The duration and course in meningococcus meningitis show much greater variations in single cases than in any other form, since the disease may terminate in a few hours or after many months (six to nine, Eichorst).
The very acute cases, which terminate fatally in less than twenty four hours, are in general rarely recognized and only positively by a postmortem. As we have already remarked, extensive pyogenic pro cesses must not be anticipated; capillary and venous hyperamia of the leptomeninges and cuticula of the pia with comparatively few men ingococci constitute all the discernible pathology. These cases have been denominated meningitis cerebrospinolis acalissima or siderans. If the disease begins suddenly with the symptoms of cerebral hremorrhage, that is, with loss of consciousness and heiniplegia or monoplegia, it is often designated meningitis ccrebrospinalis apoplectiformis. This form does not always terminate fatally.
In contradistinction to the severe acute forms mentioned there arc, abortive cases, which, if they appear sporadically, arc hardly diagnos ible, at least in young children.
The great majority' of eases run neither the turbulent course depicted nor the simple course. If the disease terminates fatally, this usually occurs at the end of the first or during the second week, often much later, after months, in a condition of extreme emaciation, either associ ated with the described complications or on account of general debility.
In these protracted cases the disease runs the intermittent or remit tent course to which we have already referred. At the same time it is impossible to predict. with any degree of certainty the probable out come of the disease. Death may unexpectedly occur during a period of evident diminution of the cerebral symptoms.
The reported percentages of recoveries vary greatly from 25-30 per cent. (Florand) to 63 per cent. (Netter) and 68 per cent. (Kolas). Leyden and Cloldscheider report from 20-70 per cent.
Whether all these cases really were clue to meningococci is doubtful and must be determined by bacteriologic investigations. We believe that the high death rates indicate any meningitis occurring epidemically, such as may be caused by pneumococei, and must be separated from meningococcus meningitis.
It may be accepted as certain that the prognosis is much worse in the first and second years than later.
meningitis has more complica tions than the other meningitides. Apparently these originate metas tatically, rarely or probably never by direct extension from the diseased meninges. These. are diseases of the eye and Car as well as the secondary development of ehronic hydrocephalus. Furthermore there occur, £LS already mentioned, articular and periarticular pyogenic processes, in the pleura, endo- and pericardium. First, with reference to the ocular complications, we refer to IIcine's classification, which also embraces the most important extracts from Kuies, Schmidt-Rimpler and others concerning the numerous injuries, which the motor and visual functions as well as the anatomieal integrity of the visual apparatus may undergo. Let it be noted that visual disturbances rarely are of cortical origin, most frequently neuritic basilar, not infrequently, however, clue to an inflammation of the interior of the eye itself. This consists in a metasta tic iriclocyclitis, which often appears on one side but may be double. Hypopion appears only with severe iritis, otherwise most frequently the optie lens becomes cloudy. It shows no pyogcnic tendency but, usually by the development of a so-called pseudoglionnt or aniaurotic cat's eye leads to permanent loss of sight. It should be mentioned that this metastatie ophthalmia may occur also in lighter forms, whieh appar ently nifty not induce psettdoglionia with resultant blindness. It is remarkable that these milder forms are not infrequently double, while pseucloglionia is almost invariably single.
This ophthalmia aceompanies not only severer cases of meningitis: it occurs more frequently as the most important localization of the 'tiepin gococeus in light, indeed in abortive eases whose obseure cerebral symp toms are first correctly interpreted through the eye-trouble.