HOSPITAL NOTES AND MEMORANDA ; 
IN ILLUSTRATION OF THE 
CONGESTIVE FEVER, 
(SO CALLED) OR 
EPIDEMIC CEREBRO - SPINAL MENINGITIS, 
AS IT OCCURRED IN THE WINTER AND SPRING OF 1862-63 IN THE 
CAMPS IN AND AROUND THE TOWN OF NEWBERN; 
WITH SOME ACCOUNT OF ITS 
gate an& fcatat 
By J. BAXTER UPHAM, M.D. 
Surgeon in charge of Stanly General Hospital, 18th Army Corps, Dep't of North Carolina 
[Re-printed from the Boston Medical and Surgical Journal.] 
BOSTON: 
DAVID CLAPP, PRINTER 334 WASHINGTON STREET. 
1863. TO 
MY ESTEEMED ASSOCIATES 
ON THE 
IHttffcal anti Sutflical Staff 
OF 
STANLY GENERAL HOSPITAL, 
fdu ^nges 
ARE GRATEFULLY INSCRIBED. ILLUSTRATIONS 
OF THE 
" CONGESTIVE FEVER " (SO CALLED), OR EPIDEMIC CEREBRO-SPINAL 
MENINGITIS, AS IT APPEARED AT NEWBERN, N. C. 
I propose, in the present paper, to give, in outline, a few brief notes 
of cases of this affection as it has presented itself in hospital during 
the last two or three months-with some observations as to the ori- 
gin and nature of the epidemic in question. The disease (so far as I 
can learn) has, in every case, originated in the camps adjacent to the 
town, whence it lias been brought into the hospital at an earlier or 
later stage of its progress. The records here submitted are mainly 
from the note-books of my associates on the medical and surgical staff 
of the Hospital, and the autopsies were made-under my own inspec- 
tion mostly-by the attending surgeons in whose wards they occurred. 
These notes are necessarily fragmentary and imperfect-obtained, as 
they were, by snatches in such intervals of leisure as could be found 
amid the pressing duties of a crowded military hospital. 
The four cases first adduced were in the service and under the 
care of Assistant Surgeon J. Q. A. Meredith, of the 103d Regiment 
Penn. Vols. 
Case I.-J. M., a private, aged 19, was admitted to Hospital on 
the evening of January 16th, in a moribund condition. No previ- 
ous history of his case could be obtained, further than that he had 
been attacked the night before, suddenly and violently. When ad- 
mitted, he was unconscious, having frequent epileptic spasms; froth- 
ing at the mouth; pupils insensible to light. Tonics and stimulants, 
in large doses, were prescribed, and stimulating injections were ad- 
ministered ; these last were not retained, but brought away immedi- 
ately large quantities of hardened feces. Sinapisms were applied 
over various parts of the body and limbs. 
17th.-No improvement; skin moist and moderately warm; pulse 
160, irregular, soft and very compressible; spasms growing worse; 
stimulants assiduously employed. Died, without a sign, at 4, P.M. 
1 2 
HOSPITAL NOTES AND MEMORANDA. 
Autopsy, twenty hours after death. Head.-Investing membranes 
of the brain were found much congested-the substance of the brain it- 
self slightly so, with a deposit of thick, pus-colored fluid within the ven- 
tricles and at the base of the brain, and upon the lobes of the cerebel- 
lum. Chest.-Lungs greatly congested; more posteriorly than ante- 
riorly. Heart normal in size, with a deposit of lymph in both ven- 
tricles. Stomach healthy. Liver normal. Spleen of natural size 
and highly congested. Kidneys and Peyer's glands healthy. 
Case IL-J. C., a private, aged 17, was admitted to Hospital Jan. 
10th. No statement of his previous condition received. When ad- 
mitted, he was in a high state of delirium, with a hot and arid skin; 
tongue dry and almost impossible to protrude; abdomen tympani- 
tic ; pulse frequent and feeble; surface of a livid color. He had 
involuntary discharges from the bowels, of a blackish hue. His 
respiration was hurried and difficult; extremities cold. Prescribed 
pil. hydrarg., gr. i. every hour; quinia,gr. ij. every two hours. Hot 
applications to back, abdomen and extremities. Whiskey and 
beef-tea. 
Jan. 12th.-No abatement in virulence of symptoms. Continued 
pil. hydrarg., with an equal amount of pulv. ipecac, every hour. 
Quinia, grs. iij., every two hours. Continued whiskey, beef-tea and 
hot applications. 
13th.-Growing worse; constant muttering and occasional excla- 
mations. Continued treatment, adding neutral mixture and acid 
drinks, with sinapisms to chest. 
14th.-No improvement. Applied blister to chest and back of 
neck. Quinia, gr. v., every two hours. Morphia at bed-time, to 
check diarrhoea. 
15th.-Moribund. Died at 4, P.M. 
Autopsy, twenty hours after death. Body small, spare, somewhat 
below the medium size; external appearance of a dark livid hue. 
Head.-Upon removing the calvaria, the investing membranes of 
the brain were found to be somewhat congested. On cutting into 
the substance of the brain, some points of blood exuded, more pro- 
minent than natural. The arachnoid presented a slightly clouded 
appearance. In other respects normal. Chest.-Heart normal; 
lungs greatly engorged, more so in posterior and dependent portion, 
where were found circumscribed spots of discoloration, varying in 
size from that of a split pea to a five-cent piece, resembling some- EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
3 
what the condition of pulmonary apoplexy. The same appearance, 
though less marked, anteriorly. Abdomen.-Spleen nearly double 
its natural size, greatly engorged with blood. Liver slightly en- 
larged and somewhat congested. Kidneys normal. Stomach healthy. 
Peyer's patches in a few instances more prominent than natural, fri- 
able apparently, with, in one case, ulcerative points; not having, how- 
ever, the legitimate appearance recognized in typhoid fever. Other 
organs healthy. 
Case III.-C. B., private, aged 18, was admitted into Hospital Jan. 
16th, in a moribund condition. He had been on duty the day previ- 
ous, and was attacked in the afternoon with chills, headache and de- 
lirium. Cups were applied to the back of the neck, and cathartics 
and quinine were administered freely. Upon entering the hospital, 
his breathing was irregular, difficult and accompanied with groan- 
ing; 44 inspirations in a minute. His pulse was imperceptible. 
There was a mottled appearance of the skin, approaching petechia. 
Percussion of chest clear anteriorly; the extremely low condition of 
the patient precluded percussion posteriorly. Directed enema of 
spts. vini gallici, § iv.; ol. terebinth., § i. M. Whiskey and qui- 
nine to be given freely. Sinapisms applied to back of neck, spine, 
abdomen and extremities. 
The patient died at 4 o'clock, P.M. 
Autopsy, twenty hours after death. Body of medium size and 
well developed. Head.-Brain but slightly congested in its sub- 
stance, having at its base a deposit or exudation of tenacious con- 
sistence, presenting much the appearance of false membrane, con- 
joined with a pus-colored fluid, most noticeable and abundant around 
the origin of the nerves of sense and on the base of the cerebellum. 
The same substance also occurred in the ventricles. No alteration 
in the texture of the brain itself. Chest.-Lungs extensively con- 
gested, more posteriorly than anteriorly; the upper portion inter- 
spersed with tuberculous deposits; the lungs were generally crepi- 
tant, with well-defined spots, resembling those of pulmonary apo- 
plexy. Heart normal in size, with extensive deposits of lymph in 
both ventricles. Old adhesions of both lungs to pleura, and of left 
to diaphragm. Abdomen.-Liver enlarged and congested. Stomach 
healthy. Spleen enlarged to double its natural size, and greatly 
congested. Kidneys normal. Intestines healthy. No alteration of 
Peyer's patches. 4 
HOSPITAL NOTES AND MEMORANDA. 
Case IV.-S. P., a private, aged 32, was brought to Hospital 
Jan. IGth, in a moribund state. No history of his previous condi- 
tion given, though we learned from his comrades that he was attack- 
ed suddenly the day before. Quinine and whiskey, with capsicum, 
administered in free doses. Brandy and spirits of turpentine given 
in enema. 
Jan. 17th.-Patient this morning was lying on his right side, his 
head thrown back, groaning heavily, giving indications of great pain. 
He was roused with difficulty. His skin was moist and moderately 
Warm; sordes on teeth; tongue dry and inclined to black; pulse 
120, weak and compressible, inclined to intermit; petechial eruption 
on limbs; percussion good in front, flat posteriorly. Treatment of 
previous day continued. Sinapisms also applied to back of neck 
and chest, abdomen and calves of legs. 
Evening.-Growing worse; powers rapidly failing; totally uncon- 
scious and insensible. Same treatment continued with more vigor, 
accompanied with frictions along the spine. 
Jan. 18th.-Died at 7, A.M. 
Autopsy, six hours after death (conducted by Dr. Fisher, Assistant 
Surgeon of the 44th Mass.). Cadaver of good size, well de\ eloped ; 
no emaciation. Rigor mortis very strongly marked. A few pete- 
chial spots are to be seen upon the arras and hands. Head.-On 
removal of the calvaria some signs of congestion were apparent, the 
veins of the investing membranes being considerably engorged, be- 
neath which a purulent lymph-like substance was observed, thinly 
spread over the surface of the brain-upon the base and between 
the lobes of the cerebellum particularly-and, in greater abundance 
about the origin of the nerves, and upon the surface of the medulla 
oblongata. The same substance was also seen in the lateral ventri- 
cles, being here more opaque and thickened than elsewhere. The 
substance of the brain itself was apparently normal. Chest.-Lungs 
moderately congested, more posteriorly than anteriorly, crepitant 
throughout; old adhesions upon the left lung. Upon opening the 
pericardium, an abundance of diffluent lymph, easily washed away 
with water, was observed; its inner surface uniformly congested. The 
ventricles of the heart were filled with dark fluid blood, which subse- 
quently clotted in the basin. There were no fibrinous deposits; size 
and texture of heart normal. Abdomen.-Stomach not examined. 
Liver normal in size and appearance. Spleen enlarged and slightly 
softened; of a deep maroon color. Kidneys normal. Small intes- EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
5 
tines, in the space of two feet from coecum, showed Peyer's glands, 
in one or two instances, more prominent than natural; in one case, 
some loss of substance, not amounting to ulceration; one or two 
patches a little raised or thickened perhaps. No redness or conges- 
tion of the mucous membrane. 
The cases which follow occurred in the wards under the charge 
of Dr. J. B. Treadwell, Asst. Surgeon of the 45th Mass. Vols. 
Case V.-J. M., a private, aged 21, was received into Hospital 
on the 14th of January, in an algid condition, exhausted and deliri- 
ous. The statement of his regimental surgeon, Dr. Robert Ware, 
is to the effect that he was seized, on the 12th, with a chill, followed 
by high febrile excitement, with a full pulse, and, at first, a hot skin; 
soon after became delirious. He had been treated with full doses 
of quinine, the free administration of stimulants, and cupping at the 
back of the neck. A similar line of treatment was continued on 
his admission to the Hospital. , 
Jan. 15th.-Passed an unquiet night, with but little sleep. There 
was constant muttering delirium and jactitation; pulse 80, very 
weak; skin cool and moist; respiration quiet; bowels open; mark- 
ed subsultus tendinum. 
