In this respect there exists a striking ancl interesting analogy with the most important ear disease whieh occurs with meningococcus men ingitis, acute otitis intima, or labyri Wills. This clisease also oceurs in severe eases and belongs to the early symptoms, but it seems to pre ponderate in the lighter or lightest cases.
As evidence of this it may be mentioned that it was originally described by V°ltolini as an independent disease beginning with indis tinct cerebral symptoms and it was only recognized as an incident of cerebrospinal meningitis much later. Clinically- it is charaeterized by its oeeurrence on both sides, by the presence of another labyrinth symptom—dizziness—and by the severity of the functional clisorder.
With the disease of the labyrinth there may be associated otitis media, as in any meningitis or in any severe general clisease, but even then the complete irreparable deafness after the disturbances of equilibrium have ceased, indieates that not the middle ear alone has suffered.
The third of the complications of niening,ococcus meningitis men tioned above, chronic hydrocephalus, naturally eannot be an early symptom, since its development requires weeks at least. Either the inflammatory process persists in a weak form for months or years (Ziemssen), or mechanical factors, which it has caused (obliteration of important passages), or both factors tog,ether keep the intracranial pressure constantly above normal and lead to continually inereasing ventricular dilatation with its well known clinical results. Arrest and relative recovery gradually appear in many eases, but not infrequently hydroeephaltis is the eause of "late death" after apparently complete recovery.
Diagnosis.—The diagnosis of meningococeus meningitis, which, in many cases may be so easy and safe, can only be made by lumbar puncture in atypical cases. Increased pressure of the fluid is not invaria bly present, but we always obtain a punctate, turbid and purulent or containing gross pus floccules, in which we almost invariably find poly nuclear leueocytes and meningococci. It has already been mentioned that these latter may be searee, to such a degree that a culture is indis pensable for their positive identification. Hygienic institutes and
bacteriological bureaus founded for the investigation of epidemics devote themselves to this necessity of medical practice.
En exceptional eases even the lumbal puncture may be indecisive, particularly under two conditions. Either the pus in the spinal canal may be so thickened that it cannot discharge through the cannula, in which ease it ean be diluted by injecting a small quantity of sterile salt solution; or the purulent process is limited to the cerebral meninges and by adhering to the occipital foramen is prevented from flowing into the spinal canal. Then in spite of the increased intracranial pressure a small quantity of more or less clear liquid is obtained. in which however meningococci can usually be found in cultures.
Treatment.—The treatment of meningoeoccus meningitis is still chiefly symptomatic. The hypenesthesia of the patients requires a quiet, comfortable position and the greatest possible avoidance of all painful manipulations. For small children, on account of the excessive tenderness of the spinal column, a plaster of paris bed or a similar firm bandage has occasionally been employed with success. During the paroxysms of pain morphine in ample closes may be given without hesitation, if chloral, trional, phenacetin, antipyrin, etc., have failed.
Concerning the application of cold to the head, neck and along the spinal column it appears proper to proceed according to the sensation of the patient ; i.e., to relinquish this treatment if it affords no relief or is unpleasant to the patient. Also local blood letting has been both condemned and lauded.
That a disease leading to such severe etnaciation, through difficult nutrition (opisthotonos). vomiting, persistent fever and probably specific trophic disturbances, demands the most careful nourishment and nursing requires no further discussion; but it should be remembered that fluid nourishment, which is most necessary. should not consist exclusively of milk, but should conform to the general principles of nutrition.
Two other therapeutic measures should be especially considered: first, baths; second, lumbar puncture.