Kuskow described, under the title of "hemorrhagic influenza," cases of simple hemorrhage into the meninges, especially "infiltration of blood into the pia, without a trace of an inflammatory infiltration." On the other hand, the descriptions of Trouillet and Esprit completely coincide with our combined form of disseminated hemorrhagic leptomeningitis and encephalitis, and the same is true of the communications of Cornil and those of Colin to the Paris Academy. Colin found streptococci, and therefore speaks of "meningites a streptocoques."

Under the names of "pseudomeningitis grippalis," "forme pseudo meningitique de la grippe," are embraced in the French literature (Lepine, Trastour, Leveque, Sevestre, Guibout, Virey, Da Costa) those well known and practically most important cases in which the disease assumes all the characters of meningitis, either from the commencement of the influenza attack or early in its course. The patients, usually children, are frequently, after an acute eclamptic incipient stage, attacked by violent headache and vomiting, soon followed by high fever, apathy, sopor, cervical rigidity, strabismus, mydriasis, inequality in the size of the pupils, and grinding of the teeth. General hyperesthesia, bradycardia, and intermittent respiration complete this picture of meningitis. The abdomen is but rarely retracted. But soon, often after a few days, this alarming condition, justifying the gravest prognosis, is replaced by the symptoms of a typical influenza. Or death may take place and pathologic findings by no means confirm the diagnosed meningitis; the condition may be merely a hyperemia of the soft envelops of the brain, or only a serous moistening of these parts (" serous meningitis ").

* Our influenza lectures, p. 30.

Kohts has described instructive cases of this sort in which children were affected. In one of these cases there was even left hemiplegia. But the expected meningitis and cerebritis were not found at the postmortem examination conducted by von Recklinghausen. "There were hyperemia of the dura mater; marked injection of the pial vessels at the convexity, as well as at the base; marked hyperemia of the gray matter of the cerebrum and the cerebral ganglia; extensive accumulation of fluid in the ventricles; no tubercles; no focal inflammation." Kohts speaks of an "irritation of the meninges without any particular reason for the same, due to the influenza micro organisms or their pto mains."

So too in a case described by Warfvinge, which ended fatally in epileptiform convulsions, there were found at the postmortem examination only hyperemia and edema of the meninges. Regarding the cases of severe pseudomeningitis which recover within a short time, Lepine points out that these cases are probably due to a superficial recoverable or abortive meningitis. He states: "Une pneumonie ne passe pas necessairement a l'hepatisation [solidification]; il en est qui sont presque ephemeres. De meme il peut se produire des lesions de meningitide, superficielles et curables." While we completely agree with this view of Lepine, we must, on the other hand, point out that there are many cases of influenza presenting a typical picture of meningitis which recover, whose cerebral symptoms may have been due to functional toxic disturbances of the brain having no relation to meningitis.

We must finally also remember those numerous cases in which, especially in children, an otitis calls forth all the symptoms of meningitis, and in which, upon the perforation of the abscess, the alarming symptom complex of the supposed meningitis immediately disappears.