Evening.-Symptoms much the same, but aggravated. 
Died at 12 o'clock, midnight. 
Autopsy, twelve hours after death. Body well developed; no 
emaciation; rigidity about as usual. Head.-Both ventricles of the 
brain were greatly distended with a semi-opaque fluid, having a pus- 
like deposit at the bottom. This same deposit was also manifest 
at the base of the cerebellum, and entangled about the origin of the 
nerves of sense, where it was abundant, lymph-like, somewhat tena- 
cious, much resembling false membrane in appearance, and could be 
traced onward, by carefully unfolding the convolutions, into both 
lateral ventricles. Chest.-About three ounces of fluid were found in 
the pericardial cavity. Heart below the normal size; mitral valves 
a little thickened; very firm adhesion of the pleural surface through- 
out the whole of the left side. Right lung, with the exception of a 
small portion of anterior lobe, congested. Left lung one third 
smaller than natural-the result of disease. Abdomen.-Liver of 
natural size; external appearance good; interlobular veins some- 
what congested. Spleen normal. Kidneys healthy. Stomach slightly 
congested, with cadaveric softening along its greater curvature. 6 
HOSPITAL NOTES AND MEMORANDA. 
Peyer's patches appeared slightly engorged and enlarged, and were 
more prominent than natural. 
Case VI.-G. B., a private, aged 21, was received into Hospital in 
evening of the 19th of January. The statement of his regimental 
surgeon, Dr. Ware, was as follows:-" Patient was attacked sud- 
denly with symptoms of a severe cold, and some disposition to 
paralysis of the tongue and muscles of the face. He was treated 
with quinine in half-drachm doses, stimulants and beef-tea, and was 
cupped to the extent of five ounces at the back of the neck. Reac- 
tion came on, though incompletely. 
"Jan. 19th.-Same treatment continued, but he has become gradu- 
ally worse, and, since noon, delirious." 
Evening.-Patient, on admission into Hospital, appeared in a 
state of complete exhaustion, almost amounting to collapse, death 
following immediately. 
Autopsy, twelve hours after death. Body of medium size, but 
little emaciated. Rigor mortis great. Arms, chest and legs studded 
with petechial spots, of one, two and three lines in diameter. Head.- 
The membranes of the brain but little, if any, congested. Slight 
cloudiness on the superior surface visible through the membranes; 
a little opacity of the arachnoid noticed; otherwise nothing abnor- 
mal. Chest.-Lungs more than usually engorged, especially at de- 
pendent and posterior portions; crepitant throughout. The peri- 
cardium contained six or eight ounces of sero-purulent fluid, holding in 
suspension masses of flocculent lymph; both surfaces covered with a 
layer of lymph, of sufficient thickness and consistency to be torn off 
like a membrane, having the appearance, in fact, of genuine false 
membrane; some fibrinous clots in the ventricles, and thickening of 
the mitral valves. Abdomen.-The liver, spleen and kidneys were 
normal; mucous membrane of stomach and intestines also natural. 
Peyer's patches healthy. 
Case VIL-0. W. W., a private, aged 22, was suddenly attacked, 
according to the statement of his regimental Surgeon (Dr. Newton), 
on the 13th of January, with violent headache, accompanied with 
hot skin and full pulse. 
14th.-All symptoms aggravated, with retention of urine. 
Jan. 15th.-Admitted to Hospital in a state of high febrile ex- 
citement; pulse 70, full and moderately strong; hot skin; dusky EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
7 
hue of face; easy respiration; much delirium, patient frequently at- 
tempting to get out of bed. Prescribed wine, § i. every two hours; 
quinine, gr. vi. every three hours; also,hyd. chlor, mit., gr. xv.,to be 
taken at once, to be followed in three hours with carb, ammon., gr. 
v. Delirium still increased; skin became cool and moist, with less 
febrile excitement. [The further notes of this case have been mis- 
laid.] All symptoms, however, became rapidly aggravated; deliri- 
um gave way to symptoms bordering on coma; the respiration be- 
came hurried; involuntary discharges increased, and the patient died, 
with but slight signs of exhaustion, on the 22d of January. 
Autopsy, four hours after death. Subject of medium size. No po- 
techim (a few spots had appeared, during his illness, upon the left 
forearm). No rigor mortis. Head.-Dura mater healthy; upper 
surface of brain slightly engorged; on the base of the brain, around 
the origin of the nerves of sense, and upon the medulla oblongata 
especially (sheathing this latter completely), was observed a deposit 
of consistent, pus-like lymph of about two lines in thickness, extend- 
ing also into the crevices of the brain and cerebellum. On opening 
the ventricles, a gush of dirty, semi-opaque fluid exuded, and, at the 
bottom and posterior parts, flakes of lymph were seen. The right 
lateral ventricle contained, in its posterior part, about a drachm of 
this lymph-like matter. Chest.-Heart normal. The left lung of 
slate color, and has on its posterior aspect a hepatized look and feel. 
Bronchia; filled with tenacious lymph-like substance, of a consistency 
sufficient, in some parts, to be drawn out by the forceps. The lung, 
indeed, was in a state of red hepatization. Abdomen.-Stomach 
healthy. Liver of normal size, a little congested. Gall-bladder dis- 
tended with dark fluid bile. Kidneys natural. Spleen very small, 
not congested, of lighter color than natural. Peyer's patches natural. 
Case VIII.-D. N. H., a private, 18 years of age, was admitted 
to Hospital on the 13th of January. His previous circumstances 
and condition, according to the statement presented by his regimental 
surgeon, Dr. Kneeland, were as follows :-" Patient was of nervous 
temperament and of rather slight figure-had always enjoyed good 
health up to the present time. In the forenoon of January 28th, 
had a slight chill, which was succeeded by violent headache and pain 
in back and limbs; he had slight epistaxis; urine was scanty and 
high colored. R. 01. ricini, § i. R. Spts. aeth. nit., 3 i., every 
two hours. 8 
HOSPITAL NOTES AND MEMORANDA. 
"29th.-No better; all symptoms increased in severity; complains 
of ringing in cars; pulse full and frequent; tongue furred; some 
cough. Treatment continued." 
30th.-Had, on admission to Hospital, the following symptoms:- 
Skin hot and dry; severe headache, particularly in occipital region; 
head thrown back; tongue dry, and dark colored in centre, with 
white edges; abdomen natural; extremely violent delirium. R. 
Liq. ammon. acet., spts. eth. nit., aqua camph., aa § i.; chloroform, 
3 ss. M. s. 3 ii. every two hours. Sinapisms to feet. Beef-tea 
and farinaceous diet. 
31st.-Rather more quiet. Symptoms, with the exception of de- 
lirium, quite as marked as yesterday. Rather profuse epistaxis. 
R. 01. terebinth., 3 iv.; syr. simp., § i. M. s. 3 i. every three 
hours. 
Feb. 1st.-No better; slight diarrhoea; pulse 124, less full. R. 
Quiniae sulph., 3 ss.; acid, sulph. arom., gtt. xv.; aqua font., 3 x. 
M. s. 3 i. ter in die. 
2d.-Delirium less active; expresses himself better; diarrhoea 
increased. R. Plumbi acet., gr. xviii.; opii pulv., gr. v. M. Div. 
in pil. No. vi., s. one after second discharge. 
3d.-About the same as yesterday; cough rather troublesome; 
sibilant rales heard over both breasts; sordes on teeth. R. Pulv. 
ipecac, et opii, 3 ss. Div. in ch. No. 6. One every four hours. 
Continue treatment. 
4th.-Febrile symptoms very much diminished; pulse 100, weak; 
skin cool and moist; answers quite readily. Omit prescription of 
January 30th. R. Vin. alb., § i., every four hours. Continue 
treatment. 
5th.-Much the same as yesterday; gurgling in the right iliac 
fossa. Continue treatment. 
6th.-Seemed rather stupid; muttering delirium; no diarrhoea. 
Omit prescriptions of Feb. 2d and 3d. 
7th.-About the same; rather weaker; several spots on abdo- 
men. Increase wine to § iss. every three hours. 
8th.-Comatose; does not answer questions. Continue wine, 
turpentine and quinine. 
9th.-No better; pulse 90, rather weak; tongue discolored, dry 
and thickly furred. Continue treatment. 
10th.-Died at 4 o'clock, P.M., apparently but little exhausted. 
11th.-Autopsy, fourteen hours after death. Head.-Slight injec- EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
9 
tion of vessels of cerebral membranes. Lateral ventricles of brain 
distended with fluid mixed with a purulent-looking substance. On 
the inferior aspect of the cerebeltthn and medulla oblongata was a 
copious deposit of lymph, from one fourth to three eighths of an 
inch in thickness, having a lobulated appearance and being quite 
firm. There was also a slight deposit of lymph in some of the fis- 
sures. Thorax.-Heart normal. Lungs healthy, with exception of 
slight congestion of posterior lobes. Abdomen.-Liver, stomach, 
spleen, pancreas, kidneys and bladder natural in size and healthy. 
Peyer's glands very much thickened, and, in one or two instances, 
ulcerated. The solitary glands somewhat enlarged. 
The two cases immediately following are reported by Assist. Surg. 
J. B. Treadwell, having been received in the wards under his care. 
Case IX.-Private J. W. M., aged 21, was admitted to Hospital 
on the 17th of January. No notes of this case during its progress 
have been preserved. The disease was sudden in its attack and 
severe in its manifestations, and ran its course rapidly, terminating in 
death on the 20th, three or four days subsequent to its onset. 
Autopsy.-Body of medium size; muscular development good. 
Head.-Upon removing the calvaria, the surface of the cerebrum be- 
neath the arachnoid was found to be covered with a questionable 
lymph, most abundant along the longitudinal fissure and in the sulci 
between the hemispheres, and a larger deposit at base of cerebellum, 
and between its lobes, as well as over its surface. This deposit is of 
a pale greenish yellow, and diffluent upon raising and loosening the 
membranes; there was a free deposit also at the crossing of the optic 
nerves and along the origin of the nerves generally. Pia mater 
beneath appears normal. Similar lymph-like matter was observed 
in the posterior cornu of left ventricle. Chest.-Pericardium nor- 
mal. Firm clots of fibrine in the cavities of the heart. Valves, 
with the exception of apparently old indurations of mitral valves, 
normal. Abdomen.-All organs healthy. Peyer's patches indistinct. 
Case X.-J. Y., a private, aged 22, was admitted to Hospital 
January 14, 1863, at which time his regimental surgeon, Dr. Ware, 
gave the following statement of his case: " Congestive attack yes- 
terday morning, with intense headache, vomiting, &c. Cupping to 10 
HOSPITAL NOTES AND MEMORANDA. 
the extent of five ounces. Quinine, forty grains in twenty-four hours, 
with half a drachm of whiskey every two hours. Has had two drops 
of veratrum viride. Much easier this morning." 
