Psychological Science 7th Ed 7th

Edition Elizabeth A. Phelps

Visit to download the full and correct content document:
https://ebookmeta.com/product/psychological-science-7th-ed-7th-edition-elizabeth-a-
phelps/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Insight Guides Finland 7th Ed 7th Edition Insight

Guides

https://ebookmeta.com/product/insight-guides-finland-7th-ed-7th-
edition-insight-guides/

The Earth and Its Peoples: A Global History (7th Ed.)

7th Edition Richard Bulliet

https://ebookmeta.com/product/the-earth-and-its-peoples-a-global-
history-7th-ed-7th-edition-richard-bulliet/

Complementary and Alternative Medicine Sourcebook, 7th

Ed. 7th Edition James Chambers

https://ebookmeta.com/product/complementary-and-alternative-
medicine-sourcebook-7th-ed-7th-edition-james-chambers/

Cardiac Nursing, 7th Edition Elizabeth M. Perpetua

https://ebookmeta.com/product/cardiac-nursing-7th-edition-
elizabeth-m-perpetua/
Contracts Cases and Doctrine 7th ed 7th Edition Randy E
Barnett Nathan B Oman

https://ebookmeta.com/product/contracts-cases-and-doctrine-7th-
ed-7th-edition-randy-e-barnett-nathan-b-oman/

RV Vacations For Dummies, 7th ed. Christopher Hodapp

https://ebookmeta.com/product/rv-vacations-for-dummies-7th-ed-
christopher-hodapp/

The Media Handbook A Complete Guide to Advertising

Media Selection Planning Research and Buying 7th ed
7th Edition Helen Katz

https://ebookmeta.com/product/the-media-handbook-a-complete-
guide-to-advertising-media-selection-planning-research-and-
buying-7th-ed-7th-edition-helen-katz/

Albania Bradt Travel Guides 7th ed 2022 Gillian Gloyer

https://ebookmeta.com/product/albania-bradt-travel-guides-7th-
ed-2022-gillian-gloyer/

Bradleys neurology in clinical practice by Bradley,

Walter GeorgeDaroff, Robert B 2016 7th Ed 7th Edition
By Bradley

https://ebookmeta.com/product/bradleys-neurology-in-clinical-
practice-by-bradley-walter-georgedaroff-robert-b-2016-7th-ed-7th-
edition-by-bradley/
Publisher’s Notice
Please note that this version of the ebook does not include
access to any media or print supplements that are sold
packaged with the printed book.
W. W. NORTON & COMPANY has been independent since its
founding in 1923, when William Warder Norton and Mary D. Herter
Norton first published lectures delivered at the People’s Institute, the
adult education division of New York City’s Cooper Union. The
Nortons soon expanded their program beyond the Institute,
publishing books by celebrated academics from America and abroad.
By mid-century, the two major pillars of Norton’s publishing program
—trade books and college texts—were firmly established. In the
1950s, the Norton family transferred control of the company to its
employees, and today—with a staff of four hundred and a
comparable number of trade, college, and professional titles
published each year—W. W. Norton & Company stands as the largest
and oldest publishing house owned wholly by its employees.

Copyright © 2022, 2018, 2016, 2013, 2010, 2006, 2003 by W. W,

Norton & Company, Inc.
All rights reserved

Editor: Sheri L. Snavely Developmental Editor: Beth Ammerman

Project Editor: Linda Feldman Assistant Editor: Chloe Weiss Media
Editor: Kaitlin Coats Associate Media Editor: Christina Fuery Media
Project Editor: Danielle Belfiore Assistant Media Editor: Emilia
Pesantes
Ebook Production Manager: Emily
Schwoyer
Marketing Manager: Casey Johnson
Production Managers: Eric Pier Hocking, Sean Mintus, and Richard
Bretan Design Director: Rubina Yeh Designer: FaceOut Studio/Lissi
Sigillo

Photo Editor: Ted Szczepanski

Director of College Permissions: Megan Schindel Permissions

Manager: Bethany Salminen Permissions Specialist: Elizabeth
Trammell Composition: Graphic World Managing Editor, College:
Marian Johnson Managing Editor, College Digital Media: Kim Yi The
Library of Congress has catalogued the printed edition as follows:
Names: Gazzaniga, Michael S., author.

Title: Psychological science / Michael S. Gazzaniga, University of

California, Santa Barbara, Elizabeth Phelps, Harvard University, Elliot
Berkman, University of Oregon.

Description: Seventh edition. | New York, NY : W. W. Norton &

Company, [2022] | Includes bibliographical references and index.

Identifiers: LCCN 2021032552 | ISBN 9780393884586 (hardcover) |

ISBN 9780393428186 (paperback) |ISBN 9780393884722 (epub)
Subjects: LCSH: Psychology.

