and there as a
separate case (sporadic). It is caused by a specific organism (germ) and
the disease attacks the membranes of the brain and spinal cord.

Of late years great progress has been made by patient investigation, and a
serum is now prepared for the treatment of this disease. The results of
this treatment are better than the treatments formerly used, and there is
good reason to believe that in a few years this treatment will be as
effective in this disease as antitoxin is in diphtheria.

Cause.--Young adults and children are affected most often. Bad
surroundings and over-exertion are predisposing factors.

Conditions.--There is congestion of the membranes of the brain and spinal
cord which are covered with an exudate confined on the brain, chiefly to
the base.

Symptoms. Ordinary Form.--Incubation is of unknown length and occasionally
marked by want of appetite, headache, and pain in the back. The invasion
is usually sudden, chill, projectile vomiting, throwing forward, severe
headache, pain and rigidity of the back of the neck, pain in various parts
of the body, skin over-sensitive, irritable, and temperature about 102
degrees, with all symptoms of an active fever. Later, pains are very
severe, especially in the head, neck and back; the head is drawn back;
often the back is rigid; the muscles of the neck and back are tender and
attempts to stretch them cause intense pain. The vomiting now is less
prominent. Temperature is extremely irregular, 99 to 105 degrees or more.
Pulse is slow, often 50 to 60, and full and strong at first. The delirium
is of a severe and variable type in common, alternating with partial or
complete coma, the latter predominating toward the close of fatal attacks.
Stimulation of nerve centers causes cross-eyed look, drooping of upper
eyelid, movement of eyeballs unequal, contracted, dilated, or sluggish
pupils; acute and painful hearing, spasmodic contractions of the muscles
followed by paralysis of the face muscles, etc. The disease may last
several hours or several months. Many die within five days. In fatal cases
the patient passes into seemingly deep sleep with symptoms of a very
prostrating and weakening fever, and often retention of urine. Mild cases
occur with only a little fever, headache, stiff muscles of the neck,
discomfort in back and extremities. The malignant type occurs epidemically
or sporadically.

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Malignant type.--Sudden invasion with sever