Symptoms, on admission, were as follows :-general expression of 
countenance not anxious, mind clear; pupils slightly dilated; skin 
moist and cool; pulse 86, regular and moderately full; respiration 
24, and slightly labored; tongue moist, slightly furred in centre; 
abdomen natural; bowels regular. To take, at night, live grains of 
quinia every hour, and ol. terebinth, twenty drops in emulsion every 
three hours. 
Jan. 15th.-Had some headache; pulse 86, not very full; tongue 
moist; skin moist and cool; complains of pain in legs. 
16th.-Pulse 96, rather fuller than yesterday; tongue moist and 
dark, furred in centre; respiration 26, rather labored; general sur- 
face natural. Treatment continued. P. M., appeared better; pulse 
90; slight headache. 
17th.-Pulse 100; slight delirium since ten o'clock, A.M.; two 
dejections since yesterday; respiration 22, quiet. Treatment con- 
tinued. 
18th.-Pulse 90, rather weak; tongue moist and clear; one de- 
jection ; abdomen normal; mental condition good; in all respects 
apparently better. Wine, one ounce, every three hours. 
19th.-Better. Continue treatment. 
20th.-Pulse 84; tongue moist; respiration quiet. Treatment 
continued. 
29th.-Until the 29th continued to improve rapidly. On this 
day pulse 160, quick and full; severe headache; respiration embar- 
rassed ; tongue dry; bowels regular. Sinapisms to back of neck, 
and mustard foot bath. 
30th.-Has been delirious since visit last evening; slept very lit- 
tle during the night; pulse 120; tongue dry and darkly furred; 
respiration 26; two dejections since yesterday. Mustard foot bath. 
R. Equal parts ( 5 ij.) of fid. ext. valerian and aqua camph. every 
three hours. 
31st.-Much the same as yesterday, although delirium less mark- 
ed. R. Whiskey, § i., every two hours, in addition to wine. 
Feb. 1st.-Mind quite clear; countenance anxious; pulse 120, 
rather weak; strabismus of right eye (convergent); complains of 
headache; had slight diarrhoea, which came on during the night, 
Continue treatment; opii ct plumbi acet, to be added. EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
11 
2d.-Appeared somewhat better than yesterday. Treatment 
continued. 
3d.-Died rather suddenly at 3, P.M., without any symptoms of 
exhaustion. 
Autopsy, nineteen hours after death. Body of medium size, but 
little emaciated. Considerable rigor mortis. Head.-Brain firm 
and of natural consistency. Some cloudiness of arachnoid and slight 
deposit of lymph beneath between convolutions on superior portion 
of cerebral hemispheres. Inferior aspect of cerebellum and medulla 
oblongata covered by a layer of lymph, averaging one sixth of an 
inch in thickness, and situated beneath the arachnoid, firm, like liga. 
mentous structure. About one ounce of fluid in left lateral ventri- 
cle, in which were floating small flocculent masses, and at its poste- 
rior cornu was found about one drachm of purulent matter. Same 
appearance observed in right ventricle to somewhat less extent. 
Thorax.-Heart normal. Lungs healthy; very slightly congested 
at posterior portion. All the organs of the abdomen were healthy. 
Case XI.-A. W., a private, aged 20. This case occurred in the 
wards under the care of Dr. II. W. Siddall, Asst. Surg. 85th Penn. 
Patient was brought into Hospital on Tuesday, March 17tli. Pre- 
vious history of the case, gathered from his comrades, is as follows: 
March 16th, 1863.-Was taken with a chill and vomiting the 
night before, while on picket duty, having recently returned from a 
fatiguing march of 60 miles in two days. Complained of headache 
and pain in limbs; some fever. 
17th.-Very restless during the night, much tossing about; be- 
came delirious this morning, with continued anorexia. Was receiv- 
ed into Hospital about 11 o'clock, in a moribund condition, collapsed 
and pulseless; cold and livid skin, and insensible; tossing about 
with much violence; purpural spots covering a great part of legs 
and body; lips livid and covered with black sordes; could not open 
his mouth sufficiently to exhibit his tongue; the tip was moist, how- 
ever. He was ordered a stimulating mixture of carbonate of 
ammonia; was well washed and rubbed. 
7, P.M.-Much in same condition; extremely restless. Directed 
sinapisms to legs, wrists, &c. To take whiskey and quinine, with a 
portion of morphine every hour. It was with much difficulty he 
could be made to swallow the medicine. Continued violently rest- 
less until 11 o'clock, P.M., when he died. 12 
HOSPITAL NOTES AND MEMORANDA. 
Sectio Cadaver is, twelve hours after death. Body well developed ; 
no emaciation; almost covered with purpura. Rigor mortis great. 
Head.-Upon opening the head, and removing the dura mater, the 
brain was seen thinly covered with a layer of lymph, pervading the 
arachnoid membrane throughout; also, to a less extent, about the 
base of the cerebellum, medulla oblongata and the origin of the nerves 
of sense. Lymph was also seen, to some extent, in the lateral ventri- 
cles at their posterior part, and also a fungoid growth appeared, at- 
tached to the floor of each ventricle, being each about fifteen lines 
long and four lines thick. The spinal cord was examined to the 
extent of about three inches, which was found apparently healthy, 
with no appearance of extravasated lymph. Chest.-The heart was 
larger than natural, but without any signs of diseased structure. 
The cavities, however, were found filled with firm lymph, of a bright 
lemon color-the right auricle containing a complete cast of the cavi- 
ty, with a prolongation into the superior vena cava. The lungs were 
congested throughout, but otherwise healthy; crepitant. The pleu- 
rae exhibited no signs of disease. Abdomen.-Liver about one half 
larger than natural, somewhat congested, but otherwise healthy. 
Spleen somewhat larger than natural, congested and much softened. 
Kidneys healthy in appearance, with a small quantity of fluid lymph 
in the pelvis of each. Stomach and bowels healthy. No disease of 
Peyer's patches. 
Case XII.-The following case occurred in regimental hospital, 
the account of which, during its progress, was furnished by Dr. 
Kneeland, Surgeon of the regiment. The autopsy was made here, 
by Assist. Surgeon Treadwell. 
Private W., aged 31, had enjoyed the most robust health since 
coming to this Department, and would be selected among his com- 
rades as one of the healthiest and strongest men in his company; 
stature was short, and form robust; had become quite fleshy since 
entering the service. 
Jan. 11th.-Was on duty all day, Jan. 11th. At night began to 
feel unwell, and went to the hospital at midnight to get medicine for 
headache. R. Sp. setheris comp., 3 ss. Had severe chill later in 
night, with severe headache and " pain in bones." 
12th.-Much the same as in night. R. Hyd. chlor, mit., gr. x.; 
quinia sulph., gr. x. M. Dejection in a few hours; headache not 
relieved; skin hot; pulse weak, not much accelerated; tongue dry; EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
13 
not much thirst; no cough. Cold applications to head. R. Potas. 
nit., gr. x.; pulv. ip. et opii, gr. v.; capsici, gr. v.; quinia sulph., gr. 
iij. M. Wrapped in blankets. Perspired freely, and expressed 
himself at night as having less pain, although headache continued 
undiminished. At 8, P.M., had R. Spts. aetheris comp., gtt. xxv.; 
liq. morph, sulph., 5 i. M. Cold applications to head, and warmth 
to body by means of blankets. At midnight, comatose; eyes open, 
pupils insensible to light-one dilated, the other natural; large ec- 
chymoses on upper surfaces of globes, under sclerotic apparently; 
impossible to arouse patient; respiration not stertorous, and per- 
formed through the tightly-shut teeth in a hissing manner; no con- 
vulsions or rigidity, with exception of obstinate closure of jaws; 
head very hot; pulse 125, moderately strong, compressible; occa- 
sional uneasiness, but no evident agitation; skin natural; no vomit- 
ing or chills. Enema of turpentine, no dejection following. Sina- 
pism to abdomen. Hot foot-bath. Brisk rubbing of whole body with 
ol. terebinthae for half an hour. Turpentine enema repeated. Urine 
passed involuntarily; paralysis of sphincter ani. These remedies 
seemed to be useful in bringing down the frequency of the pulse and 
increasing its strength. The respiration and facial expression be- 
came more natural, and the lids were frequently closed. Friction 
over surface continued; also repeated doses of hyd. chlor, mit. and 
quinia sulph. to be given. 
Jan. 13th.-At 2£ o'clock, A.M., Jan. 13th, the respiration be- 
came slow and interrupted, the pulse fell, and death quietly took 
place. 
Autopsy, fourteen hours after death. Head.-Vessels of cephalic 
membranes containing more than normal amount of blood. Entire 
cerebral mass less firm than natural; marked softening of superior 
portion of left cerebral hemisphere. Thorax.-Heart larger than 
normal, less firm than usual. Right cavities contained a large 
amount of dark colored fluid blood. Left lung considerably engorg- 
ed with dark-colored blood and frothy serum, most marked in poste- 
rior lobe. Right lung; posterior lobe very much congested; small 
portion of anterior lobe healthy. Both lungs crepitant. Abdomen.- 
Liver nearly twice its normal size and weight; large venous vessels 
very much engorged. Texture of a pale yellowish color and more fria- 
ble than usual. Imparted a greasy stain to paper, and, after being 
slightly dried, burned with readiness. No question about its being 
in a state of complete fatty degeneration. Spleen normal, with ex- 14 
HOSPITAL NOTES AND MEMORANDA. 
ception of some congestion. Kidneys one half larger than natural. 
Other abdominal organs healthy. Body well formed and in good 
condition. Conjunctivae injected, and in some places presenting the 
appearance of ecchymoses. 
The six cases immediately following were received into the "Acade- 
my Hospital " at Newbern. The notes in regard to them have been 
kindly furnished me by Dr. Clayton A. Cowgill, U.S.V., Surgeon in 
charge, under whose immediate supervision the cases were treated 
and the record of them drawn up. 
Case XIII.-F. D., aged 23 yeffts, a deck-hand on steamer Paw- 
tuxent, was admitted Dec. 20th, 1862, with well-marked symptoms 
of inflammation of the brain-violent excitement, with contracted 
pupils, pulse not much quickened, tenderness at nape of neck. He 
was cupped, blistered and treated principally with calomel and ipe- 
cacuanha. In about three weeks he exhibited marked symptoms of 
improvement, although with mind confused. About this time the 
iodide of potassium was used in his case. After being much better 
for a week, sitting up and giving rational answers, in most instances 
he became suddenly worse, and soon sunk into stupor, and died on 
the 24th of January, 1863. 
Post-mortem examination exhibited great injection of pia mater, 
deposits of yellowish lymph along the sulci of the upper surface of 
hemispheres, and a thicker deposit of apparently plastic purulent 
matter over the pons Varolii and medulla oblongata; two ounces of 
serum in the lateral ventricles. The spinal column was not exami- 
ned. The thoracic and abdominal organs were all healthy. 
Case XIV.-E. F. W., a private, aged 18 years, was admitted 
Friday, Jan. 30th, 1863. Had a slight chill yesterday afternoon, 
and became suddenly and violently delirious in the evening. Upon 
admission, pulse 90, full; very delirious; tongue clean and moist; 
contraction of muscles of back of neck, throwing the head far back; 
nape of the neck tender to the touch. 
