EPIDEMIC CEREBRO-SPINAL MENINGITIS. 353 



Epileptiform convulsions are rare, which is very remarkable, con 

 sidering the exudation is often widely spread over the convexity of the 

 hemispheres. 



Paralysis. Usually there is no actual paralysis till death; but 

 there are a few cases where hemiplegia or paraplegia, and quite a 

 number where paralysis of the facial, oculomotor, or of the abducens, 

 were observed. It is not at all difficult to explain these paralyses ; on 

 the contrary, it is almost wonderful they are not more frequent. 



Psychical Disturbances. At the commencement of the disease, 

 the intellect is almost always unclouded ; the patients answer ques- 

 tions correctly. But they soon become ill at ease and very restless. 

 Then questions prove annoying, and they will only give short and in- 

 complete answers. The incessant jactitation, which is scarcely inter- 

 rupted by pauses of a few minutes, is very characteristic in the first 

 stage of tne disease. Subsequently most patients have delirium of 

 variable intensity, which finally gives place to a soporose condition. 



Disturbances in the Organs of Special Sense. Patients not un- 

 frequently become blind from keratitis, which is probably induced by 

 incomplete closure of the eyelids, due to paresis of the orbicularis 

 palpebrarum, or from exudative choroiditis and neuro-retinitis, prob- 

 ably a result of direct propagation of the purulent infiltration along 

 the optic nerve from the cranium to the eye. Deafness is remarkably 

 frequent, so that we are almost obliged to suppose that it has several 

 causes, among which, however, the most important, doubtless, is the 

 propagation of purulent infiltration along the auditory nerve to the in- 

 ternal ear. 



Among the eruptions, groups of herpes vesicles in large numbers 

 are very often seen, and more rarely erythema, roseola, urticaria, pete- 

 chia, and siidamina. The frequency of the exanthemata, and particularly 

 the occasional symmetry of their occurrence, have led to the supposition 

 that they might depend on irritation of the cutaneous nerves, as Bar 

 rensprung has shown to be the case in herpes zoster from neuralgia. 



According to Ziemssen's numerous and accurate observations, the 

 fever has no regular course. Very few temperature curves resemble 

 each other ; sudden leaps and exacerbations of short duration often 

 occur. But generally a remitting type, with exacerbations of half a 

 degree to a degree, is most frequent. Very high temperatures are al- 

 most exclusively seen in severe cases that terminate fatally. In most 

 3ases the temperature does not rise above 103. The intermittent 

 fever that occasionally accompanies the other symptoms during conva- 

 lescence is regarded by Ziemssen as a reabsorbing fever, while he re- 

 fers that occurring during the first and second weeks to an interrupted 

 progress of the meningitis. The frequency of the pulse does not at 



