DEFINITION.- Inflammation of the membranes covering the surface of the brain and lining the brain cavity.
The meninges may be inflamed as a result of injury to the skull or by extension from middle ear disease. Apart from these conditions the important forms of the disease are Tubercular Meningitis and Epidemic Cerebro-spinal Meningitis and other acute Cerebral-spinal Meningitis. Encephalitis or inflammation of the brain substance may accompany meningitis, but is best considered separately, and when both conditions are present it is difficult and relatively unimportant to distinguish the precise degree of each.
Meningitis is a very serious disease, and a physician’s aid should be sought. The paragraphs that follow are to be taken as guides for such treatment as can be undertaken when skilled help is unavailable.
TUBERCULAR MENINGITIS.- This disease has also been called acute hydrocephalus, or water on the brain. It is much more common in children than in adults. In the latter it is usually a sequel to marked Tuberculosis elsewhere; in children it may be the first obvious sign of tubercle, although the actual source of meningeal infection in these cases, is virtually always elsewhere in the body, e.g., a causating gland infecting the blood stream, or tuberculosis of bone, middle ear, etc.
It may occur in the first year of life, but the most common time of attack is from the second to the fifth year. The membranes at the base of the brain are usually those most affected. Pus is exuded, tubercules are present and the lateral ventricles are dilated and full of a turbid fluid. Some encephalitis usual.
SYMPTOMS.- Premonitory symptoms are common, restlessness, loss of appetite, peevishness and loss of flesh. Measles or whooping cough may be precedent conditions. The actual disease generally sets in suddenly with a convulsion, or with violent headache, vomiting and fever. The pain is intense and the short, sudden cry which it causes the child to utter is characteristic. Vomiting is independent of food-taking. Constipation is the rule. The fever rises gradually to 102 degree or 103 degree. The pulse, at first quick, becomes irregular and slow; muscles twitch and the pupils are generally contracted.
After a day or two this stage of irritation give way to one of dullness and apathy with periods of delirium. The abdomen is retracted and the constipation obstinate. The head is drawn back and the neck rigid. Squint is common and the pupils now dilate. This stage deepens into coma with convulsions, relaxed sphincters and a final typhoid state. The temperature tends to be subnormal, but may rise very high just before death. The pulse quickens again at this period of the disease. Optic neuritis is often present. The whole duration of the disease may be from two three weeks, but in adults when meningitis is a terminal lesion, and occasionally in children, it is very rapid and kills in a few days.
DIAGNOSIS.- Typical cases are fairly easy to diagnose. Lumbar puncture by an expert drawn off the cerebrospinal fluid and in it tubercle bacilli may be found. Tubercular disease elsewhere naturally helps to the realization of the condition.
TREATMENT.- Very few cases of Tubercular meningitis recover and treatment is correspondingly hopeless. In the early stages Calcarea is the most hopeful remedy, especially in fat, chilly children with poor digestion. Bryonia may help the symptoms of onset. Iodoform and Oxalic Acid are both to be considered in the second stage, and Hellebore particularly when effusion may be held to have taken place into the ventricles. Tuberculin in relatively low potencies (Tuberculinum Bovista 6 to 30) has now and then seemed to help.
It is usual to apply ice to the head, but very often hot applications, will be found much more soothing to the delirium and convulsions, and Belladonna or Hyoscyamus may control these symptoms, though neither will cure the disease. Light diet, mostly fluid, should be given and in the rare event of the disease taking a favourable turn, great care is essential during convalescence.
77. Epidemic Cerebro-Spinal Meningitis.
This is a disease due to a specific diplococcus and characterized by inflammation of the membranes of brain and spinal cord. When if occurs in epidemics it is easily recognized. Sporadic cases may be mistaken for Tubercular Meningitis. The symptoms generally resemble those described above. Herpes is common, and erythema. Headache is very marked with retraction of the head, and spasm of various groups of muscles, and sometimes violent delirium is present. The expert can draw fluid from the spinal canal and examine for the characteristic organism. The treatment in general is as described above. The remedies most likely to help are Gelsemium, Apis., Lachesis, Tarentula, Hellebore, Veratr.-Vir.
