Symptoms

Cerebro-spinal meningitis is an infectious disease of microbic origin, in which the chief lesions are an inflammation of the meninges of the brain and spinal cord. This inflammation of the membranous coverings of the nervous system results in the production of a variety of symptoms, including fever, disturbances of the nervous and muscular systems, nausea, vomiting, and constipation.

The symptoms vary greatly in severity and duration, lasting from a few days to several months. In mild cases convalescence is established at the end of a week, but in severe and protracted cases the nervous symptoms increase in severity. The stage of excitement and irritation of the nerves with active delirium is succeeded by profound prostration and coma, with progressive emaciation, a variable temperature, and paralysis of the sphincters, with involuntary evacuations. Such cases as a rule prove fatal, but they are not necessarily hopeless, and recovery may occur at any time. Much, therefore, depends upon the careful nourishment of the patient, and every effort should be directed towards maintaining strength and promoting nutrition.

Dietetic Treatment

In mild cases a liquid diet of milk, broth, meat, and egg albumin, with, perhaps, a little toast or crackers, may be given while acute symptoms last. In protracted severe cases, and especially where convulsions, delirium, and coma are present, the patients must be fed with great care, and all nourishment must be given in frequent small doses and in an easily assimilable form. Huebner sometimes employs forced feeding with the stomach tube. Pancreatinised meat broth, pancreatinised milk, albumoses, and beef juice must be ordered, if necessary, every fifteen minutes. Brandy or whisky is required when hyperemia is succeeded by exhaustion. If given too early, alcohol may increase the delirium. In extremely feeble patients such fluids must be administered in teaspoonful doses, or even in smaller quantities, with a medicine dropper, by which they are passed between the closed teeth. It will be also advisable to employ rectal alimentation. There is seldom any lesion of the alimentary canal present, and consequently in those cases in which larger quantities of fluid nourishment, or even solid food, can be taken there is no objection. If the patient is able to eat and swallow properly, milk toast, scraped beef, eggs, custard, wine jelly, farina, Bavarian cream, blancmange, etc., are indicated.

Water may be given ad libitum to relieve the thirst, which is often severe.

Convalescence will be promoted by giving abundance of food. Five or six meals a day may be taken. The appetite is frequently good from the commencement of convalescence. Beefsteak, chops, roast beef, mutton, or chicken, bread and butter, oatmeal, porridge, hominy, and rice with cream, may be allowed as soon as the patient's digestion admits. A milk punch, or glass of claret should be ordered three times a day.