MENINGITIS. 318 MENINGITIS. sores, or from renal or vesical complications. In this form of meningitis the i)ia mater is reddened and congested and small hemorrhages may occur. An exudation, at first grayish in color, but later purulent and yellow or greenish-yellow, takes place into the meslies or upon the surface of the pia, and the spinal fluid is rendered turbid and opaque. The iullanmiatory process may ex- tend to the substance of the spinal cord (causing myelitis), or to the inner surface of the dura mater, involving of course the arachnoid and gluing the three membranes together. Treat- ment comprises rest in bed, upon the side or face, active purgation, and cups or leeches along the spine, followed by the application of ice. In- ternalh- drugs are given to relieve pain and diminish sensibility. In the chronic stage coun- tcrirritants are applied along the spine, and mer- curials or iodides are administered. During con- valescence tonics, massage, cold douches, and the electric current are of great service. C/iroiiic Icplomeniitflitis may be a continuation of the acute form or it may be chronic from the beginning, and has been attributed to cold and exposure, sy|)hilis, chronic alcoholism, and in- jury. It often occurs in connection with de- generative processes of the cord itself. The con- dition is one of gi-adual thickening of the pia mater with compression and atrophy of the nerve- roots. The symptoms are the same as in the acute form, with the diflTorence that they come on gradually' and there is no fever. Muscular spasm and rigidity are less marked. Epidemic C'erebro-Spinal Memxgitis lias been known only since the beginning of the nine- teenth century, being first recognized in Geneva, Switzerland. It made its first appearance in America in Massachusetts in 1802. JIany severe epidemics have since occurred both in Europe and .America. The disease visited Ireland in a very fatal form in 1840 and again in 1800-08. It is a specific infectious disease due to a micro- organism, perhaps the diplococcus intraccllularis, although this is not definitely settled. Very lit- tle is known of the causes which favor its trans- mission. The disease is not directly contagious from man to man, and it has been suggested that the virus may be transmitted through one of the lower animals. Epidemics occur most fre- quently in winter and spring. Any conditions which produce bodily or mental de]iression pre- dispose to the disease, and it has assumed its most fatal type during times of famine and among squalid tenement dwellers or soldiers in crowded barracks. The changes observed in the meninges are those characteristic of a wide- spread and severe leptomeningitis; the pia mater is intensely congested and its blood vessels di- lated. Pus and lym|ih are abundant on the con- vex surface of the brain, ahing the large blood vessels, and in the fissures. The ventricles contain turbid serum or pus. Small hemorrhages and sometimes abscesses are found in the cortex of the brain. There is in ailditinn congestion of the lungs, liver, spleen, ami kidneys. Several clinical varieties of the afTection have been noted and the course and symptoms vary remarkably in the different types. In the maliimant or fulminant type, the disease may prove fatal in a few hours. The abortive type presents only a few symv>toms and is characterized by rapid recovery. Remit- tent and intermittent forms are recognized in which the fever is lower or entirely absent for two or three days, and there is a form that much resembles typhoid fever. The average duration of the disease is three or four weeks, and tlie mortality from 30 to 70 per cent, in the different epidemics. As might be expected from the ex- tent of tissue involved, the symptoms are very numerous and dierse. Xo single set of symp- toms occurs in all cases. In some there is an indefinite jirenionitory stage, with malaise, nausea, and headache; but usually the onset is sudden, with a cliill, severe headache, vomiting, pains in the back and limbs, and fever. With these manifestations come stillness of the nuiscles of the neck and back, so that the head is re- tracted and the back arched. There are also pains in the lower extremities and hypeiiesthesia of the skin. In addition to these symptoms due to irritation of the spinal nerve-roots, there are others referable to implication of the cranial nerves. These are in different cases, drooping of the eyelids (ptosis), squint, contraction, dilata- tion, or inequality of the pupils, or spasms of the facial muscles. Conjunctivitis or suppuration of the eyeball or ear may occur and the sense of smell is impaired. Unlike most siieeific fevers, the temperature runs a very irregular course. An imi)ortant feature of the disease is the oc- currence in many cases of a herpetic eruption or jietechial or purpuric spots, whence the names 'spotted fever' and 'petechial fever.' Recovery is apt to be marked by the occurrence of many dis- agreeable sequels. Deafness is common from de- struction of the perceptive apparatus of the ear; and when this happens in infants, deaf- mutism results. Sight is often impaired. Chronic hydrocephalus with headache, nuiscular weak- ness, and mental deficiency oecirs in a few in- stances. Treatment must be conducted on the same general jirinciples as in other forms of meningitis. CEREnRO-Spix-^i. JIeningitis. A non-contagious disease of varying and poorly defined symptoms, afl'ecting horses, mules, and other domestic ani- mals, which is most frequent and has been most studied in horses. The most serious outbreaks have occurred in the United States, England, Saxony, Hungary, and Russia. Si/mijtoins. — The disease is often preceded by digestive disturb- ances. It begins suddenly with chills and signs of meningitis, .fter a short perioil of cerebral excitement the animal becomes abnormally sleepy, is indifferent to surroundings, and rests its head against any convenient object. At intervals there is noticeable dizziness, accompanied by nuiscular trembling, grinding of the teeth, and falling fits. When the animal is forced to move it staggers around in circles. There are no con- stant post-mortem lesions in the vitiil organs, the most important alterations being found in the nicmluanes (if the brain. -Vcciirding t" Sie- damgrotzky and Sclilegel, the disease is due to the presence of a specific micrococcus in the cen- tral nervous system, an opinion that many in- vestigators are inclined to deny entirely, attrib- uting the trouble to digestive disturbances produced by improper or unwholesome fodder. .
outbreak of the disease occurred in Mary-
land, anil acquired the name of 'new horse dis- ease.' .
investigation indiealed the probability
that it was due to moldy fodder, JIusty oaU, musty blaile fodder, and deeayeil corn silage have been suspected of causing the disease, .ftcr making a study of an outbreak of the disease
