The mode of infection is obscure, but the organism is thought to gain access to the circulation through the mucous membrane of the nose and conjunctiva, as the organism has been isolated from the mucous membrane of the nose, not only of those suffering from the disease but from healthy persons who have been in contact with cases. Cerebro-spinal fever has an undoubted tendency to follow bad sanitary conditions and to prevail in damp, sunless houses. It is a disease of temperate climates, and the outbreaks usually take place in the spring of the year. The victims are mostly children and young adults, and Koplik states that few recoveries take place in children under two years of age.
The onset of symptoms is sudden, as contrasted with tubercular meningitis, in which the onset is gradual. The attack comes on sharply with intense headache, rigors and vomiting. The pain soon localizes itself in the back of the neck and occiput, and may thence radiate down the spine, limbs and abdomen. The pain is soon followed by a characteristic symptom, namely retraction of the head. The head is drawn back and rigidly fixed, the spine arched and the limbs drawn up, and muscular spasms may take place. There is general hyperaesthaesia, the slightest contact producing pain. More or less fever is present, but the temperature is not characteristic. The headache continues with great severity and restlessness and delirium supervene, or there may be long periods when the patient is comatose. Twitching of the limbs and general convulsions may occur and facial paralysis is frequent. Paralysis of the ocular nerves causing squint, dilatations and contractions of the pupil are common as in other varieties of meningitis.
Some of the most striking symptoms are the rashes. These usually occur about the fourth day of illness and vary widely in character, resembling erythema, urticaria, rose spots or purpuric spots. The rashes have usually no relation to the gravity of the disease, but severe cutaneous haemorrhages usually indicate a severe form of illness. Should the patient survive the first shock of the attack serious complications may arise; the eyes may be attacked by severe conjunctivitis, iritis or keratitis or inflammation of the deeper parts may take place leading to detachment of the retina. More frequent even is disease of the auditory apparatus, and purulent otitis media or disease of the labyrinth may lead to permanent deafness. Serous effusion may take place into joints which are painful, red and swollen as in acute rheumatism.
Certain forms of the disease are rapidly fatal, these are known as the fulminant type, and death may take place within 12 to 24 hours of the onset. Death usually occurs between the fifth and the eighth day, but many cases drag on for weeks with rapid and progressive emaciation, and recovery is slow. The mortality has varied in different epidemics. Hirsch’s tables of forty-one epidemics give a mortality of from 25 to 75%, and Koplik rates it at 48 to 90%. During 1907, 623 cases of cerebro-spinal fever were notified in Belfast, and the deaths numbered 495. During that year the disease was made notifiable in 48 Irish urban and 55 rural districts. The mortality in Dublin was 75%. Osler states that in children under one year (in New York) the mortality reached 87·6%.
The changes found after death from cerebro-spinal fever are an acute inflammation of the pia-arachnoid membrane both of the brain and spinal cord, with effusion of serum or pus into the ventricular and subarachnoid spaces. With such rapidity may the effusion become purulent that it has been found purulent in a case where death took place within five hours from the apparent onset. The operation of lumbar puncture (or puncture of the spinal canal between the lumbar vertebrae) has enabled the physician to make an accurate diagnosis by bacteriological examination of the contents of the spinal fluid. Lumbar puncture too has been found to be of eminent service in many cases, the withdrawal of from 30 to 50 cc. of the spinal fluid serving to relieve pressure and at least temporarily ameliorate the symptoms.
Up to a few years ago it may be said that there was no effective treatment for cerebro-spinal fever but that of endeavouring to alleviate pain by the administration of opium, but with the recent introduction of serum therapy the future is full of hope. In the epidemic in New York (1905) the serum of Flexner and Jobling was used, and the most striking results were seen in young patients, the death-rate where the serum was used sinking to 46·3% as against 90% without. Like other serum treatments, to get the best results the serum must be administered early in the disease. Of 221 patients injected during the first week of illness the mortality was only 18%, while of 107 others injected after the first week of the disease the mortality was double that amount. When given subcutaneously, as in diphtheria, the serum has little or no effect, and to obtain good results it must be injected directly into the spinal canal after the removal of a certain amount of the spinal fluid. The injections are then continued daily as required according to the severity of the case. Dr Robb of Belfast reports that during the epidemic there, of 275 cases treated by ordinary means, the death-rate was 72·3%. but in 90 cases treated with injections of Flexner and Jobling’s serum the death-rate was only 30%. Dr Ivy McKenzie and Dr W. B. Martin of Glasgow have published a series of cases treated with the highly immune serum of patients who have recovered from the disease with encouraging results.