Applied wet cups to nape of neck and a mustard plaster over en- 
tire spinal column, and gave calomel gr. ij. and ipecac, gr. £, every 
two hours. His condition continued about the same until Monday, 
Feb. 2d, when he began to sink, and died Tuesday, Feb. 3d, at 
6, A.M. EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
15 
Post-mortem exhibited extensive engorgement of bloodvessels of 
the brain, and a deposit of lymph over upper surface of hemisphere 
of cerebrum and cerebellum. Some effusion in the ventricles-tho- 
racic and abdominal viscera healthy. 
Case XV.-H. G. L., a private, aged 21 years, admitted Feb. 2d. 
In perfect health until this morning, when he complained gf chilli- 
ness, and was soon after violently delirious. Brought into the Hos- 
pital at once. Pulse 85, full. Skin moist, and tongue clean and 
moist. 
Applied cups to nape of neck and mustard plaster to spine and 
extremities, and gave quinine gr. iij., and cal. gr. ij., every three 
hours; two comp. cath. pills at bedtime. 
Feb. 3d.-No change. Continue medicine. 
4th.-Pulse 90; other symptoms the same. Stop quinine and 
give calomel gr. ij. and ipecac, gr. ss. every two hours. 
5th.-Decided opisthotonos; head at right angles to body. Con- 
tinue medicine; applied ice to head, with hair closely cropped, and 
cups to back of neck. 
6th.-Ice apparently not comfortable to the patient-discontinue 
its application. Pulse 120 and feeble. Continue medicine, and give 
whiskey § i. in § iv. of milk every three hours. 
There was no permanent improvement in this patient's condition; 
pulse continued quick and feeble, mind wandering-frequently dwell- 
ing upon several subjects. The rigidity of the muscles of the neck 
relaxed about the end of the second week, for a day or two, but 
gradually returned. He died Feb. 24th. 
Post-mortem.-Sinuses filled with black blood, which poured forth 
freely. More diffused redness of the pia mater of cerebrum and 
cerebellum than in any case examined. Three ounces of serum in 
the ventricles; medulla oblongata covered with deposit of yellowish 
lymph ( ?) two lines in thickness; some softening of the substance 
of the brain; effusion of yellowish scrum in sheath of spinal cord, 
and the cord completely enveloped in a deposit (one-fourth of an 
inch thick), similar in substance to that upon the medulla oblongata. 
Case XVI.-J. D. M., a private, admitted Feb. 4th, was taken 
sick the day previous. When admitted was violently delirious- 
pulse 80, feeble. Applied cups to neck, mustard to spine, and tur- 
pentine enema; and gave cal. gr. ij., and ipecac, gr. ss,, every two 
hours. He died early in the morning of Feb. 6th, without any ame- 
lioration of symptoms. 16 
HOSPITAL NOTES AND MEMORANDA. 
Post-mortem showed injection of vessels of pia mater, deposit of 
lymph over sulci of hemispheres and over medulla oblongata and 
pons varolii. Congestion of pia mater of spinal cord, with some 
effusion in sheath near lower dorsal vertebra;. 
Case XVII.-E. H. B., corporal, aged 23 years, was taken sick 
early inathc morning of Feb. 11th; was admitted into Hospital in 
the evening. Pulse 10G ; respiration hurried ; pupils natural; tongue 
dryish ; great headache; skin moist. 
Applied cups to back of neck, mustard plaster over spine, and 
turpentine enema. Gave calomel gr. v. At 11, P.M., quinine gr. ii. 
and cal. gr. v. were given. 
Feb. 12th, 4, A.M.-Condition the same. Repeat the quinine and 
calomel. 9, A.M., pulse 96; tongue furred white in centre, with 
brownish streaks upon sides; face and skin moist. Ordered 6 grs* 
quinine to be given at once, and gr. ij. of cal. and one-fourth of a gr. 
of ipecac, every two hours. 6, P.M.-Pulse 106; skin moist; bow- 
els freely opened. Ordered two grs. quinine at 9, P.M.. and 6, A.M., 
to-morrow. Omit the calomel and ipecac. 8, P.M.-Pulse 90, va- 
riable ; mind very confused. 
Feb. 14th, 9, A.M.-Pulse 80; tongue dry and brown; pupils 
contracted; conjunctivas injected. Blister to nape of neck. Con- 
tinue medicine. 6, P.M.-No change. 
15th.-Pulse 130, feeble; perspiring freely; low muttering deli- 
rium. Died at 10, P.M. 
16th.-Post-mortem. All the sinuses gorged with black blood ; 
pia mater highly injected; one ounce of serum in lateral ventricles; 
deposit of lymph over entire surface of cerebrum, cerebellum, me- 
dulla oblongata and spinal cord; purulent serum in sheath of cord; 
thoracic and abdominal viscera healthy. 
Case XVIII.-A. A. D., corporal, aged 19 years, was taken sick 
with headache and chilliness, the evening of Feb. 10th; admitted 
into Hospital Feb. 11th, violently delirious. Pulse 90, and feeble; 
countenance pale; pupils contracted; skin moist; tongue furred and 
moist. Cups to back of neck; mustard to spine; turpentine enema. 
Gave whiskey § ss. in milk, pro re nata, and five grs. calomel. 11, 
P.M., gave quinine gr. ii., and cal. gr. v. 
Feb. 12th, 4, A.M.-Repeat calomel and quinine. 9, A.M.-Pulse 
104, stronger; bowels well opened; skin moist; eyes natural; tongue EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
17 
dry in centre; headache. Ordered six grains of quinine to be given 
immediately; and cal. gr. ii., ipecac, one-fourth gr., every two hours. 
6, P.M.-Pulse 90, stronger. Quinine gr. vi., at 9 o'clock, P.M., and 
6, A.M. to-morrow. At midnight, very restless and violent. Gave 
one drachm sol. morph. 
13th.-Pulse 88; continue medicine. 
14th.-Pulse 96; very restless and violent; tongue swollen and 
dry; throat slightly reddened; pupils contracted. Ordered cups to 
back of neck, to be followed by blister. 6, P.M.-Pulse 100. No 
change in symptoms. 
15th and 16th.-Pulse 120, feeble; mind very dull; pupils dilat- 
ed. Half ounce of whiskey in milk every three hours. 
17th.-The patient died. 
18th.-Post-mortem. Sinuses of brain gorged with blood; pia ma- 
ter uniformly injected; the usual deposit of yellowish lymph over 
cerebrum, cerebellum, pons varolii and medulla oblongata, and around 
spinal cord; effusion of serum in ventricles, with some pus; yellow- 
ish fluid in sheath of cord. 
Case XIX.-C. H., private, aged 18 years, was taken sick the 
morning of Feb. 17th, and admitted into the Hospital at 6, P.M., the 
same day. Pulse 90, and full; perfectly unconscious, very restless, 
constantly throwing himself about, requiring three men to hold him 
in bed; no moaning or utterance of any kind; skin natural; pupils 
natural. Bled him 24 ounces; blood very black; pulse became 
stronger under the bleeding-no symptoms of fainting. Became 
quiet twenty minutes, when the jactitations became as violent as be- 
fore. Gave turpentine enema and opii et camph. aa gr. ii. and cal. 
grs. v., which was immediately rejected. At 8 o'clock, repeated the 
powder, when it was retained. Very violent muscular actions; pulse 
86, and strong. The bandages becoming loosened, permitted 16 
ounces of blood to flow, the patient being held upright in bed. No 
evidence of syncope, no lessening of muscular action. Ordered two 
grains of calomel every two hours, and one grain of opium at 11 
o'clock and 2 o'clock, if not quiet. 
Feb. 18th, 8, A.M.-Same excitement continued all the past night. 
Pulse 90, and feeble. In the afternoon his strength declined, and at 
8, P.M. he died, thirty-six hours after the first appearance of disease. 
Post-mortem.-All the bloodvessels of the brain highly injected; 
abnormal adhesion of dura mater to skull along longitudinal sinus; 18 
HOSPITAL NOTES AND MEMORANDA. 
a cloudiness of entire surface of cerebrum and medulla oblongata; 
one ounce of effused serum in ventricles; choroid plexus very much 
injected; pia mater of spinal canal very much injected; turbid se- 
rum in lower part of canal, and evidences of inflammatory action 
along entire cord. 
The following case is interesting as showing, in a marked degree, 
the petechial eruption which has, in many instances, been an early 
and prominent feature of the disease. 
Case XX.-W. B., a private, was admitted to Hospital January 
19th, at 7, P.M., when his regimental surgeon, Dr. Ware, gave the 
following statement of his case. " Attacked this morning (Jan. 
19th). Has had eighty grains of quinine since 10, A.M; has been 
cupped to extent of five ounces, and taken stimulants and beef-tea 
steadily during the day. Since 3, P.M., his pulse has improved in 
force and volume." 
The disease was ushered in by slight chills, followed by hot skin 
and full, quick and frequent pulse; soon afterwards the surface be- 
came cool and moist. Had, on admission to hospital, intense head- 
ache, but no active delirium; recognized his friends readily; intelli- 
gence good when roused; general powers good; some deafness; 
eyes natural; lies upon right side; tongue dry, tending to brown at 
base, with a pasty yellowish stripe along its sides, natural at tip; 
respiration 28; some dulness on percussion; mucous rale at left 
base; pulse regular, moderately full, hard, 132. A typhus-like 
eruption, scattered very generally over shoulders, arms, chest, legs 
and back-none upon the face. These spots vary in size from a pin's 
head to a split pea, are dark, measles-like in hue, persistent, not 
prominent to the touch, seemingly imbedded in substance of the 
skin. There was slight fulness of abdomen. Patient had had an 
enema of turpentine, producing one dejection. His face was of a 
dusky hue. Skin moderately warm, inclining to moist. Delirium 
soon after set in, which presently became active, accompanied with 
spasmodic action of the facial muscles and convergent strabismus. 
There was tumultuous action of the heart, with well-defined tripli- 
cate sound. Patient gradually grew worse, without any mitigation 
of symptoms till his death, which occurred without much apparent 
exhaustion, in a few days. No post-mortem could be obtained. 
The following was under the care of Dr. Treadwell till March 
8th, when, Dr. T. being taken ill, the case was continued by my as- 
sociate, Dr. Haddock. EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
19 
Case XXL-L. T. P., private, previously healthy, came into Hos- 
pital Feb. 19th. Seized with slight chill on 17th. Soon became 
delirious, with symptoms of high febrile excitement. Condition on 
admission.-Surface hot; petechice on arms and breast; countenance 
expressive of pain; respiration somewhat accelerated; tongue dry 
and covered with dark fur; wholly unconscious; pulse 124, small 
and corded; abdomen natural; bowels regular. Was bled eighteen 
ounces, with decided relief; pulse became fuller and less frequent; 
respiration less labored; semi-conscious; deglutition impossible. 
