INFLAMMATION OF THE BRAIN ENCEPHALITIS. 259 



indefinite feelings, anaesthesia, twitchings, contractions, paralyses in 

 some parts of the bo$y, which, in many cases, accompany the symp- 

 toms previously mentioned, and which we fully described in the second 

 and fourth chapters, as the results of partial hyperaemia and partial 

 anaemia of the brain. These do not continue unchanged, like the local 

 symptoms, which are the immediate results of partial destruction of 

 the brain from the inflammatory process, but are rather apt to have a 

 variable course ; this is partly due to occasional enlargement of the 

 abscess, by which the space is more contracted, partly on the occasional 

 increase and decrease of collateral hyperaemia and collateral oedema. 

 It is evident that such a variation in the symptoms would occur oftener 

 in encephalitic inflammations than in slow and steadily-growing tumors 

 of the brain. 



The attacks of epileptiform convulsions, which not unfrequently 

 occur during encephalitis, are more difficult to explain, and we shall 

 not even offer a hypothesis as to the mode of their occurrence. Sta- 

 tistics have been made as to how often headache, contractions, epilep- 

 tiform convulsions, etc., were present or absent in a large number of 

 cases of cerebral abscesses. In individual cases, the results of these 

 statistics are, of course, of but little value in the diagnosis of abscess 

 of the brain, or in its differential diagnosis from tumor of the brain. 

 The injurious influence of the local inflammation on the general nutri- 

 tion of the brain, which may occur earlier or later, but never fails wheii 

 the disease is protracted, evinces itself by the previously-described 

 symptoms of a general paralysis of all the cerebral functions. I think 

 I have fully shown, by this description, that, in many cases, it is possi- 

 ble to recognize an abscess of the brain, although it has no constant or 

 pathognomonic symptom. 



The duration of encephalitis varies ; some cases terminate in death 

 after a few days or weeks, while in others this does not occur for years. 

 Occasionally, while the symptoms of cerebral paralysis increase, so 

 that the patient becomes idiotic, we find a remarkable development of 

 fat. Death occurs either suddenly and unexpectedly, from the devel- 

 opment of meningitis, from sudden increase of the abscess, and, occa- 

 sionally, without our being able to find, on autopsy, any cause for the 

 sudden catastrophe ; or else it occurs with the symptoms of gradually- 

 increasing sleepiness, finally becoming deep coma, or else it is induced 

 by intercurrent diseases. Recovery is very rare. Even in the most 

 favorable cases, where the cellular infiltration forms a cicatrix or en- 

 capsulates the abscess, while its contents calcify, we can only speak of 

 a- relative cure, since both the remains of the inflammation and the 

 atrophy of the brain, which usually develops under such circumstances, 

 affect the f-mctions of the brain for the rest of life. 



