244 DISEASES OF THE BRAIN. 



J3 not simple miliary tuberculosis, but a tuberculous inflammation of 

 the meninges. During these symptoms, which usually last for several 

 weeks, the children become emaciated because their digestion is im- 

 paired, and probably also because they have fever. Nevertheless, it 

 often happens that the mother overlooks or pays little attention to 

 this period, and subsequently, when severe symptoms appear, assures 

 the physician that the child was suddenly taken sick. We must know 

 how important it is to decide whether there is the beginning of a new 

 disease, or the commencement of the final stage of an old one, so as to 

 make a more accurate examination. I have often found that the rela- 

 tives and neighbors had noticed the altered manners of the child, while 

 the mother had entirely overlooked them. 



If the above symptoms be accompanied by vomiting, which cannot 

 be traced to errors of diet, and does not occur after eating, but when 

 the child is raised up, if the patient at the same time suffer from con- 

 stipation and the abdomen is sunken, the physician must regard the 

 case as very serious, although the parents usually think it free from 

 danger. The little patients soon begin to complain more of their 

 heads ; they become sensitive to light and sound, gnash their teeth 

 during sleep, and occasionally give a piercing cry (crie hydrocepha- 

 tique). From time to time we see twitchings of certain limbs, or sud- 

 den spasm of the entire body. The patients start from their sleep 

 with terror at some dream, and do not find relief from it even in wak- 

 ing. They are very much excited, and often repeat the same word or 

 phrase innumerable times. At this time the pupils are usually con- 

 tracted and the pulse is more frequent. When these symptoms succeed 

 the premonitory stage, and when we at last see the child bending its 

 head backward, boring into the pillows, with the muscles of its neck 

 contracted, and the cervical lymphatic glands swollen, we become cer- 

 tain of the sorrowful fact. 



After a few days, or even sooner, the scene usually changes very 

 suddenly. The passage into the second stage is generally marked by 

 an attack of general convulsions, such as we have already described. 

 The vomiting then becomes rarer or ceases entirely, the children no 

 longer complain of pain, but put their hands to their heads in a pecu- 

 liar way ; loud noise does not disturb them, and they do not turn the 

 face away if a bright light be held before it ; the peculiar cry and the 

 gnashing of the teeth continue. We often find the muscles of some 

 of the limbs or of one half the body slightly contracted, while those of 

 the other side are relaxed. Now the previously-contracted pupils be- 

 some dilated, occasionally first one, then the other ; the children no 

 longer regard objects held before them, and they begin to squint. The 

 previously-frequent pulse becomes slower, falling to sixtv beats a 