The organism of this disease enters and leaves the body by the mucous membrane of the naso-pharynx. Therefore great care is needed to guard against infection by coughing and sneezing, and a disinfectant gargle and nose wash should be used. Apparently healthy people can be carriers of the disease, and a bacteriologist may be required to identify them.
The anti-meningococcic serum of Flexner seems to have had great success in certain epidemics, though reports vary as to its efficacy. It is claimed that whereas before its use seventy-five per cent. of cases died, with its help seventy-five per cent. recover. It requires an expert, for it is given (up to 400-600 c.c.) intravenously or (up to 100 c.c.) into the spinal canal in severe cases but for the latter meningeal fluid must be drawn off thirst, and it is possible that to this operation of lumbar puncture and drainage is due part of the efficacy of the treatment. The seem should be made from many strains of the germ (polyvalent serum). Recently in America, wonderful results were obtained by homoeopathists, using the indicated remedy (after Gelsemium) in low to medium potency intra-spinally, as the serum is given. This method requires an expert, but should be tried, and it is possible that even in Tubercular Meningitis the pain might succeed.
78.- Acute Cerebro-Spinal Lepto-Meningitis.
DEFINITION.- Inflammation of the membranes of brain and spinal cord, due to other organisms than those of Tubercular and Epidemic Cerebro-spinal Meningitis. These cases are associated with (a) acute fevers (pneumonia, erysipelas, small pox, enteric, measles, influenza, etc.); (b) injury or disease of bones of the skull (generally middle ear disease, or disease of nasal bones); (c) the terminal stages of chronic nephritis, heart disease, etc. The causal organism vary with the associated conditions and may be pneumo-cocci, streptococci, typhoid germs, etc.
The symptoms are those already described under Tubercular Meningitis, except the squint, ptosis, or other nerve-muscle affections are common. Great general hyperaesthesia also, is to be noted, which suggests serpent poisons as remedies. In any form of meningitis is to be seen Kernig’s sign, as inability to flex completely the extended leg on the abdomen. Lumbar puncture by an expert, and examination of the fluid is very helpful.
TREATMENT.- The remedies already mentioned are likely to be the most useful, and the intra-spinal method may be tried with them.
DEFINITION-A local dropsy, consisting of a collection of watery fluid within the cranium, which may be congenital or acquired.
The congenital form is generally noticed within the first year, before the sutures and fontanelles are closed, so that the bones yield to pressure from within. Infants are sometimes born hydrocephalic, when it is an occasional cause of difficult labour. It is due to obstruction of outflow of cerebro-spinal fluid from the brain ventricles, or to decreased absorption from the sub-arachnoid space.
SYMPTOMS-The premonitory indications of this disease not very distinctive; there may be squinting or rolling of the eyes if the disease be congenital, followed by convulsions and enlargement of the head.
The most marked features area disproportion between the size of the skull and that of the face, e the fontanelles are wider than usual, and the bones feel thin under pressure for he fingers. Emaciation is generally present through non-nutrition; in some cases there is an unnatural fat condition. If an infant, he sucks well, even voraciously, and et he does not grow; his bowels are constipated, and his motions unhealthy. The gradually increasing head soon attracts Notice the anterior fontanelles pulsates, there is heat of the head; and he child becomes very restless. Fluctuation may felt by applying the hand tot he top of the head; the hair ceases to grow as usual; the face appears small and triangular; the countenance is full, having an aged appearance and the a patient is continually wishing to lie down. Unfavorable cases the senses become impaired; Paralysis sets in and the patient dies from exhaustion, Convulsions, or Spasmodic Coup, to which such children are liable.
The duration of the disease varieties from one to eight, or seven ten years. Should effusion be arrested, the accumulation of serum already fusion be arrested, the accumulations of serum already present remains, f or it is never absorbed.
TREATMENT.-The best remedies for this disease are those adapted tot he constitutions cachexia these are -Calcarea carb.,. Sulph., Ferrum-Iodium, Silicea
Belladonna, Apis., Arsenicum-Iodium, Helleborus, Dig or Mercurius, may be required as adjuncts.