R. Quinine and turpentine, by injection, every three hours. 
20th.-Appears better; skin less hot; delirium less active; pulse 
116, full, soft; respiration 18, quiet; moans, as if suffering pain; 
two dejections. Treatment continued. Blister to neck. Twenty 
grains of Dover's powder at night. 
21st.-Answers questions; pulse 116; respiration 18; skin moist; 
countenance more natural; can swallow. R. Twenty 7Tl turpen- 
tine, ev. 3 hrs. Dover's powder at bedtime. Quinine by injection. 
22d.-Continued same; pain in back and limbs; tongue coated; 
pulse 118, full; respiration 20, labored; one dejection. 
23d.-Remained same; one dejection. (Continue.) 
24th.-Perfectly rational; pulse 110; respiration 16; skin moist 
and cool; diarrhoea came on during night; thirst. R. Pulv. Doveri, 
3 i.; acet, plumbi, gr. xviii. M. chart. No. vi., s. 1 ev. 4 hrs. 
25th.-Remained very much the same; no diarrhoea since mid- 
night ; asks for more food. Omit powders. Continue treatment. 
26th.-Continues to improve; skin cool and moist; pulse 112, 
full; respiration 18. (Continue.) 
27th.-No apparent change; less pain; mind clear; sleeps well; 
strength remains good. (Continue.) 
28th.-Skin natural; pulse 110, good; respiration 20; two de- 
jections. (Continue.) 
March 1st.-Apparently improving. (Continue.) Five grs. quinine 
ev. 3 hs. 
2d.-Restless night; pain in back and legs; tongue dry, whitish 
fur; pulse 112; respiration 20; one dejection. R. Dover's pow- 
der, gr. x., ev. 4 hrs. Continue treatment. 
3d.-Had a good night; less pain. R. of 2d omitted. Treat- 
ment continued. 
4th.-Pulse 108; respiration 16, quiet; one dejection; strength 
good. Insisted upon getting up. (Continue.) 20 
HOSPITAL NOTES AND MEMORANDA. 
5th.-Much the same. (Continue.) 
6th.-Apparently improving. (Continue.) 
7th.-Mind clear; pain in back and neck; skin natural; pupils 
regular; pulse 70, full and strong; respiration 20, quiet; abdomen 
natural; one dejection; strength good. (Continue.) 
8th.-Very much same. R. Aq. camph., § i. ev. 3 hrs. 
9th.-Remains same. (Continue.) R. Pil. morphia and copper 
pills, 1 ev. 3 hrs. 
10th.-Delirious; skin dry and hot. R. Aq. camph., § ij.; carb, 
ammon., gr. xv. M. § ss. ev. 2 hrs. 
11th.-Pain in limbs and back of neck; answers questions cor- 
rectly; much heat; pulse 110. Morphia, | gr. 
12th.-Remains same; not much pain; four discharges during 
the day. (Continue.) 
13th.-Great pain in limbs; delirious; hot; tongue dry, brown; 
frontal headache; mind clear at times. R. 5 i. morph, solut. ev. 
4 hrs. 
14th.-Seems better; passed a good night; some pain yet; says 
he feels pretty well. (Continue.) 
15th.-One dejection; bad night; great pain in limbs; bed sores. 
Fl. ext. ergot, gtt. x. ev. 4 hrs. 
16th.-Remains same. Delirious; constantly talking; noisy all 
night. Increased ergot to 15 m. 
17th.-Apparently failing. (Continue.) 
18th.-Very feeble; tremulous; unconscious; muttering delirium; 
singing at times; eagerly catching at objects, real or imaginary; vi- 
sion lost or greatly impaired. 
19th.-Continue ergot, 15 ev. 4 hrs. 
20th.-Answers questions correctly at times; relapses into stu- 
por ; less tremulous. 
21st.-No dejection for three days. R. Sal. Epsom, § i. ev. 4 hrs. 
Urine free, involuntary; answers questions at times; face red, shin- 
ing ; pulse variable; subsultus; head persistently thrown back; 
urine strongly ammoniacal; great pain if moved. 
22d.-Puts out his tongue when asked; eruption on face and ab- 
domen ; eyes dull; one discharge; tongue dry, brown, cracked. 
23d.-Improved vision; puts out his tongue when asked; pulse 
rapid and feeble; tongue same as yesterday; more quiet; urine 
involuntary, ammoniacal; sordes on teeth; jactitation; subsultus; 
neck thrown back, stiff; groans if moved. EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
21 
24th.-No intelligence; tongue dry, brown; limbs cold; appa- 
rently dying. 
25th.-12.10, A.M., died. 
Autopsy, 10 hours after death (conducted by Drs. Haddock and 
Meredith). Body of medium size, well developed; but little ema- 
ciation ; rigor not marked. Head.-Nothing abnormal in external 
aspect of cerebral membranes; veins beneath somewhat engorged. 
A thin milky fluid in spots on surface of cerebrum. Substance of 
brain firm and normal; no points on its cut surface. A small clot 
of pus-like lymph is seen on middle of its upper surface on either 
side of longitudinal fissure. On its base, covering the origin of the 
nerves of sense, pons Varolii and medulla oblongata, and lodged in 
the posterior fissure of the cerebellum, is a mass of tenacious, yel- 
lowish, pus-like lymph, three eighths of an inch in depth, and (by 
estimate) from one half to three fourths of an ounce in quantity. A 
deep longitudinal incision through the pons Varolii and medulla ob- 
longata caused three ounces of slightly clouded serous fluid to well up 
with considerable force. The lateral ventricles were filled with a simi- 
lar fluid-that in the left holding partly in suspension one drachm of 
the pus-like .deposit above mentioned, and a few drops of the same 
deposit in the right. The exudation seemed also to extend down 
the spinal cord. Chest.-Lungs healthy; pericardium normal. 
In right ventricle of heart was found two to three drachms of par- 
tially organized lymph. Abdomen.-Stomach not examined. Liver 
and spleen natural. Gall-bladder fully distended with dark fluid 
bile. Colon swollen with gas; small intestines healthy; Peyer's 
patches in some cases presenting the shaven-beard appearance, in 
one instance a little thickened; otherwise nothing abnormal. Blad- 
der distended with urine. 
The case just cited was longer in its duration than any previously 
reported, and may be taken as a type of a large class that seemed 
almost to yield to assiduous treatment, but finally succumbed, with 
pathological results similar to those seen in the most rapid and 
violent forms of the disease. 
The cases hitherto reported have been those only which had a fa- 
tal result. Those which follow are among the recoveries, which, it 
must be reluctantly admitted, have up to this time formed the sad 
minority. The five cases next in order were furnished by Dr. Cow- 
gill, in charge of Academy Hospital. 22 
HOSPITAL NOTES AND MEMORANDA. 
Case XXII.-F. L., private, aged 20 years, admitted Jan. 31st, 
at 6, P.M. Had a slight chill at noon, very slight febrile action, 
apparently not very sick. Prescribed one cathartic pill at bed time. 
Feb. 1st.-At noon, was suddenly seized with violent delirium 
and great excitement, requiring force to restrain him in his bed. 
Pulse 90; pupils contracted; great tenderness of back of neck. 
Applied cups to neck, mustard to spine and extremities, and gave 
quinine gr. viii., and calomel gr. v. at once, and ordered the dose to 
be repeated at 9 o'clock, P.M., and 6 o'clock, the next morning. 
2d.-Symptoms the same. Gave calomel, gr. ii., and ipecac., gr. J, 
every two hours, and repeated the cupping. This treatment con- 
tinued until- 
5th-When conjunctivitis occurred, accompanied by an eczema- 
tous eruption around lids. Patient became weaker and brain was 
greatly relieved-delirium lessened, after which prescribed whiskey, 
§ ss. with milk every three hours, and cal., gr. ii., with quin., gr. ii., 
every four hours. 
6th.-Pulse 94; tongue clean and moist, as it had been through- 
out the attack, and delirium subsided. 
8th.-Pulse 85; and patient better in every respect, except the 
eyes. Applied blister to side of temple, leadwatcr to eye, and dis- 
continued all medicine, giving the milk punch and food. 
This patient continued gradually to recover without further medi- 
cation, and now- 
March 7th-Is sitting up, and appears to be entirely well, except 
the eyes, which are weak, and show a tendency to inflammation. 
Case XXIII.-H. J. R., private, aged 19 years, admitted Wednes- 
day, Feb. 4th, 1863. Was taken sick Monday night with chilliness 
and headache. By Tuesday evening was quite delirious-was treat- 
ed, principally, before entering the Hospital, with large doses of qui- 
nine. When I first saw him, he was quite delirious; pupils con- 
tracted ; tongue clean and moist; great tenderness in nape of neck 
and spine. He would cry out violently if any pressure was applied 
to those parts. Pulse 84, and full. Treatment, wet cups to back 
of neck; mustard to spine; turpentine enema; hyd. chlor, mit., gr. ii. 
and half a grain of ipecac, every two hours. 
Feb. 5th.-Pulse 90; head thrown back by contraction of muscles 
of neck. Continue medicine; ice to head and cups to nape of neck. EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
23 
6th.-Pulse 120, feeble; other symptoms unchanged. Gave half 
an ounce of whiskey in milk every three hours. Applied cups again. 
7th.-Pulse 125. Gave beef tea freely, and continued whiskey 
and milk. Ordered calomel and quinine, aa gr. ij. every four hours, 
and applied mustard to spine. This condition continued with very 
little variation until March 3d, when the mind became clearer, pa- 
tient less fretful and querulous, and has Continued to improve slowly. 
Case XXIV.-G. W. M., private, was taken sick on the morning 
of Feb. 11th, "with nausea, vomiting, headache, and pulse depress^' 
ed." Came into the Hospital at 6, P.M., almost pulseless, stupid, 
pupils contracted, skin warm. Applied cups to nape of neck, mus- 
tard to spine, turpentine enema; cal., gr. v. immediately, to be re- 
peated at 3, A.M.; half an ounce of whiskey every half hour through 
the night. 
12th.-Pulse 90, stronger; pupils contracted; skin cool; stupid 
and wandering-complained of head being 11 big and somebody in- 
side of it." Gave cal., gr. ii., ipecac, gr. every two hours; half 
an ounce of whiskey in milk every hour. 6, P.M., no change. 12 
o'clock, midnight, several operations from bowels; discontinue cal. 
powders. 
13th.-9, A.M. Pulse 96, stronger. Gave food, and whiskey; 
slightly salivated. 8, P.M. Rational; answers questions readily 
and clearly; for the first time is aware that he is in Hospital; pu- 
pils respond to light; gums quite tender; salivation profuse. After 
this, the case slowly progressed, with copious salivation, without 
other medicine, until now, March 5th, he is entirely relieved from 
disease. 
Case XXV.-P. G., private, aged 28 years, admitted Feb. 22d_ 
He was taken suddenly sick the same morning with headache and 
pain in back of neck. Pulse 90, and full; tongue clean and moist. 
Applied cups to nape of neck, mustard to spine, and gave cal., gr. vi. 
and jalap, gr. x., and ordered six grains of quinine to be given in 
the morning. Tenderness at back of neck well marked. 
