24:0 DISEASES OF THE BRAIN. 



quently as its remains are found on autopsy of drunkards and insane 

 patients. This is especially true of the commencement of the disease. 

 It is probable that it is accompanied by headache and functional dis- 

 turbance of the brain of an irritative character ; but in drunkards, for 

 instance, it will always be doubtful whether these are symptoms of 

 inflammation of the brain or of alcoholic poisoning. The advanced 

 stages of the disease may be more readily made out. If, in a patient 

 who has been exposed to the above causes, and in whom we can ex- 

 clude other brain-diseases, we find decided impairment of memory, dul- 

 ness of intellect, disjointed frame of mind, if there be also trembling 

 of the limbs, tottering gait, and other symptoms of gradually-progress- 

 ing paralysis, we may diagnose chronic meningitis. 



TREATMENT. There is no doubt that favorable results are some- 

 times attained by active treatment in acute meningitis with puro-fibri- 

 nous exudation. It is not generally proper to bleed from the arm, but 

 we may apply leeches to the brow and behind the ears, and, if the 

 strength of the patient permit, may repeat the application. We may 

 also cover the shaved head with cold compresses, and give an active 

 purge of calomel and jalap. In the later stages of the disease, if, in 

 spite of the previous treatment, there be coma and other signs of cere- 

 bral palsy, we may apply a large blister to the nape of the neck, and 

 rub pustulating ointment on the head. Still more efficacious than 

 these derivatives are douche baths, pouring cold water over the head 

 from a pitcher held some distance above it. The patients almost al- 

 ways recover consciousness as this is being done ; but, it must be re- 

 peated at intervals of a few hours, to secure a permanent result ; with 

 each successive employment of the douche we must increase the num- 

 ber of pitcherfuls. I shall lastly mention that frictions with mercurial 

 ointment, and the continued administration of calomel, are much em- 

 ployed. In chronic meningitis, Kruckenberg also recommended cold 

 douche baths as the most efficacious treatment. He particularly quoted 

 the case of an old official, over whose head he daily poured as much as 

 fifty pitcherfuls of cold water. 



CHAPTER IX. 



BASILAR MENINGITIS, TUBERCULOUS INFLAMMATION, AND SIMPLE MIL- 

 IARY TUBERCULOSIS OP THE PIA MATER ACUTE HTDROCEPHALUS. 



ETIOLOGY. In basilar meningitis there is a deposit, in the sub- 

 arachnoid space at the base of the brain, of a readily-coagulating exu- 

 dation, containing few pus-corpuscles. At the same time, there are 

 almost always tubercular granulations in the meninges, causing a form 