Classification: LCC BF121 .G393 2022 | DDC 150—dc23

LC record available at https://lccn.loc.gov/2021032552

W. W. Norton & Company, Inc., 500 Fifth Avenue, New York, NY
10110

wwnorton.com

W. W. Norton & Company Ltd., 15 Carlisle Street, London W1D 3BS

Ebook version: 1.1-retailer

For Tyler, Alexandra, Connor, Samantha, and Evangeline—LP

For my wife, Natalie—ET

With gratitude, Lilly, Emmy, Garth, Dante, Rebecca,

Leonardo, Fiala, and Carmen—MG
Brief Contents
Preface ix
Chapter 1 The Science of Psychology 2
Chapter 2 Research Methodology 28
Chapter 3 Biology and Behavior 66
Chapter 4 Consciousness 118
Chapter 5 Sensation and Perception 158
Chapter 6 Learning 202
Chapter 7 Memory 242
Chapter 8 Thinking, Decisions, Intelligence, and Language 282
Chapter 9 Human Development 328
Chapter 10 Emotion and Motivation 374
Chapter 11 Health and Well-Being 410
Chapter 12 Social Psychology 444
Chapter 13 Personality 494
Chapter 14 Psychological Disorders 538
Chapter 15 Treatment of Psychological Disorders 594
Answer Key for Practice Exercises A-1
Glossary G-1
References R-1
Permissions Acknowledgments P-1
Name Index N-1
Subject Index S-1
Meet the Authors

ELIZABETH (LIZ) A. PHELPS is the Pershing Square professor of

human neuroscience at Harvard University. Her career is
characterized by distinguished scholarship and cutting-edge research
in cognitive neuroscience, along with her passion to communicate
the excitement of psychology to students by teaching introductory
psychology nearly every year of her career. The primary inspiration
behind her research is the observation that emotions color our lives,
and even subtle, everyday variations in our emotional experience
can alter our thoughts and actions. Liz received her PhD from
Princeton University and served on the faculty of Yale University and
New York University. Professor Phelps is the recipient of the 21st
Century Scientist Award from the James S. McDonnell Foundation,
the George A. Miller Prize in Cognitive Neuroscience, the
Distinguished Scholar Award from the Social and Affective
Neuroscience Society, and the William James Award from the
Association for Psychological Science. She is a Fellow of the
American Association for the Advancement of Science, the Society
for Experimental Psychology, and the American Academy of Arts and
Sciences. She has served on several distinguished boards and has
served as the president of three societies, including Society for
Neuroeconomics, the Association for Psychological Science, and the
Social and Affective Neuroscience Society
ELLIOT T. BERKMAN is a professor of psychology at the University
of Oregon. He teaches social psychology, introductory psychology,
and graduate courses in statistics and neuroimaging. His research is
about the motivational and cognitive factors that contribute to
success and failure in real-world goals such as cigarette smoking
cessation and dieting. His teaching, research, and mentorship have
been recognized with the APS Janet Taylor Spence Transformative
Early Career Award, the Excellence in Graduate Mentorship Award
from the University of Oregon, the Social-Personality Health Network
Early Career Award, the Joseph A. Gengerelli Distinguished
Dissertation Award, the UCLA Social Psychology Dissertation Award,
the Arthur J. Woodward Peer Mentoring Award, and the UCLA
Distinguished Teaching Award. He received his PhD in 2010 from the
University of California, Los Angeles. His blog, The Motivated Brain,
is located at Psychology Today, and he tweets as @Psychologician.

MICHAEL S. GAZZANIGA is distinguished professor and director of

the Sage Center for the Study of the Mind at the University of
California, Santa Barbara. He received a PhD from the California
Institute of Technology, where he worked with Roger Sperry and had
primary responsibility for initiating human split-brain research. He
has carried out extensive studies on both subhuman primate and
human behavior and cognition. He is the founding editor of the
Journal of Cognitive Neuroscience and also a founder of the
Cognitive Neuroscience Society. For 20 years he directed the
Summer Institute in Cognitive Neuroscience, and he serves as editor
in chief of the major reference text The Cognitive Neurosciences. He
is a member of the American Academy of Arts and Sciences, the
National Academy of Medicine, and the National Academy of
Sciences. He has written many notable books, including, most
recently, Psychological Science, 6e; Cognitive Neuroscience, 5e; and
The Consciousness Instinct: Unraveling the Mystery of How the Brain
Makes the Mind.
Preface
Welcome to the seventh edition of Psychological Science! A lot has
happened in the world in the past few years: social upheaval,
contentious elections, and a global pandemic. The field of
psychological science grew and changed because of these
developments. At the same time, psychological scientists continued
to make headways on methodological reforms stemming from the
replication crisis. When we set out to revise this edition as new
coauthors, our goal was to update Psychological Science to reflect
the latest developments in the field while also strengthening the
parts that we loved about the previous editions. This book retains
the soul of Psychological Science—a science-forward, comprehensive
text with a focus on the intersection of neuroscience and psychology
—while bringing new style and content that will resonate with the
introductory psychology students of the post-pandemic era.

