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 severe chills, slight rise in temperature, pain in the back of the neck, headaches, stupor, muscular spasms, a slow pulse, often purple bleeding, eruption, coma and death within hours, rather than days.  This is a terrible disease, and a physician is needed from the first.  The death rate varies from twenty to seventy-live per cent.  Treatment must be given by a physician.  Spinal meningitis is inflammation of the membrane of the spinal cord along with the accompanying back and extremity symptoms, while the head remains clear and free from complications.

Meningitis.—­This is an inflammation of the membranes covering the brain alone, and generally commences with fever and severe headaches, with avoidance of light and noise as these are painful.  In some cases we have delirium, stupor and coma.

Treatment.—­Treatment must be given by a physician, but cold applications to the head and back are generally good.  The bowels also must be kept open.

Meningitis.  Tubercular, (Basilar Meningitis).—­This affection which is also known as acute hydrocephalus (meaning water on the brain), is essentially an acute tuberculosis in which the membranes of the brain, sometimes of the cord bear the brunt of the attack.  It is more common in children than in adults.  It is more frequent between the second and fifth years, than in the first year.  It is caused by the tubercular infection, and follows the usual course of this disease.  Ordinary meningitis is rapid and well defined in its course, with “high fever,” severe pains in the head, intense nervousness, avoidance of light and sound, loss of appetite and constipation.  These symptoms are easily understood and are generally clearly read by those around the patient.  Unfortunately in tubercular meningitis the clearly defined symptoms