EPIDEMIC CEREBRO-SPINAL MENINGITIS. 247 



is not at first a simple inflammation of the meninges, which is sub- 

 sequently accompanied by the development of the tubercle, after 

 repeated relapse of the inflammation. When the local abstraction of 

 blood proves beneficial, it may be repeated during subsequent relapses. 

 In these cases, at the onset of the disease, laxatives and ice compresses 

 may also be used. Otherwise the treatment is the same as that for 

 meningitis, with puro-fibrinous exudation. But the treatment must be 

 entirely different when the inflammatory symptoms are less decided, 

 when the headacne is slight, and the disease drags on slowly. Then 

 a single venesection is admissible, it is true, but it rarely has even a 

 temporary effect, and its repetition is almost always injurious. On 

 the strength of two successful cases, opposed, it is true, by a large num- 

 ber of unsuccessful ones, I recommend large doses of iodide of potas- 

 sium, continued for a long time. In the cases above mentioned, where 

 recovery took place under this treatment, there was a very extensive 

 iodine eruption, and an iodine catarrh of the nose. These signs of 

 iodism were absent in the unsuccessful cases. It cannot be denied 

 that cold douches have a palliative effect, but I would advise against 

 their use in marked cases of tuberculous basilar meningitis, and con- 

 sequent acute hydrocephalus. During the affusion, the children almost 

 always recover consciousness, but it is only for a short time. More- 

 over, when not successful, the operation is very painful, not for the 

 children, but for the persons around. The latter feel very much 

 pained that the child was worried at the last, when it could not be 

 assisted. The same is true of the application of moxse, and of frictions 

 to the scalp with tartar-emetic ointment. Hasse recommends very 

 small doses of morphia (^ of a grain) even in the early stages, as he 

 has seen undoubtedly beneficial effects from it in some cases. 



CHAPTEK X. 



EPIDEMIC CEREBRO-SPINAL MENINGITIS. 



FROM the fatal epidemics of this disease which have occurred of 

 late years in Germany, cerebro-spinal meningitis has acquired a greal 

 interest for German physicians, to whom it was previously almost ex- 

 clusively known from the accounts of French observers. In 1865, 1 

 wrote a treatise on epidemic cerebro-spinal meningitis ; this article was 

 well received on many sides, but also caused some opposition, because, 

 in spite of the small number of my observations, I had ventured to 

 make various hypotheses concerning the nature of the disease and the 

 indications of the symptoms. But, on careful examination of the ex 

 tensive literature on the subject, of late years, I have found nothing 

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