks may also occur in other areas of the world. The word meningitis comes from
12995-698: Was held at the Washington National Cathedral in Washington, D.C., and her body was cremated in Bridgeport, Connecticut . Her ashes were buried at the Washington National Cathedral next to her constant companions, Anne Sullivan and Polly Thomson. Keller's life has been interpreted many times. She and her companion Anne Sullivan appeared in a silent film , Deliverance (1919), which told her story in
13110-422: Was hired to keep house. She was a young woman from Scotland who had no experience with deaf or blind people. She progressed to working as a secretary as well, and eventually became a constant companion to Keller. Keller moved to Forest Hills, Queens , together with Sullivan and Macy, and used the house as a base for her efforts on behalf of the American Foundation for the Blind . "While in her thirties Helen had
13225-478: Was young, Anne Sullivan introduced her to Phillips Brooks , who introduced her to Christianity, Keller famously saying: "I always knew He was there, but I didn't know His name!" Her spiritual autobiography, My Religion , was published in 1927 and then in 1994 extensively revised by Ray Silverman and re-issued under the title Light in My Darkness . It advocates the teachings of Emanuel Swedenborg ,
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