Epidemic cerebrospinal meningitis, or spotted fever, is due to a special micro-organ ism, the diplococcus intra-cellularis. Death fre quently occurs in a few hours; recovery usu ally requires 30 or more days. The disease has spread over sections of this country two or three times, mainly in the winter and spring. The exact manner of its transmission is not known. One form is characterized by fever with no eruptirm; the other by fever and an eruption. The symptoms are a chill or chilli ness, followed by nausea and vomiting, fever, violent headache, sometimes with pain down the spinal column, general hyperasthesia, great prostration, vertigo, tetanic rigidity of muscles, irritability or apathy, delirium and other symp toms of meningeal irritation, followed more or less rapidly by those of coma. In the ma jority of patients if the head is raised when the patient is lying on his back, the knees are involuntarily flexed. When there is an erup tion it usually appears early and consists of dark blotches, from the size of a pinhead to that of a nickel, and is not marked on the ex tremities.
Where death occurs within 12 hours from the time of attack only a congestion of blood vessels of the brain and, it may be, of the spinal cord, is generally found. Almost always there is lymph or pus beneath the pia mater, and sometimes serous effusion in the pleura, pericardium or peritoneum. The blood under goes a change, ecchymoses are found some times in the muscles, or in connection with the pericardium or pleura. This disease is best treated with a scrum, which was first produced in the monkey but now is successfully derived from the horse. The serum is given in fre quent doses depending on the severity of the case, from 12 to 24 hours apart; this treat ment has reduced the mortality to 30 per cent. In the chronic variety serum therapy is of no avail; the application of cold to the head should depend upon the desires of the patient. Pain has to he reduced by morphine. Consult Tel liffe and White, Di s ease s of the Nervous Sys tem' (3d ed., 1917).