The Soul of Psychological Science

Longtime users of this book will be familiar with the seventh edition’s
nuanced, accurate presentation of robust and innovative findings in
psychological science, as well as its strong focus on critical thinking.
A distinguishing characteristic of Psychological Science is the
integration of neuroscience data and methods to inform
psychological questions. Over the past few decades, neuroscience
has become increasingly integrated with psychological research, and
this book remains at the frontier of teaching students the ways that
neuroscience is increasingly woven throughout psychology. As in
most introductory textbooks, one chapter focuses on the brain and
neuroscience methods, but we do not stop there. Throughout the
book, we introduce level-appropriate neuroscience data along with
psychological findings when considering a broad range of
psychological questions. Our goal when discussing neuroscience is
not just to show that a behavioral or mental function has a brain
basis. Instead, we specifically identify how neuroscience findings
have advanced our understanding of psychological questions. Many
introductory students question why they need to learn about
neurons and the brain. By emphasizing how brain data has
enhanced psychological science throughout the text, we aim to help
students understand the value of this approach.

As every introductory psychology instructor knows, the most

important lessons from an introductory psychology course are not
about the content, but rather the process of critical and scientific
thinking. The content of psychological science is an outstanding
vehicle to teach students this kind of thinking because people are
“intuitive scientists” when it comes to psychology. We naturally
hypothesize about the causes of our own and other people’s
thoughts and behaviors. The “You Be the Psychologist” feature in
this textbook leverages this inherent curiosity to scaffold the
scientific thinking process for our readers. In these sections,
students are encouraged to hypothesize about the factors
contributing to some psychological phenomenon, consider
alternative explanations for it, weigh the strengths and limitations of
methodological tools to study it, and ponder the conditions under
which the phenomenon does and does not hold. Asking questions
and critically thinking about interesting questions that are relevant to
their lives is highly engaging for students, and practicing this kind of
thinking is an evidence-based way to improve learning. Indeed, we
designed several features around the best practices for learning
outlined in APA’s Introductory Psychology Initiative, including a focus
on basic concepts and integrative themes, application of
psychological principles to students’ lives, and scientific thinking.

Understanding the thought process that drives psychological

research can also help students appreciate the methodological issues
around scientific replication. Like all sciences, psychology is “self-
correcting” only when its knowledge base is updated by teachers
and researchers to reflect the current state of the evidence. We are
proud that the seventh edition upholds that essential scientific
activity by showcasing the psychological principles that are
supported by current, replicable evidence. The first two chapters
feature thoughtful discussions of open science and replication.
Mentions of open science and reproducibility follow throughout the
text, building on the foundation laid in the first two chapters.

Updates for the Post-Pandemic

World
We are passionate teachers who are dedicated to understanding the
perspectives of our undergraduate students. We witnessed the many
ways that the social and political turmoil of the past few years and
the massive disruption caused by the global pandemic upended our
students’ lives and understanding of the world. And, though we’ve
been in the field for decades, we keenly remember (and are
reminded by our students) what it was like to be new to the science
of psychology. Knowing that the challenges of learning are
compounded by the changes in course delivery brought on by the
pandemic, we made many revisions in this edition that consider the
learning process from the student perspective.

CONNECTING PSYCHOLOGY TO STUDENTS’ LIVES Psychology

is perhaps the academic discipline that is most inherently relevant to
people’s everyday lives. Students become motivated to learn about
the field of psychology when they understand the connection
between the concepts they learn about in class and what they see
around themselves from day to day. A side effect of psychology’s
embrace of the rigors of experimental research is that a great
proportion of studies are conducted in laboratory settings.
Nonetheless, the idea that psychology is the science of us, the
science of human minds and behavior, is always at the forefront in
this text. It is critical for students to learn that laboratory studies are
not an end unto themselves, but rather a means to model and
understand human behavior in the wild. The “Psychology Outside
the Lab” feature highlights ways that features of human psychology
and methods from psychological science play out in the world
beyond academia. This feature makes an explicit case for the
relevance of the material to students’ lives and includes concrete and
relatable examples, including the racial justice movement and the
COVID-19 pandemic.

OUR FOCUS ON STUDENT LEARNING Our commitment to

empathic and active pedagogy also emerges in the text’s research-
based emphasis on students’ conceptual understanding. Along with
the Learning Objectives and “Red Q” questions from previous
editions, we’ve also created new “Learning Tips” in each chapter to
help make tricky concepts accessible to all students. We drew from
our decades of collective teaching experience to compile a list of
topics that are often confusing to introductory psychology students.
The Learning Tips target one or two areas in each chapter that are
particularly challenging for students to understand. Each Learning
Tip zooms in on one tricky concept, definition, or distinction and
presents students with our advice for thinking about and
understanding it. This feature is emblematic of the ways the seventh
edition is particularly student focused. Revisiting a concept, at a
different time and from a different perspective, will enhance
students’ understanding and retention of it.

