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Softening Inflammation

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INFLAMMATION, SOFTENING, AND DROPSY OF THE BRAIN Inflammation of the Membranes of the brain is called Meningitis. It may be due to injury, to sunstroke, or to excess in alcohol, but in the vast majority of cases it is due to the irritation of a poison. The poison may have gained entrance by a wound, due to a blow for instance, or it may have gained ad mission from one or other of the cavities of the head or face. A suppuration of the nose, for instance, or of the ear, or in the orbit, or throat may extend gradually till it reaches the brain. Such an inflammation would be called septic. But the poison might reach the brain in the blood stream. This occurs, there is no doubt, in scarlet fever, erysipelas, influenza, typhoid fever, pneumonia, in syphilis, and in general blood-poisoning. Such cases might be called toxic. In the septic form the poison is in the shape of a living organism, such as is described in the section on infection (p. 493), in the toxic form it may be a living organism or it may be a quality of blood.

Now there are two organisms which may reach the brain and are responsible for nearly all the cases of inflammation, one is the or ganism of pus, of matter, suppuration in general, and the other is the organism of tubercle (see p. 501). The organism of pus reaches the brain from the ear or other cavity of the face, and tubercle is disseminated in the blood stream. The tubercular form will be considered by itself. One of the most frequent causes of septic meningitis net with in practice is old standing disease of the ear. The patient may have suffered for years from a "running at the ear." All the time the disease is slowly finding its way to the brain, and not infre quently the sudden stoppage of the discharge is the first occurrence in the attack.

Symptoms.—Severe and constant pain in the head, now and again becoming unbearable, is very common. Sudden giddiness and vomit ing may occur. Light painfully affects the eyes. There is fever, and often delirium, which sets in early, and may be violent or muttering, and sometimes convulsions, specially in chil dren. The pulse may be quick but it is often unusually slow. These are in general the kind of symptoms, though they vary considerably. The disease is very serious, and may go ou to 54 intense prostration, when the excitement ceases • and unconsciousness comes on. It may end in death within two or three days, or not till two or three weeks.

Treatment.—Every effort must be made to discover any source of infection about the head, in the ear, nose, &c., as if such were found some surgical procedure might be neces sary fur its removal. Should the bone behind the ear be tender, a blister or leeches should be applied there at once, though bleeding by a cut down to the bone at that place is best if a surgeon be at hand to perform it. If a dis

charge from the ear has existed, it may be well to apply large hot poultices over the ear, besides using the blister.

The bowels must be freely moved by re peated small doses of calomel, a grain every hour till a good result is obtained. Iced cloths to the bead allay fever and excitement. The rest of the treatment is as suggested for the tubercular variety.

The tubercular form is so called because in it little nodules or tubercles are found after death in the membranes at the base of the brain. It has also been called acute hydro cephalus, that is, acute water in the head, because much fluid is found in the cavities of the brain, and softening of the surrounding brain substance. It is not uncommon in chil dren under five years of age. The character of tubercle is pretty fully described on pages 375 and 551.

Symptoms.—The child attacked often shows signs of general ill-health for weeks before the disease is fully developed. The principal of these early signs are peevishness and restless ness, weakness, and falling off in health. A very auspicious early sign is sudden vomiting without sickness and without any apparent cause. The child may be wakeful at night, grinding its teeth and starting up in bed screaming. There may be also feverish turns. When at length the disease is fully developed it unfolds itself in three stages. In the first stage the child is highly fevered, with rapid pulse. It suffers front headache, which makes it scream out at intervals, and it is distressed by slight noises and by light. The bowels are usually confined. There is sometimes delirium. In the second stage the excitement ceases, and the child lies quietly, is with difficulty roused to say anything or to take food. He is indif ferent to everything, and perhaps passes water and motions without knowledge. At intervals he utters a very peculiar, distressful, shrill, plaintive cry, which is characteristic of this disease, and convulsions way occur. His hands wander aimlessly about, picking the bed clothes, or his nose and lips. In the third stage he becomes quite unconscious. The pupils of the eyes are very wide, and do not contract when a light is brought near. This stage may come on slowly or suddenly after a fit of convulsions. The pulse gets feeble and the skin cold and clammy. The child may die in a convulsion, or simply slip away. Death may occur within a few days, but fre quently not for two or three weeks.

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