The DIAGNOSIS of chronic meningitis is often obscure or impossible. Long-continued pain in the head, accompanied by vertigo, impairment of memory, drowsiness, mental apathy, etc., without paralysis, would be suggestive of it, especially if there were occasional intermissions of the symptoms. The probability would be greatly increased if the patient had a syphilitic or alcoholic history. The diagnosis should exclude tumor of the brain, chronic pachymeningitis, and chronic hydrocephalus, but as these diseases are often complicated with chronic meningitis, the distinction might be very difficult. As already stated, chronic meningitis is almost a constant lesion in general paralysis, as well as in other forms of chronic insanity, but there are no special symptoms by which its presence can be ascertained during life.
TREATMENT.—Our aim should be to relieve pain, diminish congestion, and favor absorption. Counter-irritation to the head and nucha by means of small blisters or croton oil should be employed with moderation. Bromide of potassium, or, if necessary, small doses of morphia, may be given if the pain be severe. Should there be symptoms of cerebral congestion, such as acute delirium, flushing, and heat of head, an ice-bag should be applied to the head and leeches behind the ears, or blood may be drawn from the temples or nucha by cupping. As an absorbent the iodide of potassium is much recommended, but it is not likely to be effectual, except in syphilitic cases. The bowels should be kept free, but without active purging. The general health of the patient should be promoted by suitable diet and regimen, by relief from excitement and fatigue, or by change of scene and of climate. For the treatment of chronic meningitis complicating syphilis, alcoholism, and tuberculosis, the reader is referred to the articles treating of those diseases.
TUBERCULAR MENINGITIS.
BY FRANCIS MINOT, M.D.
DEFINITION.—Inflammation of the pia mater of the brain, with effusion of lymph and pus, caused by the deposit of miliary tubercles upon its surface or into its substance.
SYNONYMS.—Scrofulous meningitis, Granular meningitis, Basilar meningitis, Acute hydrocephalus, Dropsy of the brain.
HISTORY.1—It is only within a comparatively recent time that tubercular meningitis has been distinguished from other cerebral diseases. Up to the eighteenth century the term hydrocephalus was employed not only for the dropsical diseases of the head, including internal and external hydrocephalus, but also for meningeal inflammations, both simple and tubercular, and for congestion of the brain and of the membranes; the accumulation of water in the ventricles or between the membranes being looked upon as the disease, and not as one of its consequences. The term was even applied to external tumors, as cephalæmatoma and caput succedaneum. We owe the first accurate account of the symptomatology of acute hydrocephalus, or ventricular dropsy, to Robert Whytt of Edinburgh, whose remarkable monograph, entitled Observations on the Dropsy of the Brain, first published in 1768, after his death, was founded upon the study of 20 cases with 10 autopsies. No addition of importance has been made by later observers to his graphic description of the disease or to his rules for its diagnosis. Whytt, however, had no clear notion of its pathogeny, and it was not till 1815 that Gölis pointed out that acute ventricular dropsy was a secondary condition depending upon previous inflammation of the membranes or vessels of the brain.