Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 9 (7).djvu/10

 is not uiiccnnmon in the early stages of the disease, and is of considerable diagnostic importance.

Eruption Htagc. — This iisaally appears daring the tii-st week and may be macular, erythematous, petechial or purpuric.

The macula? do not come f)ut in successive cro])S, begin to fade rapidly, and disappear usually in four days.

The erythematous rash is like the transient erythenia which may precede the eru[)tion in small [)ox or tyi)hus. Like the maculfp they may appear at any part of the body.

When petechia' and a purj)uric rash ap[)ear, they are evidence of profound toxaemia.

Herpes is common. There is usually scjme leucocytosis — '20,000 to 40,000 per c.mm. Kernig's sign is present ; this occurs in all but the fulminant cases, it is one of the earliest symptoms to appear. The pupils are usually dilated, they may l)e unequal. Towards the end of the fii'st week a condition of semi-stupor occurs, accompanied by marked retraction of the head. The temperature remains fairl' high and approaches to the continued type.

The patient remains quite the same for two or tln'ee weeks and recovery is very gradual ; ultimately the fever completely subsides, the headache and stupor pass off and the rigidities shortly disappear; the actual convalescent stage once being established is rarely interrupted, it may be weeks before the patient is free from stiffness. Unfortunately paralysis of single muscles, or of groups of muscles, may remain. Permanent deafness and blindness are by no means uncommon, and in some cases the patient never recovers his mental power and remains an imbecile.

DIAGNOSIS.

Weichselbaum discovered the meningococcus in 1887; Quincke introduced lumbar puncture in 1890. It is the presence of the diplococcus of Weichselbaum in the cerebro-spinal fluid that establishes the diagnosis.

The disease with which it is most often mistaken is influenza ; fever prolonged past the seventh day, in the absence of any complication is unlikely to be due to influenza.

There is not time to ao into the differential, diagnosis. However,