250 DISEASES OF THE BRAIN. 



Except some accidental complications, there are no particular anom- 

 alies of the other organs; we should especially note here that the 

 spleen is almost always normal. 



The post-mortem appearances, in protracted cases, are known only 

 from a very few observations. In one such case I found the exudation 

 thickened, and partly affected with caseous metamorphosis, as well as 

 considerable fluid in the ventricles. The same appearances have been 

 noted by other authors. 



SYMPTOMS .LNT> COURSE. I must again repeat that the symptoms 

 and course of epidemic cerebro-spinal meningitis may be fully explained 

 by the changes in the meninges of the brain and spine, and that, on 

 this account, the malady differs from most other infectious diseases. 

 Every thing that has been advanced in opposition to this view may be 

 refuted by the simple fact that, in genuine croupous pneumonia, which 

 no one classes among the infectious diseases, certain symptoms, such 

 as the frequent herpetic eruptions, albuminuria, etc., are just as diffi- 

 cult to explain, from the inflammatory changes in the lung and the 

 copious exudation hi the alveoli, as are some of the occasional symp- 

 toms of epidemic cerebro-spinal meningitis. 



Only in rare cases is the outbreak of the disease preceded by a 

 premonitory stage, characterized by slight headache and pain in the 

 back. Usually the scene opens with an unexpected chill of variable 

 duration, which is soon accompanied by severe headache, and in most 

 cases by vomiting. The headache rapidly becomes very severe, the 

 patient grows very restless, tosses about constantly, the pupils are con- 

 tracted, the intellect remains clear. The pulse is 80-100, the bodily 

 temperature moderate, the inspirations increase to 30-40 per minute. 

 Even at the end of the first or second day, rarely later, we notice 

 that the head is drawn backward. At this time there is often a 

 herpetic eruption near the mouth, on the cheeks, eyelids, ears, and oc- 

 casionally on the extremities. The complaints about severe headache 

 continue ; the pain extends from the head to the nape of the neck and 

 the back. The restlessness becomes excessive, the ideas confused, the 

 pupils remain contracted, the belly is sunken, and the bowels are con- 

 stipated. The pulse and respiration become more frequent, occasion- 

 ally the pulse is over 120 and the respiration over 40 per minute ; 

 the bodily temperature still remains proportionately low, or rises to 

 103 or over. The third or fourth day of the disease the tetanic con- 

 tractions of the muscles of the neck and back become more evident, 

 and are occasionally accompanied by trismus ; there is excessive opis- 

 thotonus ; consciousness is lost, but the patient still tosses about in bed, 

 the pupils remain contracted, constipation continues, the belly is sunk- 

 en, urine is passed involuntarily, or else the bladder becomes distend- 