OUR FOCUS ON DIVERSITY, EQUITY, AND INCLUSIVITY

Promoting the values of diversity, equity, and inclusion was a primary
goal of ours for the seventh edition. Too often, diversity in
psychology texts is limited only to racial/ethnic diversity and, even
then, is inadequately addressed under the label of “culture.” This
revision adopts a broad conceptualization of diversity and inclusivity
to encompass not only race/ethnicity but also gender identity,
sexuality, immigration status, socioeconomic class, body type,
neurodiversity, disability, and age, among others. We do not mince
words about the race-and gender-based social hierarchies that
systematically advantage some groups of people and disadvantage
others. Throughout the text, we address the many ways structural
racism manifests across the field of psychology, including in the
chapters on health, social psychology, and clinical psychology.

Psychological science observes the human world, but it is also a

product of that world. The insidious effects of structural racism and
other forms of systemic discrimination also harm and distort the field
of psychological science itself. Despite some recent progress, the
fact remains that scholars from many groups have been excluded
from the field. Women; queer and nonbinary people; people with
disabilities; non-Americans and immigrants; people living in poverty;
and Black, Indigenous, and other people of color, among many
others, are underrepresented as psychological scientists. Even when
such scholars enter the field, their work is underappreciated and
undercited. The lack of representation and acknowledgment of
people in these groups harms the field by narrowing its scope and
limiting its reach. The seventh edition does not sugarcoat these
realities, but it does take steps to increase the visibility of the
scholarship and personhood of psychological scientists from groups
that have been excluded from the field. Recent research and classic
discoveries by scientists who have historically been undervalued by
the field are featured throughout the text.

Another benefit of the equity focus in the seventh edition is to

increase the sense of belonging of all readers in the field. Students
who do not see people who look and live like them featured as
scientists, used as examples, shown in photos, and included in quiz
questions receive the implicit messages that psychological science is
not for them and that they do not belong in the field. We took
particular care throughout the book, not only in the studies featured
in the narrative but also in the examples, figures and illustrations,
chapter-opening vignettes, and quiz questions, to be broadly
inclusive of people of all genders, sexualities, abilities, nationalities,
bodies, incomes, races, and ethnicities. The implicit message for
readers is simple: Psychological science is for all people.
Major Changes in the Seventh
Edition
We revised the style of the narrative to go along with our student-
centered approach in the seventh edition. This edition maintains the
focus on high-quality science that has always been a hallmark of
Psychological Science while providing a clear and digestible
experience for the reader. Our aim was to provide comprehensive
and accurate coverage of the major ideas under each topic while
keeping the text concise and easy to read. We wanted to convey the
nuances of the most important findings in psychological science
without the complex and sometimes confusing language that often
accompanies scientific writing. Much of the narrative has been recast
into a livelier, more relaxed style that allows the voices of the
authors to come through. The length of the text has also been
reduced compared with previous editions. These stylistic changes
were accompanied by increased use of tables, figures, and other
visual features to break up lengthy blocks of text. On the following
page is a table with the major changes made to each chapter.

Wrapping It Up
We hope you enjoy the seventh edition of Psychological Science as
much as we enjoyed writing it. We know many students taking
introductory psychology will not major in psychology, and only a
small fraction will go on to be researchers in psychology. As such,
our goal as authors is to encourage students to think like
psychological scientists without assuming they will all become
psychological scientists. Learning about and developing a passion for
critical thinking about psychological questions foster life skills that
benefit students across the natural sciences, social sciences, and
humanities. More than anything, we hope we will encourage
introductory students to use these critical-thinking skills as they
evaluate information and understand the behavior of those around
them in their everyday lives.

Major Changes in the 7th Edition CHAPTER 1

Increased emphasis on critical thinking as a key learning

outcome
New section on diversity and inclusion in psychological science
New section on the science of learning
New sections on computational modeling, big data, and data
science

CHAPTER 2

New running example through the chapter on using e-

cigarettes, a highly relevant topic
Expanded coverage of replication and open science practices
New coverage of A/B testing in marketing and on social media
New coverage of the Bem ESP study as an example of
questionable research practices

CHAPTER 3

Streamlined discussion of neurotransmitters and the action of

drugs
Reorganized discussion of brain anatomy, highlighting regions
most relevant to psychological science
New discussion of the insular cortex
Increased emphasis on the value of brain methods in informing
psychological questions
Additional online teaching tools for brain anatomy and neurons

CHAPTER 4

Increased discussion of attention as a gateway to consciousness

New critical-thinking exercise on meditation and brain changes
 Revised discussion on the impact of brain injury on
consciousness
Updated coverage of drugs and consciousness

CHAPTER 5

Revised and streamlined discussion of principles of perception,

including Gestalt principles
Updated and expanded section on depth and motion perception
New critical-thinking discussion on the special status of face
processing in the brain

