Page:The American Cyclopædia (1879) Volume III.djvu/207

BRAIN (DISEASES) 201 enters into the treatment in the second stage. Acute cerebral meningitis may be associated with an acute inflammation of the correspond- ing membranes of the spinal cord. The affec- tion is then called cerebro-spinal meningitis. This characterizes a remarkable and extremely fatal epidemical disease, generally known by the name epidemic cerebro-spinal meningi- tis. A subacute simple cerebral meningitis, in which the inflammation does not become chronic, is infrequent ; but cases occur, chiefly in children. The symptoms in the stage of ex- citement are the same in character as in the acute disease, but notably less marked or in- tense. The symptoms due to compression may be developed after a slight or moderate head- ache, intolerance of light and sounds, febrile movement, &c. ; and a fatal coma may be caused by an abundant serous effusion. The treatment in these cases relates chiefly to the absorption of serous effusion. Subacute inflam- mation of the meninges of the brain is general- ly presented as a chronic affection, and is call- ed chronic cerebral meningitis. The local symp- toms are pain in the head, muscular weakness, undue disposition to sleep, change in the mental disposition or character, more or less impair- ment of the intellectual faculties, paralysis af- fecting sometimes certain of the facial nerves, and in some cases the two limbs on one side ; and at length, in the great majority of cases, a fatal termination occurs, preceded by great exhaustion and frequently by coma. This af- fection may follow acute meningitis, but in general the inflammation is subacute from the outset. It is often latent ; that is, it is not de- clared by well marked symptoms pointing to inflammation within the skull ; and it is, there- fore, liable to be confounded with other affec- tions. Mental irritability and dnlness of the faculties of the mind may for some time be the only symptomatic characters referable to the head. Moreover, it is by no means always easy to discriminate by the symptoms this af- fection from softening and other cerebral le- sions. The duration of the disease is often long, not infrequently lasting many months, and even years. Sooner or later, it ends generally in death. The causes are usually obscure. Happily it is rare. There is not much prospect of benefit from drugs ; but certain remedies, namely, mer- cury and iodine, may be tried. The great ob- ject of treatment is to maintain nutrition and thus enable the system to tolerate the disease as long as possible. In tuberculous meningitis, the inflammation of the meninges is referable to the presence of tubercles or miliary granu- lations. These morbid products are seated at the base of the brain, and hence the inflamma- tion is limited to or most marked at the base ; whereas, in simple meningitis, the upper por- tion or convexity of the brain is chiefly or es- pecially the seat of the inflammation. The ventricles of the brain in this affection are apt to contain liquid in more or less abundance, and hence formerly the affection was called acute hydrocephalus. The affection is vastly more frequent in infancy and childhood than in after periods of life, but it occurs at all ages. It is almost invariably associated with tuber- cles in other organs, and especially in the lungs. In general, the development of this affection takes place gradually. For some weeks or months before the disease becomes declared, children generally show symptoms of ill health, namely, loss of appetite, indisposition to exer- cise, and more or less emaciation. Especially a mental change is noticeable, consisting in irri- tability of temper and dulness of the faculties of the mind. These symptoms probably relate to the tuberculous disease, and precede the acute inflammation. The latter is characterized by headache, generally intense and persisting, accompanied often by persistent vomiting; there is usually intolerance of light and sound ; the face is apt to be flushed in paroxysms ; there is fever, as shown by the pulse and temperature of the body. These symptoms continue for a period ranging from a few days to a fortnight ; and then a change occurs which is attributable mainly to the presence of the inflammatory products, lymph, pus, and serous effusion. The pulse is now diminished in frequency, and it may fall considerably below the healthy standard; it is apt also to be irregular and faltering. The respiration is altered in rhythm, becoming irregular and suspirious. The pupils are dilated. The perceptions are blunted; the patient lies most of the time in a state of som- nolency. Lancinating pains in the head are, however, felt from time to time, giving rise in infants to a sudden sharp cry which is quite distinctive. The temperature of the body may now fall below the minimum of health. The vomiting becomes less, or it may cease. The bowels are constipated, and the abdomen de- pressed. Convulsions, which sometimes occur before, are not infrequent after this change in the symptoms has taken place. Strabismus or squinting is common. Paralysis of the muscles of the face or of the limbs on one side is fre- quent. At length vision is lost; the somno- lency eventuates in coma, and, under these circumstances, the affection ends fatally. The tendency to death is such, that when this af- fection is considered to exist, recovery is a ground for the rational presumption that the affection was not really present, but simulated. In children, it is liable to be confounded with typhoid fever, and with a condition already re- ferred to, namely, cerebral anajmia incident to disorder of the digestive system. Moreover, it is not always easy to discriminate it from a simple acute meningitis. The iodide of potas- sium has been of late years chiefly relied upon in the treatment of tuberculous meningitis. Its efficacy, however, in any case is ques- tionable ; and there are no remedies at present known which can be given with any expecta- tion of effecting a cure. The only hope, in cases which seem to present the evidence of existence of this affection, is that the diagnosis