MENIPPUS, of Gadara in Coele-Syria, Greek cynic and satirist, lived during the 3rd century B.C. According to Diogenes Laërtius (vi. 8) he was originally a slave, amassed a fortune as a money-lender, lost it, and committed suicide through grief. His works (written in a mixture of prose and verse) are all lost. He discussed serious subjects in a spirit of raillery, and especially delighted in attacking the Epicureans and Stoics. His Writings exercised considerable influence upon later literature. One of the dialogues attributed to Lucian, his avowed imitator, who frequently mentions him, is called Menippus. But this dialogue is regarded with suspicion, and since the sub-title (“The Oracle of the Dead”) resembles that of a work ascribed to Menippus by Diogenes Laërtius, it has been suggested that it is really the work of Menippus himself, or at any rate imitated from his Νέκυια by the author, whether Lucian or another. It is well known that the Menippean satires of M. Terentius Varro, the fragments of which give an idea of this kind of composition, were called after Menippus of Gadara (see Teuffel-Schwabe, Hist. of Roman Literature, § 165, 3).
Bibliography.—F. Ley, De vita. scriptisque Menippi cynici (Cologne, 1843); R. Helm, Lucian und Menipp (1906); C. Wachsmuth, Sillographorum graecorum reliquiae (1885), with an account of Menippus and similar writers. Menippus found an imitator in later times in Justus Lipsius, author of a Satyra menippaea (1637) in which he ridiculed certain literary men of his age, especially the poet laureate; and in the authors of the famous Satyre Menippée (1593; latest editions by C. Marcilly, Paris, 1882; J. Frank, Oppeln, 1884), written against the Holy League during the reign of Henri IV.
MENIUS, JUSTUS (1499–1558), Lutheran theologian, whose name is Latinized from Jost or Just (i.e. Jodocus) Menig, was born at Fulda, of poor but respectable parents, on the 13th of December 1499. Entering the university of Erfurt in 1514, he
took the bachelor’s degree in 1515, the master’s in 1516. At this time, in association with the keen humanists Conrad Mutian, Crotus Rubeanus and Eoban Hess, he was of sceptical tendency; moving to Wittenberg in 1519, he became evangelical under the
teaching of Melanchthon and the preaching of Luther. After travel in Italy (1521–1522) he was appointed (1523) town’s preacher at Wittenberg, but was soon transferred to the charge of Mühlberg, under Erfurt. Here he published his commentary on Acts (1524) and married. He resigned his charge (1525) and
opened a school at Erfurt, but the town council insisted on his resuming his ministry, appointing him preacher in St Thomas’, Erfurt. He worked in conjunction with Luther’s friend, John Lange, and was opposed by the Franciscans under Conrad Kling. Hence he left for Gotha (1528), resumed teaching, and enjoyed the friendship of Friedrich Myconius. Duke John of Saxony had placed him on the commission for church visitation in Thuringia, and in 1529 appointed him pastor and superintendent at Eisenach, where for eighteen years he administered church affairs with tact, and fostered the spread of education. In 1529 he brought out his Oeconomia christiana (a treatise in German, on the right ordering of a Christian household) with a dedication to the duchess Sybil of Saxony and a preface by Luther. His tractate, written in concert with Myconius, controverting Der Wiedertäufer Lehre und Geheimniss (1530) was also prefaced by Luther. The reversion to the Roman communion of his old friend Crotus led to his mordant Responsio amici (1532, anon.) to the Apologia (1531) of Crotus. He took his part in the theological disputations of the time, at Marburg (1529), the Concordia at Wittenberg (1536), the Convention at Schmalkalden (1537), the discussions at Hagenau and Worms (1540). His tractate (1542) against the permission of bigamy in the case of Philip of Hesse was not allowed to be printed (the manuscript is in the Heidelberg university library). In 1542 he removed to Mühlhausen, being appointed by Duke Henry of Saxony for the ordering of the church there. On the death of Myconius (1546) he was entrusted with the oversight of Gotha, in addition to that of Eisenach; to Gotha he returned in 1547. The remainder of his life was not happy. He was against the Leipzig Interim (1548) with its compromise on some Catholic usages, and was involved in controversies and quarrels; with Georgius Merula, against whom he maintained the need of exorcism in
