238 DISEASES OF THE BRAIN. 



is very sensitive to light, sound, and even to slight friction on the 

 skin. [A mere touch, especially upon the skin of the legs, will make 

 the patient cry out ; and even after the stage of stupor has set in 

 he will wince if touched, showing that reflex irritability still con- 

 tinues. This hypersesthesia of the extremities is a sign that the 

 meningitis has extended to the spinal cord. Autopsies conducted 

 by Gerhardt, both in children and in adults, uniformly support this 

 interpretation of the symptom. On the other hand, the contraction 

 of the neck-muscles so common in meningitis, which has also been 

 ascribed to the coexistence of cerebral and spinal meningitis, is 

 found more frequently in pure cerebral meningitis than when com- 

 plicated with meningitis of the cord. In some cases a marked draw- 

 ing-in of the belly affords a noticeable diagnostic mark.] Finally, 

 there are noises in the ears, sparks before the eyes, restlessness, 

 gnashing of the teeth, twitchings, and often also contraction of the 

 pupil, and vomiting. We have had to mention all these symptoms 

 in treating of simple hyperaamia of the brain and of hydrocepha- 

 loid ; indeed, there is no pathognomonic sign of meningitis which 

 is present in this and absent in other brain-diseases. It is true, the 

 etiology, the grade of the fever, especially the height of the pulse 

 and the unusual severity of the headache, occasionally speak, even 

 in this stage, with great probability against simple hyperaemia 

 or anaemia of the brain ; but frequently it is only the subsequent 

 course, the severe accidents that characterize it, the want of success 

 in treatment, and the usually fatal result, that render the diagnosis 

 certain. 



If any of the characteristic symptoms be absent in the first stage, 

 we must give a guarded diagnosis. Frequently only the effect of a 

 laxative or of local blood-letting verifies the diagnosis between hy- 

 peraemia of the brain and meningitis. An attack of convulsions, 

 usually preceded by stiffness of the neck, from tonic contraction of 

 the muscles of the nape of the neck, often indicates the passage into 

 the second stage. In this the patient falls into a deep sopor, becomes 

 entirely insensitive to the irritation, and cannot move his limbs, 

 although certain muscles, particularly those on the back of the neck, 

 are in a state of tonic contraction, and there are general convulsions 

 from time to time. [For some time after the commencement of the 

 stage of stupor, periods of excitement recur, with delirium and loud 

 screaming and convulsive paroxysms. It is remarkable that even at 

 this stage of the malady fluctuations occur, with temporary improve- 

 ment in the patient's condition ; sometimes even the consciousness 

 returns, and other deceptive signs inspire a hope of final recovery. 

 The most important diagnostic marks of depression are the palsies, 



