254 DISEASES OF THE BRAIN. 



all accord with the height of the fever ; with moderate fever it is oc- 

 casionally very high ; slowness of the pulse is only rarely observed at 

 the commencement of the fever. 



TREATMENT. Just as in other malignant and fatal epidemics, in 

 deciding the best means of treatment, we must only consider cases 

 where there is at least a slight hope of recovery. Whoever tries any 

 proposed plan only on the severest cases will attain negative results 

 by any -procedure. The customary treatment of sporadic meningitis, 

 consisting of the energetic use of cold as ice-compresses to the head, 

 the application of leeches behind the ears, and the internal adminis- 

 tration of calomel, is also advisable in epidemic cerebrspinal menin- 

 gitis, as is very evident from its excellent effect in patients attacked 

 by the premonitory symptoms of the disease, severe headache, and 

 pain in the neck, during an epidemic. 



But, according to most observers, this mode of treatment has pre- 

 served its reputation even in marked cases of the disease ; there is but 

 little opposition to it, and even this is based on its want of success in 

 the severest forms. I have no personal knowledge of the success of 

 morphium when given internally or hypodermically. But a number 

 of trustworthy observers, Ziemssen and Mannkopff among others, 

 speak most favorably of it, especially in the form ef subcutaneous in- 

 jection. Ziemssen says : " Although we have used morphia frequent- 

 ly, we have never seen any injurious effects from it, but, on the con- 

 trary, such a decidedly palliative action that, along with cold, it seems 

 the most indispensable remedy in the treatment of meningitis." Al- 

 most all observers agree that quinine is entirely useless even in deci- 

 dedly intermittent cases. 



CHAPTER XI. 



INFLAMMATION OP THE BRAIN ENCEPHALITIS. 



ETIOLOGY. In encephalitis, just as in the inflammation of other 

 organs containing little connective tissue, there is not much interstitial 

 exudation, but there are most important changes in the nerve-filaments 

 and ganglion-cells and their scanty interstitial tissue. These tissue- 

 elements swell from absorption of nutrient fluid and subsequently 

 break down, partly to simple detritus, partly after precedent fatty de- 

 generation ; in the latter case, in the inflamed parts we find quantities 

 of fatty granular cells (the formerly so-called Gluge's inflammation 

 globules), which we have a right to suppose come directly from fatty 

 degeneration of ganglion-cells and neuroglia nuclei. In the subse- 

 quent course of encephalitis there is often an extensive formation of 



