Home >> Practical Treatise On Disease In Children >> Tubercular Laryngitis to Urticaria >> Tubercular Meningitis_P1

Tubercular Meningitis

disease, children, child, inflammation, especially, illness, vessels, tuberculosis and gray

Page: 1 2 3 4 5 6 7 8

TUBERCULAR MENINGITIS.

meningitis induced by tuberculosis of the pia matey is undeni ably the commonest form of intra-cranial disease to be met with in the child. The symptoms to which this variety of meningitis gives rise are sufficiently characteristic to merit a separate description ; for the seat of the inflammation, the insidious beginning of the illness, and its well-de fined course are very different from what we find in simple inflammation of the meninges, and make the affection for all practical purposes a differ ent disease.

Infants and children of all ages are subject to tubercular meningitis. It is little less common in infants than it is in older children ; but in the former the disease invariably occurs in the course of an attack of general tuberculosis. It is then called " secondary," for its symptoms, being pre ceded by others arising from inflammatory affections of various organs also dependent upon the diathetic state, are completely masked in their earlier stages, and only reveal themselves as the more violent phenomena which mark the closing period of the illness. After the age of infancy the dis ease usually assumes the primary form, for although other organs may be the seat of tubercle, the symptoms first noticed are those arising from the brain, and these retain their prominence throughout the course of the attack.

Causation.—As a form of acute tuberculosis, tubercular meningitis is dependent upon the same predisposing causes as those which give rise to the diathetic condition. It is worthy of remark that in families in which the tubercular diathesis exists, not only the tendency to tubercular forma tion is handed down, but often, also, a proneness to the particular shape the disease is to assume. This is especially the case with regard to the meningeal form of the malady. It is not uncommon to hear of several children of the same family being carried off by tubercular meningitis ; and in doubtful cases the fact that a previous child has fallen a victim to the intra-cranial inflammation becomes an important aid in arriving at a decision.

Although children who become the subjects of this disease are often weakly and delicate-looking, with a marked tubercular family history, this is not always the case. It is not uncommon to see the disease break out in children who are stout and vigorous, and who certainly differ widely in aspect from the delicately formed and frail-looking type which is con sidered characteristic of the tubercular diathesis. It is possible that infec tion of the system by softening cheesy matter may induce the disorder in a child free from any constitutional tendency to this form of illness ; but in most cases, however unlikely a subject the child may appear to be, care ful inquiry will discover evidences of " consumptive " tendency in collateral branches of the family, if not in the direct line from which the child has descended. The disease is common in all ranks of life ; but as poverty

(which too often implies reckless indifference to insanitary agencies, or helpless submission to them, even more, perhaps, than actual privation of food) may help to determine the outbreak, the affection is especially com mon amongst the poor.

Of the exciting causes, possibly any injury or shock to the head, such as blows or exposure, may help to induce the illness. Over-excitement of the mind, whether from study or amusement, may not improbably have the same effect. It has been denied that pressing sensitive children for wards in their learning can act injuriously in this direction. I am, liow ever, strongly of opinion that such heedless expedition is very hurtful to the child, and has often determined the occurrence of the meningeal inflammation in subjects predisposed to tubercle.

Morbid Anatomy.—The starting-point of the disease is the development on the pia mater of numerous gray granulations as a result of the consti tutional state. These gray nodules are found especially on that part of the membrane which covers the base of the cerebrum. On the pia mater of the cerebellum and convexity of the brain they are much less numerous, and indeed appear often to be quite absent from these situations. On careful inspection the gray or yellow nodules may be noticed following the course of the vessels, especially of their smaller branches. They chiefly congregate in and about the Sylvian fissure, and may be often seen also in the chiasma of the optic nerve. If very numerous, they may be found sprinkled about like a fine glistening dust in these regions and along the sides of the hemispheres. The larger granules may be as big as a pin's head or even a hempseed. By the microscope the small nodular bodies are observed to lie upon the vessels within the perivascular canals, and to adhere closely to their coats. On the larger branches they form projec tions on one side of the artery. On the smaller, they may completely embrace the vessel. In either case—and this is an essential particular— they project inwards as well as outwards, so as to narrow the channel of the tube ; and they may even perforate the delicate coats and protrude into the interior of the vessel. The granulations are formed by excessive proliferation of nuclei from the epithelial lining of the perivascular canals ; and the obstruction to the vascular channels which results from this ex cessive accumulation causes thrombosis within the small vessels, great impediment to the circulation, severe congestion, and extensive -collateral fluxions.

Page: 1 2 3 4 5 6 7 8