DOI: 10.7925/drs1.ucdlib_280699
title: Cerebro spinal meningitis

description: Watercolour medical illustration depicting cerebral spinal arachnoiditis. It has the alternative reference number 1937 and P15A on the front. The Richmond Hospital Museum reference is D.a.5. The entry for this in P263/1 pg. 16 reads 'Cerebro-spinal arachnitis [arachnoiditis] Dr Mayne'. The artist's name is in the bottom right corner 'J. Connolly Del.t'. The typescript and handwritten notes on the back begin 'Cerebro Spinal Meningitis – Dr Mayne's Case. Acute Cerebro-Spinal Arachnitis; Effusion into the Subarachnoid Tissue'.
description: Scope and content: The full typescript and handwritten notes on the back read 'Cerebro Spinal Meningitis – Dr Mayne's Case. Acute Cerebro-Spinal Arachnitis; Effusion into the Subarachnoid Tissue. – Dr Mayne presented specimens and drawings of two cases of acute arachnitis, in both of which the symptoms, during life, had been nearly alike; both were very rapid in their course, were resistant to treatment, and the morbid appearance discovered after death were very similar: both occurred in the South Dublin Union. The first case was that of a boy, aged four years, who had been in good health up to the 24th of March; on that day he was running about with other children, eat his dinner, and about bedtime complained of pain in the stomach, vomited, and was very restless during the night: he was very thirsty, and vomited whatever he drank; continued to complain of pain in the belly. Next morning (25th March) he was seen by Dr Mayne, who observed that his countenance presented a tetanic expression; his head was firmly drawn back, and it resisted the efforts of Dr Mayne to bring it forward; the lower extremities were stiff, although semiflexed; he had lost the power of voluntary motion, was unable to stand up, and could not preserve the erect position when he was lifted up and placed on his feet: the epigastrium was tender to pressure; the abdomen was not swollen or rigid; there was neither headache, congestion of the conjunctive, strabismus, nor heat of the scalp; the pulse was 120, and the sense of pain was all referred to the abdomen. The diagnosis was difficult, and the treatment consequently somewhat temporizing; the head was shaved, and calomel given in small doses. On the next day (26th) the pulse had fallen to 60; he had been moaning through the night, and had raved; the vomiting still continued, and he was unable now to give any account of his sensations. On the day following he was still worse; he had been convulsed during the night so violently that the nurse, being unable to hold him, had last strapped him down to the bed. The convulsions recurred frequently, the extremities became cold, and he died on the fourth day of the attack. On examining the body, the signs of acute arachnitis were observed within the cranium; over the hemispheres the serous membrane was generally dry, with some degree of clamminess, while lymph of a greenish colour had been effused in the subarachnoid tissue on the surface of the brain, and was very obvious along the sulci between the convolutions. This effusion was so copious at the base of the brain that all the cerebral nerves were covered by it, and it extended also into the vertebral canal, the spinal cord from one end to the other being enveloped by it. There had been no effusion into the ventricles. The second case occurred three days after the first: the subject, a boy aged nine years, was attacked after dinner on the 30th of March, with similar symptoms to those observed in the previous case; thus, he had pain in the stomach, vomited, his head was retracted, the muscles of the neck were rigid, and the countenance had the tetanic expression, but the extremities were not so stiff as in the other case. Dr Mayne immediately recognised this as another instance of the same disease, and he thinks these symptoms may almost be looked on as pathognomonic. This case, like the other, obstinately resisted treatment. Dr Mayne, in the hope of overcoming the disease, directed venesection from the arm, and afterwards from the jugular vein; the bleeding was pushed so far as nearly to produce syncope. In addition to this, the head was shaved, leeches were applied over the mastoid process, and calomel administered every second hour. On the second day of the attack, convulsions set in; the left side was that affected by them. On the third day the pulse was imperceptible at the wrists, and the faeces was passed involuntarily; the calomel had, by this time, effected the gums. On the fourth day he died. The appearance observed in the examination of the body were similar to those of the other case, but more strongly marked. The arachnoid, not only within the cranium, but also throughout the vertebral canal, exhibited the effects of inflammation. On the upper surface of the cerebrum, the serous membrane was dry, and through it could be seen, in tortuous lines, the lymph filling up the sulci. On the upper part of the cerebellum, a yellowish green lymph had been effused; a similar effusion was very abundant at the base of the brain. Within the vertebral canal there was effusion of the same character, which was so copious in the lower part as to conceal the cauda equina. This lymph admitted of being scrapped off the subjacent surface, and it was then discovered that the pia mater was not congested, nor was the substance of the medulla spinalis affected by inflammation or ramollissement. – February 20, 1847'.
description: Numbering/sequence: Original reference number: 1937.