“ Much may be done in the way of prevention of this disease, and, in its earlier stages, even in the way of cure. It is most important in families where the history indicates a tuberculous or scrofulous tendency, and particularly where acute hydrocephalus has already occurred, that every effort should be used to fortify the system and avoid the causes already alluded to as favouring the development of the disease during that period in which children are liable to suffer from it. ”

“ Certain forms of the disease are rapidly fatal, these are known as the fulminant type, and death may take place within 12 to 24 hours of the onset. Death usually occurs between the fifth and the eighth day, but many cases drag on for weeks with rapid and progressive emaciation, and recovery is slow. The mortality has varied in different epidemics. Hirsch’s tables of forty-one epidemics give a mortality of from 25 to 75%, and Koplik rates it at 48 to 90%. ”

“ Squinting is common in this stage, and there may also be drooping of an eyelid, due to paralysis of the part, and one or more limbs may be likewise paralysed.
To this succeeds the third or final stage, in which certain of the former symptoms recur, while others become intensified. There is generally a return of the fever, the temperature rising sometimes very high. The pulse becomes feeble, rapid, and exceedingly irregular, as is also the case with the breathing. Coma is profound, but yet the patient may still be got to swallow nourishment, though not so readily as before. ”

“ The mode of infection is obscure, but the organism is thought to gain access to the circulation through the mucous membrane of the nose and conjunctiva, as the organism has been isolated from the mucous membrane of the nose, not only of those suffering from the disease but from healthy persons who have been in contact with cases. ”

“ There is manifestly little suffering, although the peculiar cry may still be uttered, and the patient lies prostrate, occasionally rolling the head uneasily upon the pillow, or picking at the bedclothes or at his face with his fingers. He does not ask for food, but readily swallows what is offered. ”

“ The headache continues with great severity and restlessness and delirium supervene, or there may be long periods when the patient is comatose. Twitching of the limbs and general convulsions may occur and facial paralysis is frequent. Paralysis of the ocular nerves causing squint, dilatations and contractions of the pupil are common as in other varieties of meningitis. ”

“ More frequent even is disease of the auditory apparatus, and purulent otitis media or disease of the labyrinth may lead to permanent deafness. Serous effusion may take place into joints which are painful, red and swollen as in acute rheumatism. ”

“ During that year the disease was made notifiable in 48 Irish urban and 55 rural districts. The mortality in Dublin was 75%. Osler states that in children under one year (in New York) the mortality reached 87·6%.
The changes found after death from cerebro-spinal fever are an acute inflammation of the pia-arachnoid membrane both of the brain and spinal cord, with effusion of serum or pus into the ventricular and subarachnoid spaces. With such rapidity may the effusion become purulent that it has been found purulent in a case where death took place within five hours from the apparent onset. ”

“ The countenance is pale, but is apt to flush up suddenly for a time. The eyes present important alterations, the pupils being dilated or unequal, and scarcely responding to light. There may be double vision, or partial or complete blindness. ”

“ 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. ”