CHAPTER 6

Expanded coverage of social learning, including its contribution

to attitudes about race
Increased emphasis on principles of learning common to
classical and operant conditioning
Streamlined and reorganized discussion of principles of classical
conditioning
Added coverage of instructed learning

CHAPTER 7

Reorganized coverage of memory principles based on stages of

memory processing
Streamlined discussion of types of memory
Updated discussion of memory replay and reconsolidation
Integrated tips for enhancing memory into neuroscience of
memory
Eliminated discussion of molecular basis of memory

CHAPTER 8

New and revised coverage of emotion and decision making

New discussion of the value of big data in psychological
research on decision making
 Expanded discussion of critical periods and communication in
language learning
Reduced coverage of group differences in intelligence

CHAPTER 9

Updated section on the lifelong effects of early experiences

New coverage on the effects of neonatal opioid exposure
Updated coverage on identity development, including sexual and
gender identity
New critical-thinking section on the effects of screen time on
development
Refocused discussion of the factors that promote thriving in
older adulthood

CHAPTER 10

New critical-thinking component to the learning unit on lie

detectors
New section on cultural differences in emotional display rules
New coverage on the relation between motivation and meaning
in life
New section on SMART goals
New coverage on the needs for consistency and coherence

CHAPTER 11

New, more extensive coverage of social and cultural effects on

health
Substantially expanded coverage of health disparities between
groups
Updated sections on healthy eating and smoking, incorporating
the latest research
New critical-thinking component in the section on everyday
health behaviors

CHAPTER 12
 Removal of discussion of the Stanford Prison Study, elements of
which had been fabricated
Enhanced critical-thinking elements in the coverage of social
norms marketing
Updated coverage of the IAT to reflect the current scientific
consensus
New coverage of stereotype threat and the shooter bias to the
section on prejudice

CHAPTER 13

Added coverage of gene-environment correlations in shaping

behavior and personality
Removal of outdated Freudian theories of personality
Added coverage of cultural variation in the structure of
personality
Substantially revised section on personality psychology in the
workplace and I/O psychology context
Added coverage of cognitive-affective system theory in
advancing the person-situation debate in the personality
literature

CHAPTER 14

Reorganization of the chapter into sections about disorders of

emotion, thought, and behavior
New section on disorders linked to trauma
Emphasis on the socially defined nature of psychological
disorders
Added coverage of addictions as disorders of behavior

CHAPTER 15

Expanded and updated discussion of stigma and cultural

differences in the treatment of psychopathology
Added discussion of internet-based treatments
New coverage on the treatment of addiction
New critical-thinking exercise on the efficacy of antidepressants
Acknowledgments
As new authors of Psychological Science, we’ve benefited from the
advice and responses of many reviewers, both well-known
researchers and star instructors. Thanks go out to the many
colleagues who reviewed specific revisions; read chapters for
inclusivity, accuracy, and consistency; and shared their experience
with our book. We would like to thank our students at New York
University, Harvard University, and the University of Oregon over the
years for informing our approach to this revision. We wrote the
seventh edition with you in mind. We particularly would like to
acknowledge Jagdeep Bala and Jordan Pennefather at the University
of Oregon for their guidance and student-mindedness in helping us
craft this revision. In addition to the excellent reviews supplied by
Ines Segert (University of Missouri) and Becky Gazzaniga over six
editions, we’d like to thank Adriana Uruena-Agnes at the University
of South Florida for thoughtfully accuracy checking every word and
figure in each chapter of the book and providing valuable insight and
advice.

PSYCHOLOGICAL SCIENCE, 7E, TEXT AND MEDIA

REVIEWERS We thank the reviewers who have worked to further
strengthen Psychological Science. Your excellent revisions, inspired
ideas, and insightful guidance have shaped an inclusive book and
resources that greatly benefit instructors and students alike. Your
students are lucky to have you in their classroom.

Julie A. Alvarez, Tulane University

Clarissa J. Arms-Chavez, Auburn University Montgomery Laurie

Bayet, American University Kristen T. Begosh, University of Delaware

Leslie Berntsen, University of Southern California Sara K. Blaine,

Auburn University Mary M. Boggiano, The University of Alabama at
Birmingham Katherine A. Boss-Williams, Augusta University Peter
Chen, Auburn University Alyson J. Chroust, East Tennessee State
University Marc Coutanche, University of Pittsburgh Craig W.
Cummings, The University of Alabama

Annie S. Ditta, University of California, Riverside Renee Engeln,

Northwestern University Patrick J. Ewell, Kenyon College

Elena K. Festa, Brown University

Patricia Ann George, University of Southern California Seth A Gitter,

Auburn University Oliver Hardt, McGill University

Alison Harris, Claremont McKenna College

Tasha R. Howe, Humboldt State University

Mary Hughes-Stone, San Francisco State University Jesse Husk, St.

