Attention called to frequency of phar yngitis during epidemics of cerebro spinal meningitis. Sears (Boston Med. and Surg. Jour., Aug. 9, 'SS).
Eye-symptoms studied in epidemic of cerebro-spinal meningitis. Various affec tions noted with more or less frequency are conjunctivitis, altered pupils, pus in the anterior chamber, choroiditis and iritis, suppurative cyclitis, retinitis, panoplithalmitis, neuritis, etc. The fun dus should always be examined, as there is a direct communication between the arachnoid space and the deeper structures of the eye through the intravaginal space.
Of 35 cases, 21 fatal. Case of child, aged 20 months, in which there was thrombosis of the central vein with an }Hemorrhagic retinitis. The fundus was normal in only 7 eases, and 1 of these 7 had divergent strabismus and dilated pupils, another marked nystaginus, and another greatly dilated pupils. In 0 eases there was optic neuritis, and in 19 great venous engorgement and tortuosity, with congestion of the optic disk. Of the 3 cases in which there was an absence of all eye-symptoms, 2 recovered and 1 died. All eases of strabismus (S) were diver gent, and the right eye was always af fected. Every extensive epidemic is apt to be associated with a special type of eye disease. Randolph (Johns Hopkins Hosp. Buil., June, July, '92).
Case of boy who died of eerebro-spinal meningitis, which apparently originated in trauma. Remarkable features of the case were persistent coma for two weeks and phenomenal emaciation. Thompson (Med. Ilect.rd, Apr. 8, '93).
Thirty cases of eerebro-spinal menin gitis in an epidemic. In 17 eases the most striking symptom was herpes, several of these eases dying. In 11 cases the urine contained albumin, but no casts; in 2 eases there was polyuria, and in 1 gly cosuria, the patient dying. on the fourth clay. Friis (Univ. Med. Jour., July, '93).
Case of eerebro-spinal meningitis in which persistent brematuria was present. Biggs (Epitome of Med., Aug., '93).
Many of the eye-symptoms of impor tance in meningitis are largely motor. Thirty-eight eases of meningitis reported —13 simple leptomeningitis, 12 cerebro spinal meningitis, 13 tuberculous. In 8 of the 13 cases of leptomeningitis there were no eye-symptoms. The patient with purulent meningitis, in which no eye symptoms were present, showed, post mortem, the meninges covered with pus and extensive adhesions between the pia and dura mater. In the cases of cerebro
spinal meningitis eye-symptoms were ab sent in 7. Loss of iris-reflex was present in 1, dilated and fixed pupils in another, strabismus in a third, and in the fourth the pupils were dilated, but reacted to light.
No eye-symptoms were present in 8 of those having tuberculous meningitis. Cerebro-spinal meningitis has as promi nent symptoms paralysis of third, fourth, ophthalmic division of fifth, sixth, and seventh nerves, with nystagmus and ptosis from cortical lesions; choked disk, optic neuritis, perineuritis, plastic and suppurative iritis, conjunctivitis, (edema of the lids, hemianopsia as a cortex or tract lesion. In simple meningitis or lep tomeningitis the eye-symptoms are of more importance in determining the diag nosis than in the ecrebro-spinal type. The most reliable is optic neuritis. A. E. Davis (Med. News, June 5, '07).
By practicing lumbar puneture in meningeal disease and eentriftigalizing the turbid serum thought to point Lo tubercle, a large number of lymphoey t es and la rge mononnelea ted leueocy t es were found. As observed by Mound, the cells are also present in the cerebro spinal fluid of tabetie and general para lytic patients. Thought to be a charac teristic sign of meningitis. \Vidal, Si card, and Ravaut (Seni. .Tan. 23, 1901).
The sequehn include blindness, deaf ness, chronic hydrocephalus, sevore nett ralgias of the head, and mental disease of various types.
Syphilis may very rarely Ca llSe :111 acute cerebral loptomeningitis, hut it is much more commonly a cause or (lin-Ink leptomcningitis. The symptoms do not differ from ollier varieties of :lento lop tomeningitis, excepting for their ciation with other evidences of Knelt as gun-lin:1H or specific ulcerations of thc bones.
In acute syphilitic ineningit is ext Fenn. ly-intense headaches, repea led vomiting, and occasional elevation of temperature are the first symptoms. If the proe..ss L t tilt 1 %trtigo, mental troubles, •N;• kn.; f ression of the cranial n,s, 1.01A tirm, and bulbar phenomena 1.111 t t 110, :Ind profound depression sue .4.Lds, ending in fatal coma. If the % (\Iry be chiefly affected, phenomena of mem predominate; noisy delirium, it e.ited convulsions and hallucinations t. ma cellICS 011 later—often with henti h gia or monoplegia. Specific treatment is f 110 use in these acute eases. Teissier and Roux Jrcatimift, Mar. 10, '9S).