In view of the great variety in the different forms of encephalitis it is manifestly impossible to lay down hard and fast principles for making a diagnosis. The difficulties appear still greater when we re member that hereditary syphilis is also capable of producing in the brain substance alterations which clinically resemble the various forms of encephalitis very closely. Hence, in order to avoid unnecessary repetition, it seems wiser to omit any discussion of the differential diagnosis of encephalitis at this place and to refer the reader to the various diseases which must be considered in that connection, namely, meningitis, hereditary syphilis, brain abscess, sinus thrombosis, em bolism, the various forms of bulbar palsy, cerebral infantile paralysis, brain tumor and multiple sclerosis. It should be emphasized, however, that in any disease beginning acutely with fever and presenting, in addition to general symptoms of brain irritation, rapidly developing and persistent focal symptoms, the possibility of acute encephalitis should be borne in mind. The diagnosis is confirmed if the symptoms of cerebral palsy persist after the acute stage. At the beginning of the disease lumbar puncture is useful for the purpose of excluding meningitis. But in spite of the greatest care in diagnosis there will always be found cases that run such a rapid course, with hyperpyretic convulsions, that death ensues before the cerebral localization of the disease can be definitely established.
The prognosis of acute encephalitis is always extremely grave. Even if the child survives, some form of permanent palsy may be ex pected. However, if it is a question between meningitis and encephalitis, a decision in favor of the latter diagnosis is more favorable for the pa tient since it offers some ray of hope, whereas meningitis of equal severity would be hopeless. Tho possibility of complete or practically complete recovery has been discussed. The usual termination of an encephalitis that ends in recovery is a cerebral infantile palsy.
The treatment of an acute encephalitis has for its object, to deplete the blood VOSSAS of the brain, control the fever, support the heart, and, filially, combat the brain symptoms. The first requisite is absolute rest in a darkened room, to protect the patient against light and loud noises. ..kri ice bag is applied to the head or, better, a Leiter's coil or
rubber cap through which a constant stream of cold water is passed, eVell at night. Direct depletion with leeches is strongly to be recom mended, selecting for the applieation of the leeches the mastoid process on the side which is suspected to be the seat of the disease. Venesee Hon, which is employed in adults in cases of severe congestion of the brain, should be considered in children only in exceptional cases. De pletion through the intestinal tract should always be tried, calomel being the best remedy for that purpose. With a similar object in view warm foot-baths may be given in the hope of altering the distribution of the blood.
Cold packs and baths, repeated at short intervals, are the principle means employed to combat the fever; although quinine, antipyrin or aspirin may have to be administered either by mouth or by rectum in order to reinforce the antipyretic effect of these measures. Hot baths which are commonly employed in the treatment of cerebrospinal men ingitis have occasionally been employed with good results in acute encephalitis.
The most important measures for supporting the heart are those which diminish the fever and combat the violent brain symptoms. Another important factor in this respect is the administration of suffi cient nourishment even if this be no more than milk, eggs and soup. If the child refuses to take nourishment it must be administered with a spoon like medicine, employing a mixture of sugar, egg, milk, milk of almond or a little somatosc, which can usually be done without any difficulty. Alcohol is not to be recommended; coffee, tea and cardiac stimulants are more advisable.
Severe brain symptoms such as convultions, jactitation, insomnia may be combated with large doses of bromides and chloral hydrate. Lumbar puncture, unless for diagnostic reasons, is not to be recommended in a pronounced case of encephalitis.
After the, aeute stage has subsided, potassium iodide is usually ad ministered for some time.
For the treatment of any resulting paralysis or epilepsy, see under cerebral infantile palsy