252 DISEASES OF THE BRAIN. 



ooth of those that I have already mentioned, and of others of which 1 ha\ e 

 not yet spoken, as they are less constant. Severe headache occurs even 

 in those cases which, as me*ningite foudroyante, terminate in death in a 

 few hours. In the cases that run the usual course, as long as the pa- 

 tients retain consciousness they complain of headache, either sponta- 

 neously or on being questioned, and it also seems as if the restless- 

 ness, groaning, and complaints of the patients, after the intellect is 

 clouded, were partly due to the headache. Lastly, during an epidemic 

 of this disease, there are almost always a few cases where, without 

 the disease actually occurring, persons complain of very severe head- 

 ache continuing for several days without any other apparent cause. 

 We may consider such cases as abortive forms. 



Cervical and dorsal pains usually begin very early either with the 

 headache or very soon after ; they are generally increased by pressure 

 on the spinal processes of the vertebras ; with rare exceptions, this 

 pain is far greater when the patients make voluntary movements of 

 the spine or on passive motion being made. If the disease be pro- 

 tracted, the dorsal pains and their increase by movements of the spine 

 may continue for weeks. 



Painful sensations in the extremities, unmistakably neuralgic in 

 their nature, and caused by irritation of the posterior roots of the spi- 

 nal column, are not constant symptoms ; occasionally they only occur 

 on motion of the spine. 



Hyperc&sthesia and Anaesthesia of the Skin. Usually for the first 

 days of the disease, and in some cases during its whole course, the pa- 

 tients are very sensitive to any rough handling; their restlessness, 

 groaning, and complaints are increased when they are turned over in 

 bed, occasionally even if they be percussed. Later, we often see no 

 reaction even when the skin is greatly irritated ; but in such cases, 

 when the patients are in a state of stupor, there is cerebral anaesthesia. 

 Far more rarely, there is peripheral anaesthesia, during which, while 

 the patient is quite conscious, he feels irritation of the skin very little 

 or not at all. This symptom apparently depends on loss of excitabil- 

 ity of the posterior roots from inflammation. 



Tetanic spasms of the cervical and dorsal muscles are only absent 

 in some few cases of me"ningite foudroyante. At first the head is only 

 slightly retracted, later it may form almost a right angle with the 

 body. This position of the head and the addition of opisthotonos in 

 the dorsal and lumbar regions usually render it impossible for the pa- 

 tient to lie on the back. If the tetanus attain a high grade, it almost 

 always affects the respiration. Occasionally it disappears shortly be- 

 fore death ; more frequently it continues more or less severe till death 

 or convalescence. 



