Acute Serous Encephalitis

Abstract

In the summer of 1923, one of us (Brown), working at the Children's Hospital in Boston, observed six cases of a rapidly fatal disease in children, attended by symptoms referable to the central nervous system. In five of the cases necropsy was performed and revealed intense edema and congestion of the brain. In the summer of 1924. Symmers, working independently at Bellevue Hospital, observed five cases presenting clinical and anatomic changes identical with those encountered in Boston. Interestingly enough, four of the Boston patients were admitted to the hospital in the month of July, within a period of nine days; the remaining case was observed in the month of October. Three of the Bellevue patients entered the hospital within a period of thirty-six hours, at a time when the heat was intense and, for a while, the suspicion was entertained that there was some connection between the external temperature and the disease in question. In all of the Boston cases, however, and in two of those from Bellevue, there was no traceable relationship between the disease and prevailing climatic conditions, so that the conception of the process as a manifestation of heat stroke was not tenable, nor was there anything to suggest poisoning. On the contrary, our investigations lead us to believe that it is a form of infection, and that it presents clinically and pathologically a picture which, so far as we can learn, has not hitherto been recognized and described.A summary of the clinical details follows. The naked eye and his¬ tologie changes in the brain in all of the patients were monotonously alike and, rather than indulge in needless repetition, they have been reserved for a later paragraph and described as a composite. Downloaded From: http://archpedi.jamanetwork.com/ by a University of Calgary User on 05/24/2015 THE BOSTON SERIES Case 1.-(Case M. M. in Reference 1.) The patient was a girl, aged 2 years and 9 months, who entered the hospital July 17, 1923. The past history was negative except for pneumonia at the age of 17 months and measles and mumps in March, 1923. The child was said to have had frequent colds and to have coughed a great deal. Five days before admission to the hospital, she began to vomit after eating or drinking, and was seen to place her hands to the head as if suffering from headache. Her temperature was 105.5 F. During the forty-eight hours that the child was in the hospital, she had several generalized convulsions and there was internal strabismus. Eyeground exam¬ ination revealed distinct blurring of both discs and a small hemorrhage on the temporal side of the right. The cerebrospinal fluid was removed under apparently normal pressure and was clear; there was a moderate amount of globulin and a normal amount of sugar; the cell count on two occasions was 15 and 30; 80 and 40 per cent, polymorphonuclears ; 15 and 54 per cent, small mononuclears and 5 and '6 per cent, large mononuclears.Case 2.-(Case J. L. in Reference 1.) The patient was a boy, aged 3yí years, who entered the hospital July 17, 1923. Th...

An Epidemic of Acute Encephalitis in Young Children

“…Neither clinical nor pathological facts support a diagnosis of heat or sunstroke. 3. Acute toxic encephalitis has been described occurring as an accompaniment of severe infections", 15.…”