The duration of the attacks is very variable. Death may take place in five or six hours in the most malignant forms of the distemper. In other cases the illness may be prolonged for one, two, three, or four weeks, or even longer. Convalescence is always slow, and is often intermittent. A profound debility, lasting for a long time after the fever is at an end, is one of the characteristics of the malady.
case of rigid retraction of the head in a child is not one of cerebro-spinal fever. The symptom is the consequence of a basic meningitis spreading to the cervical portion of the spinal cord ; and it may therefore be present in any case where the membranes of the brain are the seat of inflammation. It is not uncommon in the course of a tubercular meningitis.
Cerebro-spinal fever not only gives rise to severe local symptoms, but is also accompanied by more general phenomena indicating a profound con stitutional affection. Its epidemic form, its violent and abrupt onset, the extreme debility which is invariably present, and the petechial rash, remove the disease from the list of purely local disorders, and amply justify its be ing ranked amongst the specific fevers' The disease was at one time held to be merely a form of typhus fever complicated with meningitis ; but the difference between the two diseases areneither insignificant nor few. Cere bro-spinal fever prevails equally amongst the rich and the poor ; it particu larly affects children, and is very fatal to them ; it runs a rapid course, often causing death in a few hours ; its temperature as a rule is little ele vated ; the rapidity of the pulse is moderate, and when the fever is high, is not increased in proportion to the degree of pyrexia (indeed, according to some observers, it does not become rapid until the temperature falls) ; lastly, retraction of the head is one of the most common symptoms.
Typhus loves "fever haunts," and seldom attacks the well-to-do ; it rarely affects children, and if it do, runs in them as a rule an especially favourable course ; its duration is longer, and even in the adult it rarely ap pears in the overwhelming and malignant form so often seen in cases of cerebro-spinal fever ; lastly, meningitis with retraction of the head is a rare complication.
The diagnosis of cerebro-spinal fever is much easier in the midst of an epidemic of the disease. The abrupt and violent onset, the severe pain in the head and spine, the vomiting, the retraction of the head, the general stu por, and the petechial and other eruptions—this combination of profound constitutional symptoms with nervous excitement followed by depression, is sufficiently characteristic, especially if at the same time, as often hap pens, the temperature is only moderately raised and varies irregularly. In cases of simple cerebro-spinal meningitis the retraction of the head is not so extreme, and the stiffness and pain in the spine, the hypemsthesia, and the pains in the joints are seldom present. As a rule, too, the non-specific
disease is preceded by prodromata and runs a less rapid course. Still, this is not always the case, for in exceptional instances simple meningitis may prove fatal to a young child in the course of twenty-four hours. The fever in the latter is, however, always high, and the convulsions are in most cases repeated and general.
It would be difficult to confound tubercular meningitis accompanied by retraction of the head with cerebro-spinal fever. The hereditary tubercu lar tendency, the long prodromal period, the gradual onset of the illness, the more protracted and characteristic course, and the slow intermittent pulse, would to distinguish the tubercular disease.
In infants under twelve months old the disease is very difficult to de tect. It may, however, be distinguished by close attention to the course and symptoms of the illness ; especially if the case occur in the midst of an outbreak of the malady.
Prognosis.—In all cases of cerebro-spinal fever the prognosis is very serious. The disease is especially fatal to children, and the younger the patient the less hope can we entertain of a favourable termination to his illness.
In babies an arched and tense fontanelle, which shows the presence of profuse exudation and oedema, is a very grave symptom. In all cases re peated convulsions and signs of severe nervous excitation, such as violent and incessant vomiting, intense cephalalgia and pain in the back, strong tetanic spasms ; also early appearance of depression, continuous coma or return of the stupor after a period of apparent improvement, and irregular breathing, are all signs calculated to excite the gravest apprehensions.
Treatment.—The disease unfortunately is little amenable to treatment. In all cases ice-bags should be applied to the head and spine as long as the period of excitement continues. When symptoms of depression are no ticed, the ice should be removed, or supplemented by the application of hot bottles to the feet, and the administration of stimulants by the mouth. Sometimes hot applications relieve the severe headache better than cold. The ether spray has been used to the occiput and back of the neck, and is said to be of service. Large doses of chloral sufficient to produce signs of narcotism have been recommended. All writers, however, speak highly of the subcutaneous injection of morphia. For a child of three years of age one-twentieth of a grain may be used, and repeated every one or two hours until some sensible effect is produced ; or four or five grains of chloral may be given by the mouth.
During protracted convalescence the iodide of potassium must be given to further absorption. of the exudations ; and iron and tonics, with removal to a dry bracing air, are of value to hasten the child's recovery.