Francis Xavier University Tina Kao, New York City College of
Technology and City University of New York Natalie Kerr, James
Madison University Nate Kornell, Williams College

Shannon Layman, University of Texas at Arlington Diane Leader,

Georgia Institute of Technology Christine Lomore, St. Francis Xavier
University Agnes Ly, University of Delaware

Kate MacDuffie, University of Washington

Amanda M. Marín-Chollom, Central Connecticut State University

Jillian Marshall, Connecticut College Martha Mendez-Baldwin,
Manhattan College

Jeong Min Lee, Georgia State University

Tamara Nelson, Rutgers University

Kristin Pauker, University of Hawai‘i at Manoa Evava Pietri, Indiana

University-Purdue University, Indianapolis Dylan Selterman,
University of Maryland Melissa Paquette Smith, University of
California, Los Angeles Samuel D. Spencer, University of Hawaii at
Manoa Christopher Stanzione, Georgia Institute of Technology
Clayton L. Stephenson, University of Southern California Ekeoma
Uzogara, West Chester University of Pennsylvania Gretchen Van de
Walle, Rutgers University Andreas Wilke, Clarkson University

Manda Williamson, The University of Nebraska-Lincoln Rachel Wu,

University of California, Riverside Dasa Zeithamova-Demircan,
University of Oregon PSYCHOLOGICAL SCIENCE
INTERNATIONAL REVIEWERS

George Alder, Simon Fraser University

Ron Apland, Vancouver Island University

Sunaina Assanand, University of British Columbia, Vancouver Alan

Baddelay, University of York Lisa Best, University of New Brunswick

David Bilkey, University of Otago

Colin Blakemore, Oxford University

Karen Brebner, St. Francis Xavier University

Joseph L. Brooks, University of Kent

Natasha Buist, Victoria University of Wellington Tara Callaghan, St.

Francis Xavier University Jennifer Campbell, University of British
Columbia Dennis Cogan, Touro College, Israel Martin Conway, City
University London

Michael Corballis, University of Auckland

Ian Deary, University of Edinburgh

James Enns, University of British Columbia

Raymond Fancher, York University

Margaret Forgie, University of Lethbridge

Laura Gonnerman, McGill University

Peter Graf, University of British Columbia

Pascal Haazebroek, Leiden University

John Hallonquist, Thompson Rivers University

Linda Hatt, University of British Columbia Okanagan Steven Heine,

University of British Columbia Mark Holder, University of British
Columbia Okanagan Jacob Jolij, University of Groningen Steve
Joordens, University of Toronto–Scarborough Gert Kruger, University
of Johannesburg Celia Lie, University of Otago

Christine Lomore, St. Francis Xavier University Monicque M. Lorist,

University of Groningen Neil Macrae, University of Aberdeen

Karl Maier, Salisbury University

Doug McCann, York University

Peter McCormick, St. Francis Xavier University John McDowall,

Victoria University of Wellington Patricia McMullen, Dalhousie
University Martijn Meeter, VU University Amsterdam

Heather Schellink, Dalhousie University

Enid Schutte, University of the Witwatersrand

Allison Sekuler, McMaster University

Andra Smith, University of Ottawa

Ashley Smyth, South African College of Applied Psychology Rhiannon
Turner, Queen’s University Belfast Judith ter Vrugte, University of
Twente

Maxine Gallander Wintre, York University

Heather Cleland Woods, University of Glasgow

PSYCHOLOGICAL SCIENCE, PREVIOUS EDITIONS, TEXT AND

MEDIA REVIEWERS

Stephanie Afful, Fontbonne University

Rahan Ali, Pennsylvania State University

Gordon A. Allen, Miami University of Ohio

Mary J. Allen, California State University, Bakersfield Julie A. Alvarez,

Tulane University Cheryl Armstrong, Fitchburg State University

Christopher Arra, Northern Virginia Community College Lori Badura,

State University of New York, Buffalo Mahzarin Banaji, Harvard
University David H. Barlow, Boston University

Carolyn Barry, Loyola University Maryland

Scott Bates, Utah State University

Holly B. Beard, Midlands Technical College

Bernard C. Beins, Ithaca College

Matthew C. Bell, Santa Clara University

Joan Therese Bihun, University of Colorado, Denver David Bilkey,

University of Otago Joe Bilotta, Western Kentucky University

Andrew Blair, Palm Beach State College

Kathleen H. Briggs, University of Minnesota

John P. Broida, University of Southern Maine

Joseph L. Brooks, University of Kent

Tom Brothen, University of Minnesota

Michele R. Brumley, Idaho State University

Dave Bucci, Dartmouth College

Joshua W. Buckholtz, Harvard University

Randy Buckner, Harvard University

Natasha Buist, Victoria University of Wellington William Buskist,

Auburn University Elisabeth Leslie Cameron, Carthage College

Katherine Cameron, Coppin State University

Timothy Cannon, University of Scranton

Tom Capo, University of Maryland

Stephanie Cardoos, University of California, Berkeley Crystal Carlson,

Saint Mary’s University of Minnesota Charles Carver, University of
Miami Michelle Caya, Trident Technical College

