Prognosis. — The prognosis of any form of acute non-suppurative encepha litis is grave, both as regards life and the outlook for perfect recovery. In all forms many cases die during the acute attack. The prognosis of acute focal non-suppurative encephalitis depends, in great measure, upon the severity of the acute primary infection with which it is most frequently associated, and of which we must at present regard it as a resultant. Cases of perfect recovery from paralysis following this form of en cephalitis are not uncommon, and the paralysis in these cases generally shows improvement for a year following the attack. After influenza, especially, this tendency to recover from apparently grave conditions is marked. Very few cases, however, recover perfectly.
The prognosis of diffus.e non-suppura tive encephalitis in its acute form is very grave, both as regards life and re covery from residual lesions. There is almost no hope of complete recovery in any case. Cases having both hemi spheres involved generally die within a few days. The majority of cases which run a subacute course may live a num ber of months, or with crippled intelli gence and paralyzed bodies live for years. In general terms, cases of acute non suppurative encephalitis, which beg,in abruptly, with decided fever, a rapidly increasing comatose condition, and ex tensive paralysis are apt to be rapidly fatal; and, conversely, cases beginning rather insidiously, with slow develop ment of symptoms, offer more hope of re covery. All grades of acute non-sup purative encephalitis are subject to ir regularity in course and symptoms, so recovery sometimes occurs from appar ently hopeless conditions; therefore an absolutely fatal prognosis should not be given in any case.
Treatment.—The treatment of acute non-suppurative encephalitis will vary somewhat according to the age of the patient, the previous state of health, and the existence or not of some acute infectious disease; but the same general principles which govern the treatment of acute simple meningitis apply to all of these cases; absolute rest in bed in a darkened and well-ventilated room is necessary in all cases. The head and shoulders should be elevated. Absolute quiet on the part of the attendants, and the exclusion of any source of mental irritation or excitenient should be rig idly enforced. As soon as the existence of the disease is suspected, local deple tion, by means of dry or wet cups or leeches, applied to the nape of the neck or behind the ears, or to the temples; or general depletion by venesection in healthy sthenic adults with severe onset, should be practiced, followed in all cases by the ice-bag to the head. A fly blister
inay be applied to the occiput, and is better than larger blisters applied ex tensively over the head. When there is much hair the scalp should be shaved to admit of the fullest effects of dry cold. When vomiting is present small pieces of ice may be given by the mouth with sips of cinnamon-water at times, and a mustard plaster should be applied over the epigastrium; or a turpentine stoop may be used over the whole abdo men occasionally for this, and for its derivative effect. At the same time small and frequently repeated doses of mercury, preferably calomel, should be administered by the mouth, followed by a brisk purgative, and succeeded by the continued administration of smaller doses of mercury at longer intervals. In suitable cases aconite or veratrum viride may be given during the onset until their full physiological effect is secured, but in cases in children already weak ened by disease they should be cautiously employed.
For the control of pain some form of opium is necessary, and where there is active delirium and marked local or general tremblings or irregular tremor, it may be combined with chloral and the bromides. The continuous application of dry cold should be maintained during the acute stage.
The diet should consist of milk or other light nutritious preparations in small quantities, and they may be pre digested artificially with benefit. No stimulants should be given unless ur gently demanded by the condition of the pulse. Cases demanding stimulation in the early days of the disease may be given strychnine, supplemented by small doses of alcohol or ammonia in some form. The essence or wine of pepsin or champagne are acceptable stimulants to children, and are better borne by the stomach than whisky or brandy. If the patient cannot swallow, nutritive ene mata should be given.
Should the patient survive the attack, and the case continue in subacute forms, treatment must be directed to nourish ing the patient, to improvement of the general condition, and toward increasing muscular power in paralyzed parts. These indications are to be met by care ful and systematic feeding of light and easily-digestible articles, by massage, faradization, and Swedish movements of affected members to prevent contrac tions.