Feb. 23d.-Condition the same, and headache severe. Bowels 
have been freely opened. Gave cal., gr. ii., and ipecac., gr. ss. every 
four hours, and six grains of quinine at 2, P.M. Applied cups to 
neck. This treatment was continued until the 28th, when the medi- 
cine was discontinued, and the patient is now, March 7th, almost well. 24 
HOSPITAL NOTES AND MEMORANDA. 
Case XXVI.-F. L. M., private, aged 27 years, admitted Jan. 
18th, was taken sick with chilliness the evening previous. When 
admitted, he was in a state of semi-stupor; pulse 85, feeble; extre- 
mities cool; tongue clean. Regarded the case as one of 11 conges- 
tive fever," and applied mustard to extremities, ordered turpentine 
enema, and quinine, gr. iv., cal., gr. ii., every three hours. 
Jan. 19th.-In same condition. Applied cups to back of neck, 
and ordered quinine, gr. viii., and cal., gr. v., to be given at 9, A.M., 
1, P.M. and 9, P.M. 
20th.-Bowels not opened. Ordered Seidlitz powders every two 
hours till bowels should be opened, and quinine and cal. (in same 
doses as yesterday) at 3, P.M. and 9, P.M. 
This treatment, with nutritious diet, was continued till Jan. 24th, 
when the patient seemed much better, and medicine was discontinu- 
ed. In a day or two, pain in head and face supervened, with hebe- 
tude of mind and tenderness at nape of neck. His case presented 
a complication of symptoms; at one time apparently neuralgic, at 
others the symptoms of inflammatory action of the membranes of 
the brain would predominate. Used quinine and calomel, as the 
symptoms appeared to demand, with occasional cuppings to nape of 
the neck, and counter-irritation to spine, with tonics and stimulants. 
March 7th.-At this date he is gaining strength slowly. Mind 
almost normal, presents the appearance of convalescence. Am 
now giving him tincture of chloride of iron and extract of cinchona. 
The following came under the care of my Associate, Dr. Charles 
Haddock, Surg. 8th Mass. Vols., by whom the report of the case is 
drawn up. 
Case XXVII.-D. B. R. came into Hospital Dec. 5th, 1862, in 
nearly an unconscious state, delirious, cold, breathing heavily, at 
times excited and incoherent. Pulse 116, small, irregular, unequal; 
tongue dry, red. The history is that he went to the sink of the 
Regt., complaining of great pain in bowels, and back of neck and 
head; there he fainted, but recovered and returned to his tent. Af- 
terwards he had a decided chill, and by the expiration of three or 
four hours was in the condition represented, and was sent to the 
Hospital. Spots of purpura covered the arms and legs. He got at 
once, R. Camph. aq., spt. nitre, aa § i., with ten grs. sulph. quinine, 
to be repeated in four hours. Hot applications externally. EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
25 
7th.-Symptoms of iritis. R. Hoff. Anodyne, solut. morph., aqua 
camphor., aa § ss. M. 3 i. every 4 hrs. Blister to temple. 
10th.-Bowels moved. Mind clear; cornea opaque, green. R. 
Belladonna ointment to eye-brow. 
11th.-Cornea same; eye not so painful. Otherwise improving. 
13th.-Continue. From this date to Jan. 23d, he continued im- 
proving ; all the indications of cercbro-spinal meningitis disappear- 
ing. The iritis has become chronic. Belladonna ointment to pre- 
vent adhesion of the iris to lens. Quinine continued, and occa- 
sional blister to temple. Vision nearly lost-possibly may return. 
Discharged from the service, March 27th, 1863. 
Having given in the preceding pages the notes, in brief, of such 
individual cases as were at command, I next propose to offer some 
considerations as to the probable origin and nature of the epidemic 
in question, with a concise summary of such facts in regard to it 
as I have been able to collect. 
The town of Newbern is situated upon the river Ncuse, at its 
junction with the Trent, some forty miles from its entrance into 
Pamlico Sound. Both rivers are navigable for a few miles above 
their point of junction. There are no tides at this point, strictly 
speaking, but the depth of the water is greatly affected by the force 
and direction of the wTind. The town itself is built on a flat and 
sandy soil, raised but a few feet above the water. The climate is 
generally mild and salubrious in winter and spring; hot, humid, and 
subject to malarial influences in summer and autumn. The country 
around is level, alternating with sandy plains and swamps for the 
distance of a mile or more from the outskirts of the town, beyond 
which begins the endless pine forest, almost impenetrable, with marshes 
and tangled undergrowth. The troops are encamped mainly just 
outside the town, in the driest spots practicable, with due reference 
to the salient points of attack and defence. They are sheltered 
partly in tents, partly in barracks, constructed in the manner here- 
after described. The regiments most affected by the epidemic un- 
der consideration, were the 44th, 45th and 51st Mass, and the 10th 
Connecticut. The three first are composed of nine months' men, 
and had been stationed at Newbern less than two months when the 
disease appeared; the last-named is a three years'regiment, which 
had remained in or near its present locality ever since the capture of 
the town, by the troops under Burnside, a year ago. These regiments 26 
HOSPITAL NOTES AND MEMORANDA. 
were quartered in barracks. Isolated cases of the disease also 
occurred in Wessell's Brigade, which came down from Suffolk just 
prior to the expedition to Goldsboro', in December, and in some of 
the other regiments sheltered in tents, among which were the 3d, 
5th, 8th and 46th Massachusetts. The 24th Mass., an old regiment 
quartered in barracks, near the 44th, so far as I can learn escaped. 
This last, together with the 10th Conn., left the Department in the 
latter part of January, to join the expedition to Charleston, which 
was before cases of the disease became multiplied. 
Of the regiments I have designated, the 44th Mass, and 10th 
Conn, were located on the right bank of the Neuse, some half a 
mile beyond the town, on a sandy and sterile plain, elevated perhaps 
five or six feet above the level of the river. The 44th, which suf- 
fered most, was nearest the bank; quite near the camp lay a couple 
of marshy bogs, small in extent, through which flowed a sluggish 
stream to the river. Water for drinking and culinary purposes was 
obtained mainly from wells sunk in the vicinity of the camp. It 
was brackish and unpalatable. The river water was also, to some 
extent, used.* Beyond and above the camp to the edge of the 
woods, as well as opposite towards the river Trent, a broad sandy 
plain stretches out to the extent of a mile or so. The woods in this 
direction have been extensively cut off, since the occupation of the 
town, for the better protection of the place. The camps of the 
45th and 51st Mass, were similarly located on the right bank of the 
Trent, two miles above the town, on an alluvial sandy soil and flat 
surface, dotted with numerous small pools of stagnant water, some 
of which were embraced within the lines of the camp. The ground 
is here raised some twelve or fifteen feet above the river. The 
water, used in camp, was mostly obtained by means of a barrel sunk 
in the ground by the river's edge. From the river at this point to 
the swampy woods beyond, is perhaps three quarters of a mile. 
Over this plain, immense and barren, the winds have free sweep, 
bringing, in a dry time, a simoom of sand upon the camps. 
The barracks for the sheltering of a portion of the regiments, as 
above named, were built late in the autumn, and are alike in their 
dimensions and plan of construction. They were made of green 
stuff-hard pine mostly-the logs being taken newly cut from the 
* An analysis of the water obtained from a well in the centre of the town-used for culi- 
nary and drinking purposes at the Stanly Hospital-showed it to be strongly impregnated 
with lime. EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
27 
forest, or drawn out from the water, where they had been lying for 
a few weeks, sawn into joists and boards, and used in the fabrica. 
tion of all parts of the building. Between huts of such material 
and tents for the winter, there was no alternative, dry lumber being 
a thing unattainable in the Department. Thus constructed, they 
were necessarily cold and damp, and redolent of pitch and paludal 
moisture. The regimental barracks were commonly built in a con- 
tinuous line, not unlike a rope-walk in appearance, but sometimes in 
the form of a right angle, and are divided off into company com- 
partments-each compartment being sixty feet in length by twenty- 
four feet in width, and eight and a half in height to the plate under 
the eaves, and having a pitch to the roof of three feet in five. A 
side elevation of a portion of one of these barracks is shown in the 
annexed cut. 
Side elevation of a portion of barracks for one company. 
Ranged around the walls, and projecting longitudinally into the 
apartment, are the bunks for the men, in three tiers, each bunk being 
six and a half feet in length by four feet in width, and intended for 
the accommodation of two men. The lowest is one foot above the 
floor; the perpendicular space between is three feet and the lateral 
space two feet. In these last-named spaces are the windows. Air 
is admitted through openings near the floor, between the bunks, and 
vented through.occasional apertures at the ridge.* There is a fire- 
place in the side of each apartment, at about its centre, at which 
* Additional openings, for both light and air, have been made since these buildings were 
first occupied by the troops. 28 
HOSPITAL NOTES AND MEMORANDA. 
point the company kitchen extends out at right angles, furnished 
with oven, range, &c. These apartments are intended each for the 
occupancy of a company of about one hundred men-the allowance 
of air, in which case, is but about one hundred and eighty cubic 
End section of ban-acks. 
Scale 10 feet to 1 inch. 
Ground-plan of a portion of company barracks. 
feet to each man. Practically, the average number of men to each 
company does not much exceed sixty. In the best of circumstances; EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
29 
it will bo seen, the supply of air is entirely inadequate and the 
ventilation imperfect; while light and warmth, owing to the pro- 
jection of the bunks, cannot be generally diffused throughout the 
apartment. 
In its mode of attack, the disease was commonly sudden and with- 
out premonition, the patient, for the most part, continuing on duty 
and making no complaints till the very day of his seizure. Some 
of the most violent cases thus commenced; Case XIL, previously 
cited, is in point, where the soldier appeared with his company at 
the evening dress parade, complained of chilliness, headache, &c., 
during the night, and was dead within thirty-six hours following. 
And the subjects of the disease, in most cases, were those previously 
in the fulness of robust health-between the ages of 18 and 24- 
who had endured hardships and exposures with impunity. 
The symptoms were, at the first, headache, referred oftentimes to 
the back part of the head particularly, with dizziness-pain in the 
back and limbs, this last occasionally of an excruciating character- 
with sometimes rigors, and nausea and vomiting. Chilliness, rather 
than a well-defined chill, characterized the accession of the disease. 
A peculiar stiffness in the muscles of the face and neck was often an 
early symptom; this would be followed by local spasms, perversion 
of vision, &c. In some cases the initiatory symptoms were those 
of a severe cold, with a disposition to paralysis of the tongue and a 
portion of the muscles of the face. With this the respiration would 
be difficult and irregular, giving occasion to fear a congestive attack 
of the lungs. There was often tenderness at the nape of the neck 
and along the spine early in the disease. The skin was usually 
moist, but hot. The face was suffused-often of a dusky hue-and 
the features distorted in the manner before mentioned-the eyes 
congested and suffused. There was not, for the most part, active 
delirium-but perversion of intelligence rather, and dulness and in- 
difference to outward objects, from which condition the patient could 
be roused and made to answer questions consciously. The tongue 
had, at the first, a white creamy coat, which, in the course of the 
disease, became yellowish or brown at centre and base, more rarely 
dry and cracked towards the close. There was loss of appetite, but 
usually not very urgent thirst. The heart's action was irregular, 
sometimes tumultuous, to which the pulse did not always respond, 
being mostly accelerated but not strong-occasionally intermittent. 30 
HOSPITAL NOTES AND MEMORANDA. 