PREVENTION-Dr. Von. Grauvogl; states that in families in which hydrocephalic children have been born he has succeeded in preventing recurrence of cases by single alternate daily doses of Sulph.6., and Calc-Phos. 6, given to the mother during the term of pregnancy.
80.-acquired Chronic Hydrocephalus.
This condition is nearly always due to compression of the veins of Galen by a tumour at base of brain or in the third ventricle; or a foramen of Magendie into the spinal cord jay be closed and so fluid accumulates in the ventricle of the brain.
The symptoms are variable Optic neuritics and headache and attacks of coma with a slow pulse are to be expected; but it is virtually impossible to distinguish this condition with certainty from brain tumour,, which is so often the renal cause. Treatment must be symptomatic and is not hopeful.
This is a curious condition where the lining of the brain ventricles seems to secrete fluid in excessive quantities. It may be acute or chronic. the pressure symptoms of the acute state resemble those of tubercular meningitis the acute state resemble those of the tubercular meningitis (q.v.), and those of the chronic form recall the symptoms of brain tumor. Fever is rate, however. This curious condition may subside and via possibly some reported cures of meningitis and humour were in. reality instances of this disease.
TREATMENT- If diagnosed or suspected Apis, or Hellebore should be given a trial, and Calcarea would very likely be of service.
DEFINITION-Inflammation of the brain substance. The symptoms naturally vary according to the areas involved but h following varieties must be briefly considered. As meninges and cord seldom escape the condition is best named Meningo-myelo encephalitis.
DEFINITION-An acute infection, attacking a particularly the grey matter of the anterior horns of the spinal cord and corresponding brain areas.
This is an epidemic disease and the cause of Infantile Paralysis which remains as a sequel to it and demands prolonged treatment. Mild cases of this disease are often overlooked and only the consequent paralysis of a group or two of muscles betrays the attack. care is therefore needed not to overlook these unobtrusive ceases.
Young adults are attacks, d but the period or the first dentition (six months to two years) is much the most dangerous time.
The cause of the disease is a living organism which seems to invade the body thought the upper respiratory tract- nose and pharynx. The most important effect of the organism is on the spinal cord, although meninges and brain seldom if ever escape altogether. The cells of the grey matter of he anterior horn of the cord are more or less destroyed and the localized symptoms in. the muscles are the expression of the localized disease in the parts of he cord which are in intimate relation with those muscles.
SYMPTOMS-Usually localized paralysis and slight fever are the first symptoms to attract attention, but now and then naso- pharyngeal catarrh, fever, drowsiness, twitchings or gastro intestinal symptoms precede. Most generally groups of muscle with irregular, non-symmetrical distributions re paralyzed. The legs suffer most and it is rare for the whole of any limb to be involved. Bladder and rectum generally escape. Numbness and other sensory disturbances (seldom pain) are usual, but the motor (muscle) involvement is the striking feature.
Now and then, in epidemics, the disease will ascend throughout the cord and cause death by destroying centres respiratory for instance of in the medulla. or the centres in the medulla, affecting eyes, tongue, pharynx may be almost he only ones managed. At other times the meninges may be more involved and the symptoms may be those already described under Meningitis. Or the brain may suffer predominantly. These cases are sudden and actuate, with vomiting and convulsions and a high degree of paralysis of one side of the body (hemiplegia). It must be understood that the nerve centre attacked may be few or many and distributed irregularity so that anomalous cases are common.
After the onset there is little change for the two three weeks, and then power begins to return to q great r or less extent. Some muscles will remain permanently atrophied, but the sooner treatment is undertaken the grate the chance of limiting the permanent loss. The mortality from his disease is seldom sewer.
TREATMENT-To disinfect nose and pharynx as well as possible is wise during epidemics, as the germ grains access by this route. The disease is now notifiable.
