EPIDEMIC CEREBRO-SPIN AL ENINGITIS has been known only since the beginning of the nine teenth century, hieing first recognized in Geneva, Switzerland. It made its first appearance in America in ATassachusetts in 1S02. Many severe epidemics hare since occurred both in Europe and America. The disease visited Ireland in a very fatal form in 1846 and again in 1866-68. It is a specific infectious disease due to a micro organism, perhaps the dip/ocoecus intrarellularis, although this is not definitely settled. Very lit tle is known of the causes which favor its trans mission. The disease is not directly contagious from man to man, and it has been suggested that the virus may be transmitted through one of the lower animals.. Epidemics recur most fre quently in winter and spring. Any conditions which produce bodily or mental depression pre dispose to the disease, and it has assumed its most fatal type during times of famine and among squalid tenement dwellers or soldiers in crowded barracks. The changes (ibserved in the meninges are those characteristie of a wide spread and Seven' lertOlneningit Mater is intensely congested and its blood vessels dilatcd. l'us and lymph are abundant on the con vex surface of the brain. along the large blood vessels. and in the fissures. The ventricles contain turbid serum or pus. Small hemorrhages and sometimes abscesses found in the cortex of the brain. There is in addition commstion of the lungs. liver, spleen. and kidneys. Several clinieal varieties of the affection have been noted and the course and symptoms vary remarkably in the dilIerent types. In the malbmant folminant type, the disease may prove fatal in a few hours. The abortive type presents only a few symptoms and is characterized by rapb1 recovery. Remit tent and intermittent forms are reeognized in which the fever is lower or entirely absent for two or three days. and there is a form that much resembles typhoid fever. The average duration
of the disease is three or four weeks, and the mortality from 30 to TO per cent. in the different epidemics. As might be expected from the ex. tent of tissue involved, the symptoms are very numerous and diverse. No single set of symp toms occurs in all cases. In some there is an indefinite premonitory stage, with malaise, nausea, and headache; but usually the onset is sudden. with a, chill, severe headache• vomiting, pains in the hack and limbs, and fever. With these manifestations come stiffness of the muscles of the neck and back, so that the head is re tracted and the hack arched. There are also pains in the lower extremities and hypermsthesia of the skin. In addition to these symptoms due to irritation of the spinal ne•ve-roots, there are others referable to implication of the cranial nerves. These are in different eases, drooping of the eyelids tptosisi, squint, contraction, dilata tion, o• inequality of the pupils• or spasms of the facial muscles. Conjunctivitis or suppuration of the eyeball or ear may occur and the sense of smell is impaired. Unlike most specific fevers, the temperature runs a very irregular course. An important feature of the disease is the oc currence in many eases of a herpetie eruption or petechial or purpurie spots, whence the names 'spotted fever' and 'peteehial fever.' Recovery is apt to he marked by the occurrence of ninny dis agreeable sequels. Deafness is common from de struction of the perceptive apparatus of the ear•; and when this happens in infants, deaf mutism results. Sight is often impaired. Chronic hydrocephalus with headache, muscular weak ness, and mental deficiency occurs in a few in stances. Treatment must he conducted on the same general principles as in other forms of meningitis.