The bowels were regular, or inclined to diarrhoea and costiveness 
by turns. Petechias were not an unfrequent manifestation-in ap- 
pearance almost identical with the true typhus eruption, and like 
that seen upon every part of the body except the face-persistent 
on pressure, varying in hue from the darkest aspect of measles to 
that of the true petechial spots imbedded in the skin. Purpural 
spots, abundant and of large size, were sometimes present, and were 
always a grave symptom. There was no marked tenderness of the 
epigastrium or abdomen. In the cases of longer duration, there was 
in the last stages sordcs on the teeth and lips, and involuntary eva- 
cuations of urine and faxes. The patients often die without much 
symptoms of exhaustion. The decubitus was mainly on the side, 
with the head not unfrcquently thrown back-the neck rigid and 
stiff-a partial opisthotonos. There was uniformly great restless- 
ness and jactitation. As an accompaniment and occasionally a se- 
quel to the disease, iritis was several times observed. So, also, 
was synovitis-and, in one instance, pericarditis. The above are 
among the more prominent and constant symptoms-but there was 
a considerable diversity in the manifestations of the disease during 
its progress, whether towards a favorable or fatal result; in no one 
case do I remember to have seen even a majority of those I have 
enumerated present. 
Singular and anomalous symptoms were sometimes noticed. Dr. 
Jewett, Surgeon of the 51st Mass. Reg't, to whom I am indebted for 
a clear and able account of the disease, as it occurred in the troops 
under his care, reports that, " in a single case, a pleasing delirium 
was noticed, with loquacity and decidedly erotic desires, accompanied 
with priapism more or less extensive during the greater part of the 
disease." This peculiarity, he adds, was noticed in about one third 
of his cases. Dr. Cowgill alludes to the same fact. Dr. Jewett 
noticed the decubitus upon the dorsum among fourteen cases which 
occurred in the 51st Mass. Regt, in but a single instance. "In all 
the others," he observes, " the patients lay upon the side till near 
the close of life." " In a few cases, and those the most severe ones," 
he also remarks, " no moan or sound of any kind escaped the pa- 
tient, but there was a fearful restlessness which ceased only at death; 
in others there was much moaning." Stiffness of the muscles of the 
neck and back, or some perverted action of the muscles of the face, 
before alluded to, amounting at times to spasm, was almost pathog- 
nomonic. In some form, this affection was present in nearly all the EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
31 
cases sent in by Dr. Ware; it was common in those treated in Aca- 
demy Hospital. Dr. Jewett speaks of it as being present in fully 
one third of the cases which came under his observation, 11 there be- 
ing," as he says, " more or less stiffness of the muscles of the neck 
and back, with opisthotonos-in one case paralysis of the glosso- 
pharyngeal nerve, and in two others eversion of the eyes and occa- 
sional squinting." 
The duration of the affection varied from a period of less than 
thirty-six hours, to that of three, four or six weeks, and even longer. 
According to my own observation, the more usual duration has been 
from three or four to seven days. Of the twenty-one fatal cases, 
recorded in the preceding pages, death took place- 
In 2 cases on the 2d day; 
In 5 cases on the 3d day; 
In 5 cases on the 4th day; 
In 1 case on the 5th day; 
In 1 case on the 6th day; 
In 1 case on the 8th day; 
In 1 case on the 10th day; 
In 1 case on the 14th day; 
In 2 cases on the 22d day; 
In 1 case on the 34th day; 
In 1 case on the 36 th day. 
Of the five cases mentioned by Dr. Kneeland, which occurred among 
the members of the 45th Mass. Reg., four proved fatal within thirty- 
six hours from the onset of the disease, and one on the fourth day.* 
And of fourteen deaths, mentioned in the communication from Dr. 
Jewett, the greatest duration of the disease was twenty-three days, 
the least one day.t 
The age, when it could be obtained, of the patients attacked, in 
the cases hereinbefore recorded, was found to vary from 17 to 31 
years, in the proportion as follows, viz.:- 
In 1 case the ago was 17 years. 
In 4 cases the ago was 18 years. 
In 3 cases the age was 19 years. 
In 2 cases the age was 20 years. 
In 4 cases the age was 21 years. 
* See Dr. Kneeland's letter to the Surgeon-General of Massachusetts, in the Boston Medi- 
cal and Surgical Journal, March 12th, 1863. 
+ A well authenticated case, under the care of Dr. Haddock, has just proved fatal on the 
84th day! Unfortunately, no post-mortem investigation could be obtained. 32 
HOSPITAL NOTES AND MEMORANDA. 
In 2 cases the age was 22 years. 
In 2 cases the age was 23 years. 
In 1 case the age was 27 years. 
In 1 case the age was 28 years. 
In 1 case the age was 31 years. 
In 1 case the age was 32 years. 
Of Dr. Jewett's fourteen cases, the youngest was 16 years of age, 
the oldest 30 years; the average 20 years. 
In regard to the prognosis, it was generally unfavorable. Of 
about forty cases received into the Stanly General Hospital-and 
which were regarded as genuine examples of the disease-twenty- 
eight proved fatal. Of the live cases mentioned by Dr. Kneeland, 
all died.* And of the fourteen communicated by Dr. Jewett, all 
were fatal. Dr. Cowgill has reported five well-authenticated cases 
of recovery, out of twelve treated in the Academy Hospital, under 
his charge-being the largest ratio of recoveries in proportion to 
the number of cases received. 
The anatomical lesions, in the cases examined, were confined princi- 
pally to the brain and spinal cord. Where death took place early- 
within two or three days-there was commonly opalescence of the 
upper surface of the cerebrum, seemingly in the subarachnoid fluid ; 
an increased vascularity of the membranes of the brain and spi- 
nal cord, affecting the pia mater especially; a large increase of se- 
rum in the subarachnoid space and ventricles, clear or turbid, and 
mixed with flocculi of lymph, with, as often as otherwise, even in 
cases of the briefest duration, an abundant exudation of thick, yel- 
lowish, apparently semi-organized lymph on the base of the brain and 
medulla oblongata. Conjoined with those phenomena, there was in 
such cases more or less passive congestion of the lungs; increase of 
the pericardial fluid, and occasional engorgement and enlargement of 
the liver or spleen. 
In cases where the disease had lasted for a longer period-from 
seven or eight days to three or four weeks or more-the deposits on 
the brain were usually more marked, predominating at its base, 
around the pons Varolii and in the sulci of the cerebrum and cere- 
bellum, covering the surface of the oblongata, and extending down 
upon the spinal cord, sheathing it, in some cases, throughout its entire 
* Three of these were treated in regimental and two in general hospital. Sec Dr. Knee- 
land's letter, before referred to. 33 
EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
extent. This exudation was either pus-like, or concrete and semi-or- 
ganized, abundant, from two to three or four lines in thickness not un- 
frequently. It appeared, also, in the ventricles-in the posterior cor- 
nua of the lateral ventricles in its concrete form particularly, or else 
tinging and thickening, with an opaque greenish pus, the serous fluid 
of the whole cavity. The membranes of the brain, the pia mater espe- 
cially, showed, not unfrequently, evidences of congestion. The vis- 
cera of the thorax and abdomen, with the exception of some passive 
engorgement of the lungs in their depending portions, the occasional 
presence of lymph in the pericardium and ventricles of the heart, 
and sometimes enlargement of the liver and spleen, presented no- 
thing unusual. The mucous membrane of the stomach and intes- 
tines was generally normal-the patches of Peyer unaltered. 
Dr. Jewett has given the pathological appearances in two cases that 
came under his observation, illustrating the extremes of duration; 
the one case was completed in twenty-four hours, the other in twen- 
ty-three days. In regard to the first case he remarks: a On remov- 
ing the calvarium, the membranes were found to be adherent, so 
much so as to require to be torn from the substance of the brain in 
some portions; the membranes were in some places also adherent 
to each other. The subarachnoid space was filled with a straw-col- 
ored serum, from three to four ounces, by estimation, in quantity; 
there was more fluid in the right than in the left ventricle. Whole 
surface of the brain highly congested, with small patches of lymph 
at base of cerebellum. On exposing the spinal canal, the cerebro- 
spinal fluid appeared in greatly increased quantity, and of a yellow- 
ish and milky hue; meninges much congested, and the cord itself 
softened. In the latter case," he says, 11 the dura mater was strong- 
ly adherent over the longitudinal sinus; the lateral ventricles were 
filled with about three ounces of straw-colored fluid; vessels of the 
choroid plexus strongly injected; the fourth ventricle filled with 
serum and pus. A large deposit of lymph, three lines in thickness, 
covered the pons Varolii and inferior surface of the medulla oblon- 
gata. The meninges of the cord much congested; about half an 
ounce of sero-purulent matter in the spinal canal; the spinal cord 
enveloped in a layer of lymph from two to three lines in thickness 
in some parts, the lymph extending down, and sheathing to their 
very extremities the cauda equina and sacral nerves." 34 
HOSPITAL NOTES AND MEMORANDA. 
Of the seven fatal cases reported by Dr. Cowgill, that in which 
death took place earliest (within thirty-six hours) exhibited a cloudi- 
ness of the entire surface of the cerebrum and medulla oblongata, 
increased vascularity of the membranes, with effused serum into the 
ventricles, injection of the pia mater of the spinal canal, with infu- 
sion of turbid scrum in its lower part, and evidences of inflamma- 
tory action along the entire cord. That of longest duration (thirty- 
four days) revealed injection of the pia mater, with some exudation 
of yellowish lymph along the sulci of the upper surface, and a thick- 
er deposit, of apparently plastic purulent matter, on the inferior 
surface and over the pons Varolii and oblongata especially, and two 
ounces of serum in the lateral ventricles. Of his remaining five cases, 
intermediate in duration, there was increased vascularity of the 
membranes, the pia mater especially, in all; a thin deposit of lymph 
on the upper surface of the brain in two, and a more abundant, con- 
sistent exudation of lymph-like matter, predominant at the base of 
the cerebrum and cerebellum and medulla oblongata, in four; pro- 
longed, cither in the form of lymph or sero-purulent effusion, into 
the spinal canal, in three; with, in all, distension of the ventricles 
with scrum or sero-purulent matter. 