In the acute stage Gelsemium, (especially in thereafter cases which resemble neuritis, Q.v., a nd show pain and tenderness) is useful. Following this Phosphorous is most likely to help and Manganese, Causticum and Picric aCid. After a few days Secale, Plumbum, or stannum should be studied. the affected parts should be kept warm and at rest for th fist two weeks. After this time massage is desirable, and later electricity, Faradic if there is any response, or failing response, or, filing, response, Galvanic. FAtigue is harmful for months after the disease. As far as possible the affected muscles should be entirely relaxed. AFter a time systematic re-education of the wasted muscles does much good and although a damaged nerve centre is nerve centre is never restored,. patience and training will make much of any power that remains, and encourage other muscles to replace as far as may be., those that are lost.
Some residual deformity is frequent and the orthopedic surgeon’s aid is often required to deal with these.
EPIDEMIC ENCEPHALITIS (LETHARGICA).
DEFINITION-An infective disease so-called sleepy sickness, not to be confound with Sleeping sickness, Trypanosomiasis),. attacking principally the brain and often accompanied by lethargy or stupor and paralysis of cranial nerves.
There is no doubt that the disease is infective, though its organism has not been isolated with certainty. It is not the organism that causes Anterior Poliomyelitis. This letter disease destroys ganglion cells, which escape in epidemic encephalitis, the middle parts of the brain (pons and basal nuclei) are most affected, and the actual lesions found post mortem are not unlike those found in rabies and sleeping sickness, but the causative agent is a separate one from that responsible for either of these disease. Influenza seems to predispose to encephalitis. Adults (over twenty) are more often attacked than children.
SYMPTOMS-There is a vaguely defined prodromal of infection is probably by nose of pharynx. Then in most cases lethargy deepens even to stupor, or coma. paralysis of eye muscle causes squint, and dropped more than a week, but the lethargy deepens even to super or coma. Paralysis of eye muscles causing squint, and dropped eyelids (ptosis) is very characteristic. Fever rarely lasts more than weak, but the lethargy remains, and headache. Its roused, intelligent answers to questions may be obtained from he patient. The is now and then delirium and tremor, muscles twitching and difficulties in speech are common. Pain is not as a rule marked, though there may be sensitiveness to touch and muscle tenderness. Other motor nerves than cranial may be involved with corresponding symptoms.
The lethargy is the characteristic features, whether due to toxaemia or top some interruption of normal stimuli in part of the brain.
Recovery is usual after a period of from two to twelve weeks, but a mortality of twenty-two per cent, has been recorded in one series of 168 cases. there may be mild and evanescent cases.
TREATMENT-Isolation, careful nursing (especially with regard to passable bed sores and careful feeding are needed Feeding may have to be done by nasal tube or per rectum.
When the first case occurred they were attributed to botulism, a bacterial disease. There is a nosode of their germ called Botulinum and it should certainly be tried in encephalitis, preferably in unit doses of the 30th or 200th potency. Otherwise the symptoms suggest Baptisia or Bryonia in the earlier stage and Nux Moschata Arsenicum, Antim-Tart, or Opium when the fever Arsenicum, Antim-Tart, or Opium when the fever subsides, Chloral Hydrate might be considered also; It is not a well known drug, but has symptoms that suggest its value here.
DEFINITION-A condition characterized but the abrupt loss, more or less complete, of consciousness, from extravasation of blood (Haemorrhage) within the cranium.
The symptoms are usually sudden, and its development most rapid.
