Fevers or inflammatory diseases in the young child may begin with the combination of pyrexia and convulsions. In the case of the exanthemata we should find some of the early symptoms of the eruptive fever ; and the convulsive movements themselves are few and not violent. There is little restlessness, and between the attacks the child takes notice and recognises his friends. In the case of malignant scarlatina, beginning with convulsions and delirium, there is little headache, and the eruption appears within twenty-four hours of the first symptoms of the fever.
Pneumonia in the child not unfrequently begins with convulsions, and there is high pyrexia ; but the absence of stupor and of headache, the ac tion of the nares, the greater rapidity of the breathing, and the perverted pulse-respiration ratio would serve to exclude meningitis although a physi cal examination of the chest might reveal no signs of disease. In the so called " cerebral pneumonia," where there is delirium and headache, with stupor and high fever, the nature of the disease may be often detected early by an examination of the chest. Sometimes, however, physical signs are slow to appear, and in such a case we must wait before pronouncing an opinion. Usually the head symptoms of cerebral pneumonia are not violent, but assume more the characters of tubercular meningitis than of the simple form of the disease. The distinction between these two varie ties of meningitis will be considered elsewhere (see Tubercular Meningitis).
From urmnia and the various forms of cranial disease unaccompanied by pyrexia, the high temperature which is one of the characteristic features of simple meningitis will form a sufficient distinguishing mark.
In the case of encephalitis, drowsiness with convulsions or rigidity of joints, or both, followed by coma and hemiplegia—the symptoms occurring in a child the subject of chronic otorrhcea, or following upon an attack of severe earache,—sufficiently reveal the nature of the disease. When there is no paralysis it is difficult, perhaps impossible, to distinguish inflamma tion of the substance of the brain from inflammation merely of its mem branes, and a certain amount of meningitis usually accompanies the en cephalitis.
Thrombosis of the cerebral sinuses can seldom be more than suspected. If the dura, mater be inflamed, it is reasonable to suppose that the sinuses, at the seat of disease are also implicated. If in a case where the cerebral', symptoms have evidently followed upon a long standing otorrhcea we can detect deficient filling of the jugular vein on the affected side, or can dis cern signs of pyroia—rigors, or rapid variations of temperature, with evidence of metastatic deposits in the lungs or other organs—we may con clude that thrombosis in the sinuses has probably occurred.
Prognosis.—Otitis can usually be cured by suitable treatment, mid if, while the discharge continues, proper measures be taken to prevent the collection of purulent matter in the tympanic cavity or mastoid cells, there is no reason to apprehend any ill results from the state of the ear.
If extension of the inflammation take place to the skull cavity, the worst consequences may be anticipated. The patient does not, indeed, always
die, but the proportion of recoveries is very small. In encephalitis it is common for the stupor to clear away more or less completely for a time, and therefore false hopes should not be raised by the patient's apparent amendment ; and the friends should be warned that such signs of im provement are seldom to be trusted.
Treatment.—When otitis occurs, it is important to remove pus early from the interior of the tympanum. This is done by inflating the Eusta chian tube by means of Pulitzer's bag. The operation is easily performed upon children, as it is not necessary that they should swallow. All that is required is to send a forcible blast of air through their closed nostrils. If the purulent contents are not removed by this means the tympanum must be punctured. When a discharge appears from the meatus, the passage should be syringed several times daily with warm water. If any uneasiness appears to be felt in the ear, counter-irritation with tincture of iodine may be employed behind the pinna.
A chronic otorrhcea should be stopped as quickly as possible. Any mild astringent injection may be employed ; but care should be taken thoroughly to cleanse out the passage with warm water before using the astringent lotion. In obstinate cases the use, several times daily, of an ap plication composed of sulphate of zinc and borax, ten grains of each, and one drachm of glycerine, to the ounce of water, will often arrest the discharge very quickly. Glycerine of tannin diluted in the proportion of one drachm to the ounce of water, used frequently, is often of service. Sometimes the injection, once daily, of a solution of nitrate of silver (gr. x. to the oz.) will hasten the cure. In cases of long-standing otorrhcea, when the mem brane of the tympanum is destroyed, the child should wear small pledglets of cotton wool in the ear, except in very warm weather, as a fresh catarrh is easily excited by cold and damp.
When meningitis occurs, the room should be kept in a half light ; free ventilation and perfect quiet should be insisted upon ; and the thermometer must be watched that the temperature of the room does not rise above 00°. The feet must be kept warm and the head cool. It is advisable to remove the hair, and keep the shaven scalp constantly covered with an ice-bag. The bowels must be opened freely by aperients, such as calomel and jalap. Opinions differ as to the value of morphia in these cases. Morphia, even if it produces no impression upon the inflammation itself, can scarcely be injurious. Its use has at any rate this advantage, that when the child is kept under its influence the more violent symptoms are moderated, and much saved to the friends by the apparent relief thus extended to the patient's sufferings. Counter-irritation, although often advocated, is of little value ; and the old plan of leeching behind the ears has never seemed to me to be followed by any improvement. Our great trust should be placed in the constant application of cold to the head, in perfect quiet, and in free purgation. Encephalitis is to be treated on similar principles. d