Sarah P. Cerny, Rutgers University, Camden

Christopher F. Chabris, Union College

Clarissa Chavez, Auburn University

Jonathan Cheek, Wellesley College

Stephen Clark, Keene State College

Caroline Connolly, University of Pennsylvania

Brent F. Costleigh, Brookdale Community College Graham Cousens,

Drew University

Marc Coutanche, University of Pittsburgh

Craig Cummings, University of Alabama

Eric Currence, The Ohio State University

Dale Dagenbach, Wake Forest University

Haydn Davis, Palomar College

Suzanne Delaney, University of Arizona

Heidi L. Dempsey, Jacksonville State University Joseph Dien, Johns

Hopkins University Michael Domjan, University of Texas at Austin

Wendy Domjan, University of Texas at Austin Jack Dovidio, Colgate

University

Dana S. Dunn, Moravian College

Howard Eichenbaum, Boston University

Naomi Eisenberger, University of California, Los Angeles Sadie Leder

Elder, High Point University Clifford D. Evans, Loyola University
Maryland

Patrick Ewell, Kenyon College

Valerie Farmer-Dougan, Illinois State University Greg Feist, San Jose

State University Kimberly M. Fenn, Michigan State University

Fernanda Ferreira, University of South Carolina Vic Ferreira,

University of California, San Diego Holly Filcheck, Louisiana State
University Sara Finley, Pacific Lutheran University

Joseph Fitzgerald, Wayne State University

Trisha Folds-Bennett, College of Charleston

Adam E. Fox, St. Lawrence University

Howard Friedman, University of California, Riverside David C. Funder,

University of California, Riverside Christopher J. Gade, University of
California, Berkeley Christine Gancarz, Southern Methodist University
Wendi Gardner, Northwestern University Preston E. Garraghty,
Indiana University

Margaret Gatz, University of Southern California Caroline Gee,

Saddleback College

Peter Gerhardstein, Binghamton University

Katherine Gibbs, University of California, Davis Bryan Gibson, Central

Michigan University Rick O. Gilmore, Pennsylvania State University
Jamie Goldenberg, University of South Florida Jon Grahe, Pacific
Lutheran University

Leonard Green, Washington University in St. Louis Raymond Green,

Texas A&M–Commerce Sarah Grison, Parkland College

James Gross, Stanford University

Tom Guilmette, Providence College

Meara Habashi, University of Iowa

Jane S. Halonen, University of West Florida

Thomas Wayne Hancock, University of Central Oklahoma Erin E.

Hardin, University of Tennessee, Knoxville Brad M. Hastings, Mount
Ida College Mikki Hebl, Rice University
Nicholas Heck, Marquette University

John Henderson, University of South Carolina

Norman Henderson, Oberlin College

Mark Henn, University of New Hampshire

Justin Hepler, University of Illinois at Urbana-Champaign Terence

Hines, Pace University Sara Hodges, University of Oregon

Cynthia Hoffman, Indiana University

Don Hoffman, University of California, Irvine

James Hoffman, University of Delaware

Kurt Hoffman, Virginia Polytechnic Institute and State University

Tasha R. Howe, Humboldt State University Howard C. Hughes,
Dartmouth College

Mary Hughes-Stone, San Francisco State University Jay Hull,

Dartmouth College

Malgorzata Ilkowska, Georgia Institute of Technology Jake Jacobs,

University of Arizona Alisha Janowsky, University of Central Florida
Jennifer Johnson, Bloomsburg University of Pennsylvania Thomas
Joiner, Florida State University Linda Juang, San Francisco State
University

William Kelley, Dartmouth College

Dacher Keltner, University of California, Berkeley Lindsay A. Kennedy,

University of North Carolina at Chapel Hill Sheila M. Kennison,
Oklahoma State University–Stillwater Mike Kerchner, Washington
College Rondall Khoo, Western Connecticut State University Stephen
Kilianski, Rutgers University Brian Kinghorn, Brigham Young
University, Hawaii Erica Kleinknecht O’Shea, Pacific University
Christopher Koch, George Fox University

Lisa Kolbuss, Lane Community College

William Knapp, Eastern Oregon University

Gabriel Kreiman, Harvard University

Caleb Lack, University of Central Oklahoma

Gerard A. Lamorte III, Rutgers University

Lori Lange, University of North Florida

Mark Laumakis, San Diego State University

Natalie Kerr Lawrence, James Madison University Steven R. Lawyer,

Idaho State University Benjamin Le, Haverford College

Dianne Leader, Georgia Institute of Technology Mark Leary, Duke

University

Ting Lei, Borough of Manhattan Community College Charles Leith,

Northern Michigan University Catherine Craver Lemley, Elizabethtown
College Emily Leskinen, Carthage College

