176 CEREBRO-SPINAL FEVER. 



unless Avhcn the brain-lesions are great, pain is evidenced on 

 pressure being exercised with the fingers along the spine. The 

 bowels are usually confined, and the urine is not discharged 

 with regularity, often not until from its amount it is forced 

 in a continuous small stream or repeated small discharges 

 from the urinary conduits. 



On the point of internal temperature, as indicated by ther- 

 mometric observation, there is a strange discrepancy of opinion ; 

 some observers emphatically declaring that no elevation is ex- 

 hibited in any stage, others giving high readings as habitual. 

 My own experience is that this state is rather variable and 

 uncertain, the greater number indicating considerable elevation, 

 while a few continue normal, with an occasional instance of 

 depression. The condition seems one to which from its un- 

 certainty it is not possible to give any typical range ; an 

 elevated temperature has, with my observations, been more 

 frequent than the opposite. 



There are also to be observed not unfrequently during the 

 entire course of the disease well-marked cases of intermittency 

 in the pyrexial symptoms ; these, I have noticed to occur in 

 instances where recovery has apparently taken place, and I have 

 been inclined to associate this return or exacerbation of dis- 

 turbance with the advent of reabsorption of exuded material, 

 or with the development of complications which are ajjt to 

 appear in severe and protracted cases. 



In the milder attacks of the fever, which may be encountered 

 at any time, but are oftener seen at the termination of an epi- 

 zooty, the development of symptoms is not so hurried, the 

 advance of the severe and diagnostic being heralded by dul- 

 ness, want of vigour, impaired appetite, shght rigors, and a 

 peculiar sluggishness. In these, when complete paraplegia 

 or more extensive paralysis with affections of the cerebral 

 centres does not show itself during the first three or four days, 

 with careful attention a fair proportion will recover. When, 

 however, the loss of control of the posterior extremities is very 

 early in the seizure and very complete, with well-marked and 

 persistent muscular contractions and convulsions, together 

 with impairment of consciousness, or exalted sensibility, the 

 probabilities of an early and fatal issue are great. The chief 

 complications which are apt to occur during the course of such 



