The course of the disease is extremely variable. It may be very rapid, as in the malignant form, the patients dying in from twenty-four to forty eight hours. Some cases are on record in which the patients died within ten hours after the onset of the symptoms. In other cases the patients may linger for months before the fatal issue ; or they may recover after several months of illness, with symptoms of marked defect on the part of the nervous system, such as blindness, deafness, paralysis of one or both limbs, or some other severe affection.
The death-rate varies considerably according to the virulence of the epidemic. At times as many as 75 per cent. of the patients die ; at other times only 15 to 20 per cent. In children the disease is generally more severe than in adults. Unfortunately, apart from careful nursing in the open air, little can be done with the knowledge at present at the command of the physician, although of recent years a number of surgical procedures have been tried, with good results at times. Diphtheria antitoxin has been employed, and other means of treatment suggested, but, up to the present time, there is no royal road of treatment for this severe affection.
A form of meningitis, which is by no means uncommon, is that which follows suppurative inflammation of the middle car. Here the ordinary pus-forming bacteria are responsible for the inflammation of the meninges, and, while the symptoms are similar in kind to other forms of meningitis, they usually show a much more acute form of the disease. Thus, high fever, raving delirium, and svmptoms of severe infection are characteristic. In this form of meningitis the proper treatment is surgical, and prompt opening of the skull, with free evacuation of the local pus-collection, if present, often results in recovery.
MENOPAUSE.—Term applied to the time of life %%ien menstruation ceases. This usually occurs at about the age of forty-five. While the " change of life " is taking place menstruation is sometimes very profuse, but in other cases it may be entirely suspended for months. In its place floodings may appear. The belief that excessive menstruation is a normal symptom of the menopause works much mischief. The symptom is always indicative of disease, and is frequently the result of malignant tumours. In order that such tumours may be discovered and removed in time, every elderly woman who suffers from too frequent menstruations or from exces sive discharges should undergo medical examination, especially if a hemorrhage appears after the periods have been absent for years. The non-appearance of a menstrual period may be caused by a tumour of the ovaries. Cessation of the menses, when accompanied by abdominal pain and distension, therefore necessitates medical examination. As a general rule, the cessa tion of the menstrual periods is unimportant ; and, in women who live healthy lives, do not indulge in too much coffee, and have plenty of physical exercise, this change takes place without the slightest discomfort. This fact is contrary to the widespread superstitious belief that the blood left in the body may " rise to the head " and cause " mental disturbances." Women should be especially warned against remedies supposed to excite menstruation.