Within the sphere of my own observation, of five cases that ter- 
minated fatally on or before the third day, the investing membranes 
of the brain were noticed to be congested in two instances, in the 
others not; in three there was an extensive deposit of lymph on 
the base of the brain and cerebellum particularly; in one, slight 
cloudiness on the superior surface of the cerebrum only, with 
some opacity of the arachnoid; and in one, no abnormal depo- 
sits. In the two cases of longest duration (thirty-four and thirty- 
six days respectively), there was, in the former, cloudiness and 
slight deposit of lymph between the convolutions on the supe- 
rior surface of the cerebral hemispheres and a firm layer of coagu- 
lable lymph, one sixth of an inch in thickness, on the inferior aspect 
of the cerebellum and oblongata; in the latter, a little increased 
vascularity of the pia mater, a thin, milky fluid beneath some por- 
tions of the arachnoid on the brain superiorly; and at its base a 
mass of tenacious, yellowish lymph, three eighths of an inch in depth, 
extending down upon the spinal cord; the ventricles were, in both 
cases, distended with sero-purulent matter. And of the six inter- 
mediate cases, there was more or less congestion of the investing 
membranes in three; the clouded appearance of the arachnoid only, 35 
EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
in one, and copious exudation on the base of brain and medulla ob- 
longata in five. 
In regard to treatment, when we consider the mortality, as shown 
in the preceding record, but little that is satisfactory can be said. 
In the onset of the epidemic, it was naturally taken to be of mala- 
rial origin, and the usual means of combating such an affection were 
assiduously employed-quinine, in some instances to the extent of 
sixty and even eighty grains, being given within ten or twelve hours 
from the first attack, but without effect; conjoined with this, stimu- 
lants and purgatives of calomel were freely used. Antiphlogistic 
measures were also tried-cupping, wet and dry, to the back of the 
head and nuchse; saline purgatives, epispastics, frictions along 
the spine, blisters to inside of thighs, calves and ankles, with enemata 
of turpentine and brandy. Where there was marked cerebral ex- 
citement, venesection was freely employed-but its powerlessness to 
avert, or even mitigate the symptoms, is seen in Dr. Cowgill's ac- 
count of a case which occurred at Academy Green Hospital, in which 
the remedy was faithfully tried. The patient was a strong, ro- 
bust young man-attacked suddenly, and with great violence- 
with urgent cerebral symptoms, great restlessness and jactitation, 
perfect unconsciousness and with a full pulse. He was bled to the 
amount of twenty-four ounces; his pulse became stronger under the 
operation-no symptoms of faintness. He was quiet for twenty 
minutes, when the jactitation became as violent as before. At 
evening, there was violent muscular action, pulse 86, strong and 
full; the bandages were loosened, and sixteen ounces more of blood 
allowed to flow-the patient, in the meantime, being held upright 
in bed. There was no evidence of syncope, and no lessening of 
muscular action. The excitement continued the whole night, and 
the patient died the next day. 
Calomel in combination with ipecac, in doses of two grains of the 
former and half a grain of the latter, given every two hours-in con- 
junction with frictions or sinapisms along the course of the spine, as 
reported by Dr. Cowgill, seemed, in several instances, to have a good 
effect. Dr. Haddock suggested the use of ergot, in accordance with 
the recommendations of Dr. Brown Sequard, in certain affections of 
the spinal cord unaccompanied with active inflammation. It was given 
in the form of the fluid extract in doses of from ten to fifteen minims, 36 
HOSPITAL NOTES AND MEMORANDA. 
repeated every four hours. Several of the cases thus treated by 
Dr. Haddock recovered.* Oftentimes a beneficial effect attended 
the exhibition of camphor-water in combination with the carbonate 
of ammonia. Dover's powder and the solution of sulphate of mor- 
phia were given to induce sleep at night. 
A natural and interesting inquiry here arises as to the nature of 
the affection above described. Was it an inflammation, in the ordi- 
nary acceptation of the term, of the brain and spinal cord or their 
membranes-or was it the manifestation of some obscure but ma- 
* The following is an interesting case of recovery, under the treatment by ergot, in the 
hands of Dr. Haddock:- 
DeWitt C. White, Co. I, 8th Reg't M.V.M., aged about 19, came to Hospital Tuesday, 
March 10th. Was taken suddenly the night before with convulsions, and had remained un- 
conscious for the most part since, rousing up now and then, moaning, and complaining of the 
back of his head and neck. Got, before he came in, a purge of calomel and jalap, and had 
cups, wet and dry, applied to the back of his neck. 
Found him, on admission, dull and stupid, with purple lips, and venous system in general 
congested ; tongue white, moist; delirious; breathing stertorous ; pulse 96, full; an eruption 
like purpura covering abdomen and legs. He got, at once, an ounce of whiskey, with ten 
grains of quinine, turpentine mixture and ammonia, alternately every fourth hour; mustard 
pediluvium and cold to back of neck and head. 
11th.-The bowels not having moved, he got half an ounce of salts. Pulse 116 ; answers 
questions, but talks incoherently; sighs, moans, complains of his head and neck; eruption 
full and distinct-spots large, and in form of measles. In evening, pulse 84; bowels moved 
during the night. 
12th.-Pulse 84; tongue thickly coated, white; cheeks flushed; delirium constant; an- 
swers questions correctly, but at once relapses into stupor; skin dusky yellow; eyes very 
susceptible to liglit. Continue treatment. Evening.-Pulse 80; delirious; skin moist; no 
pain ; head thrown back ; no headache; talks to imaginary persons and catches at imagina- 
ry objects. Ordered mustard pediluvium. 
' 13th.-Pulse 84; restless; delirious; three involuntary discharges; urine free, invol- 
untary, brown, ammoniacal. Continue treatment. 
14tl'i.-Restless until 12 at night (of the 13th); some involuntary discharges; pulse 72; 
skin moist; unconscious for the most part. 
15th.-Pulse 100; strabismus; tongue dry, brown, cracked; discharges involuntary; deli- 
rium constant. Continue treatment. 
16th.-Paralysis of right arm and leg; tongue same ; pulse 92, soft; headache; urine less 
free. Got fifteen drops of fluid extract of ergot. (See Dr. B. Sequard on Epilepsy.) Omit 
all else. 
17th.-Very much the same. Continue treatment. Mustard to spine. 
18th.-Rested well. Nodejection; pulse 88; no pain; urine natural; mind clearer. In- 
crease ergot to twenty minims. 
19th.-Tongue red at centre, white at edges. Continue treatment. Increase ergot to twen- 
ty-five minims. 
20th.-Pulse 84. Continue treatment. Increase ergot to thirty minims. Purgative enema. 
21st.-Seems better; mind clearer. Extract of ergot, thirty-five minims. Bowels moved; 
slight nausea. 
22d.-Rested well. Asleep. Tongue cleaning; pulse 80; pain in back of head; mind 
clear; no paralysis; no strabismus. Says he " feels sick and tired." Continue treatment. 
23d.-Remains very much the same. Nausea Lessen ergot to thirty minims. Says he 
feels better. 
24th.-Did not rest. Headache; mind clear; some appetite; one dejection; "legs arc 
tired"; pulse natural; rheumatic pains; "neck lame." Cold applications to neck. 
25th.-Synovitis (left knee); no redness or pain ; swelling large ; fluctuation distinct. 
26th.-Cold water only to knee. Fine, distinct eruption over body and arms ; urine large 
in quantity; tongue red and shining. Feels that he is recovering. 
27th.-Vertigo. Ergot, twenty minims. 
28th.-Complains of his shoulders aching severely; some nausea; bowels moved; hungry. 
29th.-Pain the same. Tincture of iodine over the spine. Continue treatment. 
From this time the patient regularly and rapidly improved. The ergot was suspended on 
the 9th of April, after which he required but little treatment, except for constipation or rheu- 
matic pains. April 20th, was sent to Beaufort, convalescent. EPIDEMIC CEREBRO-SPINAL MENINGITIS. 
37 
lignant malarial influence, or form of congestive or pernicious fever, 
so called-or in its essence a typhus fever, of a peculiar and fatal 
type, such as has heretofore been described in the history of military 
campaigns, which lurks in the track of armies, and breaks out suddenly 
and in a mysterious manner in camps and garrisoned towns ? 
From the limited number of cases as yet adduced, no definite con- 
clusions on this point can perhaps be arrived at; but, by the process 
of exclusion, we may be able to approximate towards the truth. 
That it was not, in its essential essence and primarily, an inflamma- 
tion of the membranes of the brain and spinal cord, it seems fair to 
conclude from the futility of all the known means of combating such 
disease in producing any adequate result. Venesection, both local 
and general, did not control the violence of the diseased action. 
Blisters wore not well borne. Calomel and saline cathartics were 
tried in large doses without effect. And its outward demonstra- 
tions, if carefully considered, would seem rather that of some subtle 
agency that had suddenly and overwhelmingly oppressed the vital 
energies, than the painful and excited expressions of active inflam- 
mation. 
The arguments against its malarial nature and origin, are, in my 
own mind, stronger still. It lacks many of the important symp- 
toms and characteristics of the " congestive fevers " of tropical cli- 
mates, as described in the books. It is not intermittent, nor is it 
uniformly nor commonly remittent. It occurs at a season of the 
year when miasmatic diseases do not prevail, and among the new 
troops by preference-who have not been previously exposed to 
malarial influences-and does not succumb to, nor appear to be fa- 
vorably influenced by the administration of quinine, however early 
this treatment may be commenced and vigorously prosecuted. And 
the anatomical lesions which, other things being equal, might ac- 
cord with the supposition of its malarial origin in the cases examined, 
are the rare exception, not the rule. 
The disease seemed to me rather to partake of the nature of ty- 
phus, in a severe and malignant form, identical in its essential ele- 
ments with the typhus fever of Great Britain, which, under the 
names of maculated typhus, ship fever, camp or jail fever, has many 
times been observed in this country-having, in this instance, a spe- 
cial direction to the meninges of the brain and spinal cord, as, in 
other epidemics, the weight of the disease has fallen at one time 
upon the brain, at another upon the lungs or other important visce- 38 
HOSPITAL NOTES AND MEMORANDA. 
ra of the thorax or abdomen-springing up epidemically or other- 
wise, wherever there is long-continued crowding and exclusion of 
light and air, coupled with deprivation, hardships and exposure. 
Thus, in the affection under consideration, the circumstances of its 
origin are similar in kind, if not in degree, to those in which the 
typhous group of diseases most frequently originate.* And very 
many of its phenomena and phases are like to those which are wit- 
nessed in typhus epidemics. The suddenness of its accession, the 
dusky hue of the face, the suffused and injected eyes, the petechial 
eruption and purpural spots, the defective innervation of the respi- 
ratory and circulatory system, as shown in the labored, irregular 
breathing and the often tumultuous and intermittent action of the 
heart, the sluggishness, but otherwise general freedom from func- 
tional derangements of the thoracic and abdominal viscera, and, 
after death, the passive engorgements, and dark, fluid, sizy character 
of the blood, all point to the typhus element of the disease, and 
would seem to indicate a line of therapeutical management similar 
to that which experience has found most effectual in the treatment of 
that malady. 
* How far the nature of the material of which the barracks were constructed (before 
alluded to) contributed to the existence of the epidemic, it is difficult to say. This condition 
of things, by aggravating the ordinary exciting causes of disease, may naturally be sup- 
posed to have aggravated its violence and intensity, if it did not actually favor and hasten 
its appearance. Certain it is, that in the case of the four regiments principally affected, a 
change of locality and circumstances was followed by the immediate cessation of the 
disease.