Nervous and mental diseases . mpressionable, and is hazy in his delirium is of a low grade generally, but may be wild and frantic orsuggestive of the busy delirium of alcoholism and typhoid. Vomitingof a projectile character is rarely absent in children, but is less commonin adults. The stomach seems simply intolerant and rejects withoutnausea the unchanged ingesta. It may be an early symptom. At thesame time the tongue may be quite clean; later it is often thickly furredand suggestive of typhoid. The bowels are usually constipated and theabdomen retracted. 82 DISEASES OF THE CEREB
Nervous and mental diseases . mpressionable, and is hazy in his delirium is of a low grade generally, but may be wild and frantic orsuggestive of the busy delirium of alcoholism and typhoid. Vomitingof a projectile character is rarely absent in children, but is less commonin adults. The stomach seems simply intolerant and rejects withoutnausea the unchanged ingesta. It may be an early symptom. At thesame time the tongue may be quite clean; later it is often thickly furredand suggestive of typhoid. The bowels are usually constipated and theabdomen retracted. 82 DISEASES OF THE CEREBRAL MENINGES. Convulsion? in the early stage?, particularly in children, often are general in character and of protracted duration. When theconvexity is invaded, they may later present a limited distribution, oneside of the body, the face, or a single extremity being alone involved. Almost invariably there is more or less muscular rigidity. In mostcases this is marked at the neck by a tendency to retraction that is. Fig. 27.—Attitude of patient with cerebrospinal meningitis. highly significant. At first the patient complains of a feeling of nuchalstiffness and soreness, and finds slight relief in resting the head on achair-back or over a firm pillow. In the comatose condition the headis often strongly retracted and the occiput drawn well between theshoulders. When less marked, an attempt to passively bring the headforward will provoke distress and resistance. A similar rigidity rarelyinvades the muscles of the lower jaw, producing slight trismus. It mavinvolve the extremities, and when the meningitis has attacked the spinethe trunk is often held rigidly in a position of dorsal extension. Ker-nig and Bull1 first described a peculiar rigidity in the lower limbs. Ifthe patient is placed in a chair one is unable passively to extend theknees owing to the contracture, which disappears when the thigh isstraightened on the trunk. Kerrmfs sign can be readily sought with the
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