A handbook of the theory and practice of medicine / by Frederick T. Roberts.
- Frederick Thomas Roberts
- Date:
- 1873
Licence: Public Domain Mark
Credit: A handbook of the theory and practice of medicine / by Frederick T. Roberts. Source: Wellcome Collection.
1016/1060 page 1012
![neck, and retraction of the head. In certain epidemics it is frequently accompanied by profuse purpuric eruption, and occasionally by secondary effusions into certain joints. Lesions of the b'-ain and spinal cord and their membranes are found on dissection. Etiology.—There is no satisfactory evidence of infection or contagion • it occurs principally in the winter months; in males more frequently than] in females; it is a disease eminently of early life, the aged being rarely affected ; there is no definite relation between the sanitary state of habita- tions and individuals and the occurrence of the disease; the better classes have been affected quite as much as the poorer; different epidemics have exhibited most varied conditions as regards the cause and the course on the malady. Symptoms —The symptoms and course of this disease may be fully explained by the changes in the meninges of the brain and spine. It commences generally with no prodromata ; there is sudden shivering with vomiting, and violent pain in the head, of varied seat, constant generally throughout the disease; pain in the back of the neck, and! sometimes down the spine; the head is forcibly drawn back; violent pain in the stomach ; cutaneous hyperesthesia ; pupils contracted ; bowels constipated ; pulse very weak, very varied in frequency ; temperature nofy high, very varied in different epidemics, generally between 100° F. and 103° F. ; evening exacerbation slight; by the third or fourth day of the disease tetanic contraction of the muscles of the neck and back become evident, occasionally there is trismus, excessive opisthotonos; delirium occurs; herpetic spots appear, chiefly about the lips and face, or in patches over the limbs or trunk; or purpuric spots may occur, scattered, more or less thickly over the whole surface of the body; the patient passes into a deep coma, and death ensues. Death may occur on the firJ or second day, or may not take place till the sixth or seventh week. Epileptiform convulsions are very rare ; paralysis rarely occurs ; not mm frequently amaurosis occurs from keratitis, or exudative choroiditis; deaf- ness too is very frequent. Diagnosis —The history of the development and progress of cerebro- spinal fever, together with the absence of the characteristic rashes, w9 generally serve to distinguish it from typhus, or typhoid fever; tetanuim which it somewhat resembles, never manifests the early grave cerebral symptoms. Prognosis.—The mortality varies much in different epidemics; injj pome it has been as high as 8U per cent., in others not more than 20 or 30 per cent.; it is highest at the commencement of an epidemic; more fatal among infants and young children, and adults after the age of 30. Life is most in danger during the earlier days of the disease; convalescence is generally very protracted. Mokbid Anatomy.—Dura mater of skull and spinal canal much in-](https://iiif.wellcomecollection.org/image/b20402740_1016.jp2/full/800%2C/0/default.jpg)
