1902 Encyclopedia > Meningitis

Meningitis




MENINGITIS (from meningks [Gk.], a membrane), a term in medicine applied to inflammation affecting the membranes of the brain (cerebral meningitis) or spinal cord (spinal meningitis) or both.

Of
cerebral meningitis there are two varieties :—(1) that due to the presence of tubercle in the membranes of the brain, which gives rise to the disease known as tubercular meningitis, or acute hydrocephalus; and (2) simple or acute meningitis, which may arise from various causes. Among the more common are injuries of the head, exten-sion of disease from contiguous parts, such as erysipelas of the scalp or caries of the bones of the ear, exposure to cold or to extreme heat, the presence of tumours in the substance of the brain. It may likewise occur in the course of fevers, rheumatism, and inflammatory affections, and also as- a result of mental overwork, sleeplessness, and alcoholic excess. This latter variety of meningitis is less common than the former, but it is on the whole more amenable to treatment. The symptoms present such a general resemblance to those already described in tubercular meningitis that it is unnecessary to refer to them in detail (see HYDROCEPHALUS), and the treatment is essentially the same for both.

Spinal meningitis, or inflammation of the membranes investing the spinal cord, generally results from causes of a similar kind to those producing cerebral meningitis,— injuries, exposure to cold or sudden changes of tempera-ture, diseases affecting adjacent parts such as the vertebral column or the spinal cord itself, or extension downwards of inflammation of the membranes of the brain. It is said to be most common in males. As in the case of the brain, the membranes become extremely congested; exudation of lymph and effusion of serum follow; and the spinal cord and roots of the nerves become more or less involved in the morbid process.





The chief symptoms are fever, with severe pain in the back or loins shooting downwards into the limbs (which are the seat of frequent painful involuntary startings), accompanied with a feeling of tightness round the body. The local symptoms bear reference to the portion of the cord the membranes of which are involved. Thus when the inflammation is located in the cervical portion the muscles of the arms and chest are spasmodically contracted, and there may be difficulty of swallowing or breathing, or embarrassed heart's action, while when the disease is seated in the lower portion, the lower limbs and the bladder and rectum are the parts affected in this way. At first there is excited sensibility (hyperesthesia) in the parts of the surface of the body in relation with the portion of cord affected. As the disease advances these symptoms give place to those of partial loss of power in the affected muscles, and also partial anaesthesia. These various phenomena may entirely pass away, and the patient after some weeks or months recover ; or, on the other hand, they may increase, and end in permanent paralysis.

The treatment is directed to allaying the pain and inflammatory action by opiates. Ergot of rye is strongly recommended by many physicians. The patient should have perfect rest in the recumbent, or better still in the prone, position. Cold applications to the spine may be of use, while scrupulous attention to the functions of the bladder and bowels, and to the condition of the skin with the view of preventing bed-sores, is all-important.

Epidemic Cerebrospinal Meningitis.—This name, as well as cerebrospinal fever, is applied to a disease defined in the Nomenclature of Diseases as "a malignant epidemic fever, attended by painful contractions of the muscles of the neck and retraction of the head. In certain epidemics it is frequently accompanied by a profuse pur-puric eruption, and occasionally by secondary effusions into certain joints. Lesions of the brain and spinal cord are found on dissection." This disease appears to have been first distinctly recognized in the year 1837, when it prevailed as an epidemic in the south-west of France, chiefly among troops in garrison. For several years subse-quently it existed in various other localities in France, and mostly among soldiers. At the same time in other countries in western and central Europe the disease was observed in epidemic outbreaks, both among civil and military populations. In 1846 it first showed itself in Ireland, chiefly among the inmates of workhouses in Belfast and Dublin. Numerous outbreaks occurred also about the same period in many parts of the United States. In more recent times the disease has repeatedly appeared both in Europe and America, but it has seldom prevailed extensively in any one tract of country, the outbreaks all'ecting for the most part limited communities, such as garrisons or camps, schools, workhouses, and prisons.

Little is known regarding the causation of this disease. All ages seem liable to suffer, and, as regards sex, males are affected more commonly than females. Occupation and condition of life appear to exercise no influence. It has been observed to occur most frequently in cold seasons. The question of the contagiousness of cerebro-spinal fever remains still unsettled, but the weight of authority appears to be in favour of the theory of the communica-bility of the disease. It cannot, however, be regarded as contagions in the same degree as some other specific fevers, such as typhus fever, small-pox, or scarlatina.





The following are the more prominent symptoms. After a few days of general discomfort the attack comes on sharply with rigors, intense headache, giddiness, and vomiting. Neuralgic pains in the abdomen, and pain with spasmodic contractions in the muscles of the extremities, occur at an early stage. The headache continues with great severity, and restlessness and delirium supervene, accom-panied with periods of somnolence. The pains and spasms rapidly increase, the muscles of the neck, spine, and limbs being specially affected. The patient's head is drawn backwards and rigidly fixed, the spine arched, and the arms and legs powerfully flexed, the whole condition bearing a considerable resemblance to tetanus. For a time there is greatly increased sensibility of the skin, pain being excited by the slightest contact. There is more or less fever present. About the fourth day of the disease an eruption on the skin both of the face and body frequently appears, in the form either of purpuric spots or small clear vesicles. Death may take place in from a few hours to eight or ten days. Should the patient survive the immediate shock of the attack, serious complications are apt to appear in the form of destructive inflammation "of the eyes or ears, inflammation with effusion into certain joints, and paralysis of limbs ; or, again, recovery may take place after a pro-longed convalescence. The mortality appears to vary in different epidemics, in some being as high as 80 per cent., in others only about 20 per cent. Certain forms of the disease are of malignant character from the first, and very rapidly fatal.

The changes found after death in cerebro-spinal fever are intense inflammation of the membrane of the brain and spinal cord, with effusion of serum or pus into the ventricular and arachnoid spaces.

The treatment is similar to that of other febrile conditions, but for the special symptoms of pain, spasm, &c, opium seems to have been found of eminent service, while quinine and ergot of rye are also recommended.



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