Sub-acute or chronic cerebral meningitis is a secondary disease, sometimes associated with chronic syphilis, Bright's disease, alcoholism, etc., though the cause is not always ascertained. The lesions are similar to those of acute menin gitis, but less pronounced. There is less of serum and pus, and the exudated fibrin is more circumscribed. The symptoms are insidious and vague. Headache, vomiting and photophobia are rare. The slight delirium is followed, it may be, by somnolency, irregular pulse, stra bismus and sighing respiration. With coma the pulse is rapid, 120 or more, and the patient dies as in acute meningitis.
Tubercular meningistis, also known as acute hydrocephalous granular meningitis and basilar meningitis, is an acute tuberculous in flammation of the pia mater, caused by a de posit of miliary granules over the surface of the brain, hut most numerous at the base, in the track of the cerebral vessels, and in their sheaths. There is a noticeable vascularity, es pecially in the ventricles. The .pia mater is thickened and opaque and covered with a semi purulent exudation. Serum fille the ventricles and forming, pressing upon the convolutions, and assists in softening portions of the brain. The lesions in this disease are rarely limited to the brain; tubercles are found in other or gans, especially the lungs. The disease is a phase of that protean malady, tuberculosis, though the cerebral lesions may first be no ticed. The primary causes are a hereditary diathesis (scrofulous or tuberculous), foci of caseous degeneration in some organ, a suppu ratingjoint, or a scrofulous inflammation of bone. The physically weak children of tuber culous parents are most subject to this disease, and in cases where strong children are at tacked there is generally found a tubercular relative. Though the disease is essen tially a disease of early life (from nine months to 10 years), it also attacks adults. Most of those affected die in from two to six weeks. The Symptoms may be classed under three heads: (1) Obscure symptoms; (2) those of rapid development; (3) those of coma. There are seen listlessness, loss of ap petite, occasional vomiting, slowness of the bowels and somewhat frequent pulse. Some times there is headache, a remittent form of fever and then rapid development of diagnos tic symptoms. The patient talks a good deal.
One of the most important symptoms is a change in the disposition through which the child, although bright and lively before, sud denly becomes listless, or excessively emo tional, a condition which may continue for several weeks. There are irregularity of the pupils and pulse, a sharp cry, se vere headache, insensibility to light and sound, grinding of teeth, a flushed face in paroxysms. usually before convulsions, rolling and drawing back of head, urine scanty and high-colored, oscillation of the eyes, obstinate constipation, etc. With coma comes strabismus; the pupils do not contract under the influence of light, but will contract and expand when the bowels rumble or the patient is moved. There are convulsions, paralysis and automatic move ments of the feet and hands, it may be for hours. The thumb may be turned in. There is a hollowed abdomen (boat-shaped) and congestion of the eyes, a puri form secretion sticking the eyelids together; involuntary dis charge of bowels and bladder, are common. For treatment of this affection, place patient in bed, in a quiet room: give easily digested food; apply an ice-cap to the head and warmth to the feet. Further treatment should he in the hands of a physician. Much can be done by parents and guardians to prevent the onset, by not developing the nervous system at the ex pense of the muscular and digestive systems. Precocious children are to he judiciously re strained, and outdoor life encouraged. Tuber culous meningitis in adults is commoner in men than in women, and most frequently oc curs between 17 and 30. It is generally fatal in 2 to 14 days, about one in 200 cases recov ering.. • Spinal meningitis Is not common; it is usu ally caused by tnjuries, is liable to occur in children with spina bifida and is rarely ame nable to treatment. Death occurs usually in from 8 to 10 days, either from extension of inflammation to the brain and pressure there by fluid, or from asphxyia due to spasms of the respiratory muscles. The le sions arc similar to those of cerebral menin gitis. The chief symptoms are pain in the spine and extremities, increased by movements of the body, great sensibility of the surface of the body, spasms of muscles, opisthotonos and dyspncea.