The greater portion of the forms of meningitis observed are usually tuberculous in their nature ; especially is this true for meningitis which occurs in children. The usual symptoms of tuberculous meningitis, as found in children, are more or less characteristic. As a rule, children whose parents arc tuberculous, or who live in contact with consumptive persons, are more liable to the disease.
In some cases it is observed that the child gradually fails in health ; in others the symptoms arc first noticed when the child, after an attack of measles or whooping-cough (rarely after a severe fall), commences to grow restless and irritable, loses its appetite, grows thin, and begins to show signs of suffering from headache. The child frequently puts its hand to the head, and often starts while sleeping, or wakes suddenly with a sharp, high-pitched scream. At this time constipation is usual, and irregular variations in temperature develop.
The disease usually progresses. Vomiting may be present, or may have ceased. The child is dull and apathetic, and frequently lies with the head drawn back upon the pillow. The pupils, which have heretofore exhibited a tendency to show like pin-points, become dilated. They may be irregular, and not infrequently the child commences to develop a squint. Convulsions occur, which may be localised in one portion of the body, but are more apt to be generalised. The temperature still remains more or less abnormal, ranging from too° to 103° F.
From this stage the child passes into a state of paralysis. Unconsciousness becomes more marked, the child can be aroused only with difficulty, and spasms are very frequent. Diarrhcea usually sets in, the pulse becomes frequent, the tongue is coated, and the child sinks into a state of mild delirium, with involuntary passing of urine and faxes. The whole aspect of the child is one of hopelessness.
Occasionally tuberculous meningitis advances very rapidly, the child dying in four or five days, or in a couple of weeks ; and it is this form which is so frequently confused with epidemic cerebrospinal meningitis, especially when that disease is more or less prevalent.
The only sure method of making a diagnosis between this form of menin gitis and epidemic cerebrospinal meningitis, is by means of a puncture of the spinal cord in the lumbar region, and the microscopical examination of the fluid which is withdrawn. The more common form of tuberculous menin
gitis, however, runs a more chronic course, and the entire duration of the disease may extend from four to six, or even eight weeks. Occasionally patients are seen who have been sick several months. As a rule, most of these children die.
Epidemic cerebrospinal meningitis, or cerebrospinal fever (known also as spotted lever and as malignant purpuric fever), is an infectious disease due to a specific bacterium, the Diplococcus intracellularis. The disease has been known for many years, and its first appearance in the United States is supposed to have occurred in 18o6. Since that time many epidemics have occurred. Thus, from 1805 to 1830 the disease was very widespread. From 1837 to 1850 the disease was very common in France. A number of severe epidemics occurred between 1854 and 1874 ; and since 18go the disease has again been epidemic.
The symptoms of cerebrospinal meningitis of the ordinary form usually commence abruptly, the patient, as a rule, suffering from headache, severe chills, pain in the back, and vomiting. Stiffness of the back of the neck, attended with pain on moving, is often noted in the early stages. As the patient grows worse the headache continues, excessive sensitiveness to noise and light develops, and the patient becomes very restless and peevish, par ticularly if it is a child. The pains in the back become more severe, and the painful condition in the back of the head and the associated rigidity of the muscles may at times become so pronounced that the patient lies in a very stiff, restrained, and constricted position, with the head drawn back. Spasms of the muscles, or even convulsions, may be noted as early as the third or fifth day. Occasionally paralysis of the ocular muscles develops, and the patient becomes cross-eyed early in the disease. The temperature is likely to rise suddenly and steadily (105° to 1°6° F., or even higher), and the pulse is apt to be rapid and feeble, especially in children ; adults, however, may show a slow pulse. During the early course of the fever an eruption may occur which is reddish in colour and somewhat resembles measles, although usually not as widely nor as closely distributed. Occasionally the spots resemble typhoid rash, and in some instances rare forms of skin eruption have been observed.