MODES OF ATTACK AND WARNINGS-Apoplexy may come on suddenly or gradually. the patient may be suddenly struck-falling at once bereft of motion and consciousness. such a case termed Primary Apoplexy., More frequently, however, apoplexy is indicated by well-marked premonitions, whip are, chiefly, Headache; giddiness, particularly on stooping;fullness and pulsation of the blood- vessels of the head; Epistaxis; retinal Haemorrhage; sleepiness, with heavy or snoring breathing; transient blindness; considerable different in the sizes of the pupils; deafness, nor noises in. the ears; momentary loss of consciousness, with or without indistinctness of speech or incoherent talking; flashes, motes, etc., before the eyes;vomiting, numbness or tingling of the hands or feet; unsteady gait partial paralysis, sometimes involving the muscles of the face. sometimes those of a limb; the patient becomes comatose, and drowsiness gradually increases to perfect Coma. This is called Ingravescent Apoplexy, because the symptoms become worse gradually. the sudden attack is due to the extravasation of the large quantity of blood. the Ingravescent for is caused by a more gradual leakage and subsequent softening an destruction of brain tissue and its symptoms may be paralleled by those due to brain abscess or tumour. Different areas in. the brain were and muscular movements and the nerves that govern muscles groups follow definite paths. the local symptoms therefore, of brain injury from haemorrhage or tumour vary with the site of the lesion, and the site can often be Haemorrhage affecting he convolution of of the brain in the left frontal area are generally accompanied with more or less interference with the functions of speech and writing, and degrees of what is called aphasia or agraphia result. Symptoms of this order in the case of haemorrhage follow the recovery from the attack.
SYMPTOMS DURING A FIT-These vary according to the seat and amount of the haemorrhage, and are sometimes so vague that cerebral haemorrhage can only be suspected. Pain in the head, giddiness, faintness, sickness, laboring pulse, succeeded by some reaction, may only be present. In the early stage of an Ingravescent cases before tea patient becomes comatose, where is great depression in. the circulation from the shock to the nervous system;l the surface is cold, pale, and clammy, and the pulse frequent, small and weak. As Coma comes other pulse becomes full, slow and labored (passes slowly under the fingers0; the surface warm, sometimes preternatural so, that perspiring;l the countenance has a peculiar bloated appearance, and is often congested; the pupils are insensible to light, m and usually dilate, although one or both away be contracted;l the breathing is starters from inaction of the bladder; and the bowels are sluggish.
One or several of he above symptoms may, however, occur as the consequence of indigestion Vomiting and Headache are more important as indications when they come on suddenly without any obvious cause, and to not on first rising in the morning; and the mo the vomiting, or efforts at vomiting;a nd the vomiting, or efforts at vomiting re continued beyond the emptying of the stomach;if these symptoms are associated with degeneration of the arteries, and Albuminuria, we may suspect the existence of haemorrhage into the brain.
PREDISPOSITION-(I) Age. After fifty, Apoplexy is one of the most frequent causes of death. This arises not so much from the year’s of death. This arises not so much from the year’s of a man’s life, as from a bad constitution and tissue-depravation, not often present in early life. After the middle period of life the capillaries become impaired and as a consequence the veins. Congested. The cerebral arteries also are often diseased; the heart has often acquired an abnormal power, driving the blood with great violence, and with an increased momentum, towards the brain, while the lungs have their function so impaired that the blood is only imperfectly oxygenated; and all these are causes of Congestion, a done of tendency to repeater of the vessels of the brain (Aitken). (2) Intemperance, excessive eating or drinking. in controlled passion, pressure about the neck, to close mental labour, or other habits of life that lead to cerebral Congestion. (3) Disease affecting the heat, kidneys, or blood-vessels of the brain.
APOPLEXY NOT OFTEN SUDDENLY FATAL-A popular opinion k, to some extent shared by the profession, is current that an effusion of blood in the brain is a frequent cause of sudden death. In stories and therapeutical representations the characters are made to die suddenly of Apoplexy;l in news paper, s too, accounts r often given of sudden deaths attribute do it. this error has also been of fostered by another equally common, namely, that persons with short thick beck and red face are most liable suddenly, but the suddenness of the death is generally due to heat-disease. A man with a red face had not necessarily roe blood in his head than another with a pale face; and if blood is poured out into the brain it is pale face; and if blood is pored out into the brain it s because the diseased blood vessel gave way under stress. It is then, a person with diseased arteries in whom Apoplexy is likely to occur, and this may exist in those states that he once knew a gentleman who had such an extraordinary red face that some young friends disliked to walk the streets with him, lest he should die of Apoplexy. This gentleman, whose face was a deeply purple hue. died of heart- disease. Although cerebral Haemorrhage sometimes kills rapidly, it does not kill instantly, as rupture of the aorta, or heart disease, sometimes doses (Jackson).