238 PATHOLOGY. 
the patients have retained their intelleftual faculties un¬ 
til the laft. 
The mufcular fyftem exhibits various deviations from 
the healthy ftate, viz. general or local rigidity, or con¬ 
traction, local or general palfy, local or general convul- 
fions ; to which we may add a third ftate, that of agita¬ 
tion. This laft fymptom is feldom feen except in the 
firft and fecond ftages. It is not of much importance as 
an aid in the diagnofis ; but not fo convuljions. Thefe, 
with paralyfis, are one of the moll charadteriftic figns of 
arachnoiditis. General convulfions are moft common in 
children ; and are principally feen in the fecond and be¬ 
ginning of the third ftage; more in the upper than in 
the lower extremities. Rigid contraftions of the muf- 
cles are feen (in order of frequency) in thofe of the lower 
jaw, pofterior of the neck, fuperior and inferior extre¬ 
mities. They belong to the fecond ftage, and early part 
of the third ; fometimes conftant, but generally fhowing 
intervals of relaxation. 
The temperature of the Ikin is generally elevated, and 
equally diffufed over the whole furface of the body, 
being higheft in the fecond ftage of the difeafe, diminifli- 
ing and greatly varying towards the termination of the 
third ftage. The Ikin is generally dry during the firft 
ftage; in the fecond, fometimes moift, or even covered 
with an abundant perfpiration, efpecially about the face. 
Drs. Martinet and Parent-Duchatelet take notice of a 
difagreeable odour which patients labouring under this 
difeafe exale about the end of the fecond ftage, and 
which they can compare to nothing but the fmell of 
mice. They aflert that it always proved a very unfa¬ 
vourable fymptom. We have met with this fymptom in 
other complaints, where indeed no trace of arachnoiditis 
could be found. 
The organic lefions difcoverable on the necrotomy (a 
new and exprefiive word, as confining difleCtion to the 
dead fubjedt) of patients who have died of arachnoiditis 
are—a fimple blulh or rednefs of the arachnoid mem- 
. brane ; thickening, and lofs of tranfparency, in the faid 
membrane; a purulent, fero-purulent, or fero-gelatinous, 
exudation on its furface; the formation of falfe mem¬ 
branes ; and aferous effufion into the ventricles, between 
the laminae of the arachnoid, or into the cellular tifiue 
which unites the faid membrane to the pia mater. 
The treatment of this complaint is fimilar to that of 
Cephalitis in general, as far as regards bleeding, purg¬ 
ing, and the exhibition of fedatives. Bleeding, however, 
does not do fo much good in the advanced ftages of 
Arachnoiditis as in the advanced ftages of Cephalitis. 
It ftiould therefore be ufed early in this complaint: 
local bleeding is alfo highly beneficial: the French 
furgeons, in addition to thefe meafures, order counter- 
irritants, by means of finapifms and blifters to the 
feet and legs. A blifter on the head has occafionally 
been productive of the moft ftriking relief. General cold 
affufion is particularly recommended, as alfo the applica¬ 
tion of cold water to the head alone. Compreflion of 
the carotid arteries may alfo be ufed to reprefs the too 
great momentum of blood to the head. Thefe remedies, 
according to Martinet and his colleague, will often de¬ 
ceive the praftitioner; and upon the whole they give a 
lamentable account of the ufual termination of this ma¬ 
lady. The practice of the Englifli in this complaint, 
though few of them make any diftinCtion between Arach¬ 
nitis and Cephalitis, is tolerably fuccefsful; and for this 
reafon, that the fyftem of bleeding in inflammation is 
carried to a greater extent in this country, and purging 
with draftic cathartics is more in vogue. But we fliould 
obferve, that the, arachnoiditis of this country is not 
often fo violent as in France. 
This account has been introduced here from a firm 
conviClion in the mind of the writer of this article, that 
the divifion of cerebral and arachnoid inflammation has 
a foundation in nature. Before he read the work of 
Martinet, or even a review of it, his note-book con¬ 
tained a hiftory of certain anomalous cafes of head-affec¬ 
tions which he by no means underftood the nature of. 
