ACUTE MENINGITIS. 231 
Where the onset of the disease is abrupt, the first symptoms manifested are 
those of active congestion. The victim is very restless and irritable, and evi- 
dently at times does not recognize those about him or know what he is doing. 
In other words, he is delirious. He shakes his head occasionally, and rubs the 
side of it along the ground or floor ; and now and then while doing so whines or 
cries piteously, thus indicating the location of the disturbing trouble. A symptom 
which plainly suggests rabies appears in his disposition to crawl under furniture 
or seek dark places, he evidently being sensitive to the light. That he is mad 
would also seem certain because of his peculiar susceptibility to sounds, and the 
excitement that they induce. He sleeps lightly, and is easily awakened; and 
when disturbed he starts up wildly, and makes a dash in the direction from 
whence the sound came, barking or growling as he does so. For perhaps a 
minute he continues to rage, then slinks back to his dark corner or nook. 
A dog in the first stage of rabies is not likely to bite his caretaker unless an 
effort is made to restrain him; but some victims of acute meningitis, even in the 
earliest stage, seem unable to recognize friends ; for when wildly excited they bite 
any one within reach, whether intimate or stranger. 
In meningitis the voice is altered; the eyes are glistening at first, and 
vacant in expression ; and the sufferer barks and snaps at imaginary intruders ; 
also bites at sticks extended to him. 
In meningitis, as in rabies, the violence and maniacal excitement occur in 
paroxysms, with intervals of comparative quiet. In both, also, convulsive move- 
ments are experienced ; there is snapping of the jaws and champing of the 
teeth, and not infrequently general convulsions come on, and last for ten or 
fifteen minutes unless controlled by ether. 
There is constipation in acute meningitis. For a time the hearing power 
remains unimpaired, and if not thrown into a rage when called, the dog raises 
his head as though listening ; but apparently unable to appreciate from whence it 
comes or the significance of the sound, he does not respond. 
When on his feet, if confined to a room, he circles around it, sniffing at the 
walls, and at times stops and barks for several minutes. 
While maniacal excitement and quite violent delirium are the rule in the early 
stage of acute meningitis, there are notable exceptions, and in those the victims 
appear dull and stupid. Or at least they are not easily disturbed or conscious of 
goings on about them, which would, in the other cases, be quite sufficient to 
bring on fits of frenzy. And these quiet subjects but rarely if ever show any 
disposition to bite man or animals. 
Acute meningitis has not been on long before the victim’s legs tremble under 
him, showing increasing weakness. Liquids he drinks readily and with feverish 
rapacity. Vomiting frequently occurs; the eyes are bloodshot, the face hag- 
gard, the pulse quickened, and the temperature of the body notably raised. 
Restlessness is a marked symptom in this stage. The writer recalls the case of 
