EPIDEMIC CEREBRO-SPINAL ATENINOI TIS.—This form of leptomeningitis is a specific infectious disease, but presenting as its chief pathological lesion a wide spread inflammation of the meninges of the brain and spinal cord. it has heen recognized as such for nearly one hun dred years. Other names sometimes used are "spotted fever," "petechial fever," and "malignant purpuric fever." it oc curs as a sporadic epidemic or endemic disease, and varies much in malignancy in different epidemics. (a) A very malig 1.1.1 form described in which death t-iturs before the exudate, has time t '1 he symptoms in this inalig t v are sudden onset with chills, m in head, extreme physical and men t thpr,sien. local or g,eneral muscular ,ins. fever of 102° to 103° F.; feeble p. • be(oniing slow; purpuric rash (riot tistatiO and death inside of twenty f .er hours. er even less, as iu a case re t rded bv St We. in which death occurred /lin it 11 'IOM'S.
CaSe of leptomeningitis lasting only six I ours. First symptom was a slight con % ulsion, laryngeal obstruction simulating croup: high temperature, 106.5° F. to 107.6° F.; absence of vomiting. There had been no prodromata. Autopsy show ed a dry. glazed brain, with adhesion betw een the g-yri and between the hemb :There= ; the vessels of the pia were in jected. No pus or tubercles. Other organs normal. Hosmer (Boston Aled. and Surg. Jour., May 17, 'SS).
Case of meningitis of unknown origin, ending fatally quite suddenly, with sharp elevation of temperature from nor mal to 105° F. in less than two hours, coma, abolition of all reflexes and of res piration, and apparent death, though the heart continued to beat and the pulse to be perceptible for thirty-eight hours after ward. artificial respiration being prae iced almost continuously meanwhile. 'smith (Va. Med. Mthly.. Oct., '93).
.7.- The ordinary form also begins sud (1. nly. with few premonitory symptoms, w-th a chill, severe headache, repeated a•tae -s (-4 vomiting, and moderate fever.
Vi.rv early there is ri,giclity of the r' r ry'cal mu,cles, causing severe pain.
T re is photophobia and m_-= to light and noise. Often there is pain in the limbs and back-. Tonic and choreic spasms of the limbs occur, and, in young children, general convul s;on= are more common than in older ch:ldren or adults. Strabismus, followed by paralysis of the eye-muscles, with in -,-•11.-ement of the facial muscles, fre quently occurs. During the early stage delirium may be a very marked feature, but soon the patient sinks into a stupor ous condition, but often continues to suffer from the severe head-pains and body-pains until the stupor becomes coma. The disease is very irregular in its course, remissions are frequent in all its symptoms, and the fever especially is apt to be most variable.
The respiration is not apt to be so much disturbed as in tubercular menin gitis. The pulse is often extremely rapid in young children, but in older persons it may be either rapid or distinctly slow, full, and strong in the early days of the disease. The peteehial rash occurs in a considerable proportion of the cases. Stille noted its absence in thirty-seven out of ninety-eight cases in the Phila delphia Hospital. Osler states that pete chial and purpuric spots were commonly present in his cases in Montreal. Other forms of eruptions noted as occurring in this disease are herpes labialis, erythema nodosum, ecthyma, and pernphigus. The spleen is enlarged. and constipation is the rule. Albuminuria, glycosuria, and luematuria have been observed. The dis ease runs a variable course froni a few days to several months. Of the fatal cases a majority die within the first week. Ilecovery is often slow and complications are common, including pneumonia, risy, pericarditis, and painful forms of ar thritis in some epidemics of the disease.
Peripheral or multiple neuritis occurs in some cases of cerebro-spinal menin gitis. This coincidence observed in three cases. C. K. Mills (Medical News, Mar. 3, 'SS).