24:6 DISEASES OF THE BRAIN. 



lion, we find miliaiy tuberculosis of the meninges, and slight amounts 

 of hydrocephalus, which were not indicated by any prominent symp- 

 toms during life. These cases seem to show that, in the description 

 of the disease first given, the premonitory stage belonged to the com- 

 mencement of the cerebral affection, and not to its complications or to 

 the general tuberculosis. Lastly, we must point out that tuberculous 

 basilar meningitis, and miliary tuberculosis of the meninges, develop- 

 ing during advanced pulmonary consumption in adults, have no dis- 

 tinct premonitory symptoms, but are first recognized from the occur- 

 rence of contractions of the muscles of the nape of the neck, coma, 

 slow pulse, dilatation of the pupil, and the other symptoms of the fully- 

 formed disease. Death is the most frequent termination. Well- 

 proved cases of recovery are very rare ; but, even excepting the cases 

 where the diagnosis was somewhat uncertain, there is no doubt that it 

 has occurred. Neither the ordinarily variable course of the disease, nor 

 the surprising remissions that usually occur, should induce us to give a 

 more favorable prognosis ; only a continued improvement of all the symp- 

 toms dare excite the hope that the disease will take a favorable course. 

 TREATMENT. Until within a short time, the treatment of tuber- 

 culous meningitis and acute hydrocephalus presented no difficulty to 

 the physician. The inflammation of so important an organ naturally 

 required the employment of all kinds of antiphlogistics. At the out- 

 set of the disease, venesections were ordered, calomel and flor. zinci 

 were administered, and mercurial ointment was rubbed in the nape of 

 the neck, then the occurrence of calomel stools, or the first signs of 

 salivation, were anxiously awaited, for they were a guaranty for the 

 efficacy of the treatment. In the later stages, absorption of the exuda- 

 tion was to be induced ; hence the mercurial frictions were continued, 

 and diuretics and active derivatives, even moxa on the shaved scalp, 

 or pustulating ointments to it, were prescribed. If, in spite of all this, 

 the paralysis continued to advance, an infusion of arnica and camphor 

 was given. The more this disease was recognized as one symptom of 

 extensive tuberculosis, the more antiphlogistic treatment was aban- 

 doned; then the opposite error was fallen into, either nothing was 

 done (expectant treatment), or else all the efforts were directed to the 

 cure of the tuberculous dyscrasia. The best mode of treatment of 

 tuberculous meningitis and miliary tuberculosis of the meninge? 

 s as follows: At the commencement of the disease, especially 

 when severe headache indicates tuberculous inflammation rathei 

 than simple miliary tuberculosis, we should apply leeches behind 

 the ears. This is the more urgently to be advised, as in this stage 

 an exact diagnosis of the different forms of meningitis is scarcely 

 possible, and we do not certainly know whether the disease 



