. The practice of pediatrics. onse to light. Hyperesthesia and rig-idity of the neck may be present. Purposeless movements of the leg or arm are often seen when thesymptoms of the disease are well marked. The leg or arm is raised andallowed to fall; this is repeated for hours at a time. An elevation oftemperature is usually present. It may be high, low, or is early interfered with. In the patient above referred to, whose brain is shown in Plate I,the first sign was a temperature of 102° F., a greatly distended fontanel,and stupor. The child died in three days, aged seven mo
. The practice of pediatrics. onse to light. Hyperesthesia and rig-idity of the neck may be present. Purposeless movements of the leg or arm are often seen when thesymptoms of the disease are well marked. The leg or arm is raised andallowed to fall; this is repeated for hours at a time. An elevation oftemperature is usually present. It may be high, low, or is early interfered with. In the patient above referred to, whose brain is shown in Plate I,the first sign was a temperature of 102° F., a greatly distended fontanel,and stupor. The child died in three days, aged seven months. Diagnosis.—There is no characteristic temperature range. Theonly positive information as to the nature of the infection is obtainedby lumbar puncture; only in this way can a positive differential diag-nosis between acute simple, tuberculous, and cerebrospinal meningitisbe made. In many severe diseases in which there is marked toxemia, symptomsclosely resembling meningitis will be in evidence. In pneumonia, in PLATE 1. ^w Pneumococcus meningitis. ACUTE SIMPLE MENINGITIS 531 the severe intestinal infections, and in heat prostration the cerebralsymptoms so closely simulate those of meningitis that a positive diagnosiswithout lumbar puncture may be impossible. Before the advent oflumbar puncture I have seen most excellent clinicians diagnose menin-gitis in cases which at autopsy showed no pathologic condition in thebrain. I have further known cases so diagnosed to recover toopromptly to be a comfort to the attending physician. Differential Diagnosis.—An examination of the cerebrospinal fluidis always to be carried out if possible. In acute simple meningitis thefluid is usually turbid, and when allowed to stand, a considerable depositforms in the tube, an examination of which determines the nature ofthe infection. Cases of simple toxic origin simulating meningitis showthe signs of drowsiness, stupor, and perhaps hyperesthesia and immobil-ity of the pupils, but no irregula
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Keywords: ., bookcentury1900, bookdecade1910, bookid39002, booksubjectchildren
