HYPER^EMIA OF THE BRAIN AND ITS MEMBRANES. 189 



The symptoms of hypersemia of the bruin in children, where the 

 motor disturbances are usually greatest, may very much resemble those 

 of meningitis. The two diseases are often confounded, and occasionally 

 they can only be distinguished by their course. Such children have 

 usually suffered from constipation for a few days, have had restless 

 sleep, gnashed their teeth during sleep, or have been frightened out of 

 it by dreams, which disquieted them after waking, and prevented their 

 sleeping again. Then there were vomiting, contraction of the pupil, 

 and twitching of some of the limbs. But these symptoms are often 

 only preliminary to far severer ones, which cause great anxiety. They 

 are followed by general convulsions. In rare cases, these convulsions 

 also occur without premonition, as the first symptoms of great hyper- 

 aemia of the brain. The twitching usually begins in one extremity, or 

 one half the face, and rapidly spreads over the body. Occasionally the 

 convulsive movements alternate with tetanic contractions, or certain 

 muscles, particularly those of the back of the neck, are tetanically con- 

 tracted, while the face twitches, and the extremities are tossed about 

 by clonic spasms. The children do not respond when called, or when 

 the strongest irritants are applied to their skin. They are bathed in 

 perspiration, the abdomen is puffed up, the respiration impaired ; the 

 saliva, made frothy by the movements of the masticatory muscles, flows 

 from the mouth. Occasionally there is a pause in the severity of the 

 convulsions, and we hope the attack will pass off; but, after a short 

 remission, the spasms begin again with their former severity, and, in 

 severe cases, the attack may continue, with varying intensity, for many 

 hours. In one child I saw the spasms last over twenty-four hours, 

 with only slight occasional interruptions. Still, in the great majority 

 of cases, the attack ends in half an hour or an hour. In spite of the 

 terror that patients in this state cause the laity and inexperienced 

 physicians, we may give a favorable prognosis, if we can exclude a 

 meningitis. This can usually be done with certainty. Purulent menin- 

 gitis is, on the whole, a rare disease, which, as we shall hereafter show, 

 only exceptionally occurs in previously healthy children without pre- 

 cedent injury of the head, or disease of the cranial bones. Tubercu- 

 lous basilar meningitis, a far more frequent disease, often escapes ob- 

 servation till the children have convulsions ; but, if we inquire carefully, 

 we shall find that the attack has been preceded by a long illness, 

 and by other symptoms that have been overlooked, or at least under- 

 valued, which we shall hereafter describe. If the child has been well 

 the day before the attack, except some 'signs of cerebral hyperaemia ; 

 if it has had no injury of the head, no otorrhcea, etc., we may be 

 pretty certain that it will be better, if not quite well, the next day. 

 The attack is usually followed by a deep sleep, from which the child 