Their hiftory perfectly coincided, at lead in all effential 
points, with the details given by the authors before 
mentioned. Since reading the work in queftion, and 
during the late hot weather, (June 1822.) feveral cafes 
have occurred to him. It may be worth while to notice, 
that, in one of the belt marked of thefe, the fubjeCt of 
which was a child four years old, after the moft aCtive 
bleeding and purging, and after the cold affufion of the 
head had been ufed with mere mitigation of the fymp- 
toms, at the end of the third day the exhibition of a 
fcruple of calomel combined with two grains of opium 
in four dofes completely and moft rapidly cured the pa¬ 
tient. For excellent details of cafes and dilfeCtions we 
refer to the work itfelf, or to a very good analyfis of it 
in the eighth number of Johnfon’s Journal, which we 
have made fome ufe of in our hiftory of arachnoiditis. 
In the above hiftory of the fymptoms of Arachnoiditis, 
the following are the moft remarkable variations which 
occur from the fymptoms of fimple Cephalitis. The 
contracted ftate of the features, the extreme irritability 
of fome of the mufcles, fometimes the integrity of the 
reafoning powers, the eafinefs of refpiration ; the fymp- 
toms obferving certain changes as the pain is fituated on 
the top or bafe of the brain ; the peculiar rotation, gritty 
fenfation, or turning-up, of the eyes; and laftly, the difi- 
polition of the difeafe to affeft the fpine. We cannot 
help in this place remarking, that, in the work of Ducha- 
telet and his colleague, the diftinCtion of fpinal and ce¬ 
rebral arachnitis is by no means fo unfounded as fome 
of our countrymen have fuppofed. A cafe occurred 
fome time fince to the writer of this article in which the 
attending practitioner cured a patient (as he thought) of 
Peritonitis by a fmall bleeding and a purge. The pa¬ 
tient fuddenly became affeCted with the primary fymp¬ 
toms of fpinal arachnoiditis with little cerebral difturb- 
ance. The latter however increafed ; and the patient, 
without exhibiting any very violent derangement of the 
pulfe or mental faculties, died in the courfe of ten days. 
On difleCtion of the head at the bafe of the cranium, 
the arachnoid tunic was found thickened, ftudded with 
depofitions, and adherent to the furrounding parts. 
The fame wasftill more remarkable in the fmall portion 
of the fpine which was cut up through the foramen ovale. 
A flight effufion was found in the ventricles. A fpecies 
of arachnoiditis very common in this country is Hydro¬ 
cephalus, which fee. 
The following account of Cephalitis will probably re¬ 
quire much alteration when the precife difference which 
charaCterifes the inflammation of the inverting or the in¬ 
verted parts of the cranium fhall be known. 
Cephalitis often makes its attack with a fenfe of full- 
nefs in the head, flufhing of the countenance, and rednefs 
of the eyes; the pulfe being full, but in other refpedls 
natural. As thefe fymptoms increafe, the patient be¬ 
comes reftlefs; his fleep is difturbed, or wholly forfakes 
him. Sometimes it comes on with tremors of the limbs, 
and intolerable pains of the hands, feet, and legs; fome¬ 
times with ftupor and rigidity of the whole body; and 
fometimes with anxiety, and a fenfe of tenfion in the 
breaft, which is often accompanied with palpitation of 
the heart. Sometimes, again, the ftomach is affefted; and 
naufea, and a painful fenfe of weight in that vifeus, 
fometimes heart-burn and vomiting, are among the 
earlieft fymptoms. The pain in the head foon becomes 
confiderable, and fometimes very acute. The feat of it 
is various: it generally feems to occupy the whole head; 
it is deep-feated and ill defined ; and, in other cafes, it is 
felt principally in the forehead or occiput. The rednefs 
of the face and eyes generally increafes with the pain, 
and there is often a fenfe of heat and throbbing in the 
head, the countenance acquiring a peculiar fiercenefs. 
Thefe fymptoms, for the moft part, do not laft long be¬ 
fore the patient begins to talk incoherently, and to (how 
2 ' other 