Gary W. Lewandowski Jr., Monmouth University

Celia Lie, University of Otago

Stephanie Little, Wittenberg University

Christine Lofgren, University of California, Irvine Christine Lomore,

St. Francis Xavier University Liang Lou, Grand Valley State University
Jeff Love, Pennsylvania State University

Monica Luciana, University of Minnesota

Agnes Ly, University of Delaware

Margaret F. Lynch, San Francisco State University Kate MacDuffie,

Duke University

Karl Maier, Salisbury University

Mike Mangan, University of New Hampshire

Gary Marcus, New York University

Leonard Mark, Miami University (Ohio)

Howard Markowitz, Hawaii Pacific University

Debra Mashek, Harvey Mudd College

Tim Maxwell, Hendrix College

Ashley Maynard, University of Hawaii

Dan McAdams, Northwestern University

David McDonald, University of Missouri

John McDowall, Victoria University of Wellington Bill McKeachie,

University of Michigan Corrine L. McNamara, Kennesaw State
University Mary E. McNaughton-Cassill, University of Texas at San
Antonio Matthias Mehl, University of Arizona Paul Merritt, Clemson
University

Peter Metzner, Vance-Granville Community College Dennis Miller,

University of Missouri Hal Miller, Brigham Young University

Judi Miller, Oberlin College

Michele M. Miller, University of Illinois, Springfield Ronald Miller, Saint

Michael’s College Vanessa Miller, Texas Christian University
Cindy Miller-Perrin, Pepperdine University

Douglas G. Mook, University of Virginia

Kevin E. Moore, DePauw University

Elizabeth Morgan, Springfield College

Beth Morling, University of Delaware

Heather Morris, Trident Technical College

Joe Morrisey, State University of New York, Binghamton Todd

Nelson, California State University–Stanislaus Julie Norem, Wellesley
College Erica Kleinknecht O’Shea, Pacific University

Maria Minda Oriña, St. Olaf College

Dominic J. Parrott, Georgia State University

Lois C. Pasapane, Palm Beach State College

Kristin Pauker, University of Hawaii

David Payne, Wallace Community College

James Pennebaker, University of Texas at Austin Zehra Peynircioglu,

American University Brady Phelps, South Dakota State University

Jackie Pope-Tarrance, Western Kentucky University Steve Prentice-

Dunn, University of Alabama Gabriel Radvansky, Notre Dame
University

Patty Randolph, Western Kentucky University

Catherine Reed, Claremont McKenna College

Lauretta Reeves, University of Texas at Austin Ann Renken,
University of Southern California Heather Rice, Washington
University in St. Louis Jennifer Richeson, Yale University Alan C.
Roberts, Indiana University

Brent W. Roberts, University of Illinois at Urbana-Champaign Caton

Roberts, University of Wisconsin–Madison William Rogers, Grand
Valley State University Alex Rothman, University of Minnesota

Wade C. Rowatt, Baylor University

Paul Rozin, University of Pennsylvania

Sharleen Sakai, Michigan State University

Samuel Sakhai, University of California, Berkeley Juan Salinas,

University of Texas at Austin Laura Saslow, University of California,
San Francisco Richard Schiffman, Rutgers University Lynne
Schmelter-Davis, Brookdale Community College David A. Schroeder,
University of Arkansas Shannon Scott, Texas Woman’s University

Constantine Sedikedes, University of Southampton Ines Segert,

University of Missouri Margaret Sereno, University of Oregon

Andrew Shatté, University of Arizona

J. Nicole Shelton, Princeton University

Arthur Shimamura, University of California, Berkeley Rebecca Shiner,

Colgate University Jennifer Siciliani-Pride, University of Missouri–St.
Louis Nancy Simpson, Trident Technical College Scott Sinnett,
University of Hawaii

Reid Skeel, Central Michigan University

John J. Skowronski, Northern Illinois University Rachel Smallman,

Texas A&M University Dennison Smith, Oberlin College
Kyle Smith, Ohio Wesleyan University

Mark Snyder, University of Minnesota

Sheldon Solomon, Skidmore College

Sue Spaulding, University of North Carolina, Charlotte Jason

Spiegelman, Community College of Baltimore County Christopher
Stanzione, Georgia Institute of Technology Faye Steuer, College of
Charleston Courtney Stevens, Willamette University

Benjamin C. Storm, University of California, Santa Cruz Dawn L.

Strongin, California State University–Stanislaus James R. Sullivan,
Florida State University Lorey Takahashi, University of Hawaii

George Taylor, University of Missouri–St. Louis Lee Thompson, Case

Western Reserve University Dianne Tice, Florida State University

Rob Tigner, Truman State College

Boyd Timothy, Brigham Young University, Hawaii Peter Tse,

Dartmouth College

Lauren Usher, University of Miami

David Uttal, Northwestern University

Robin R. Vallacher, Florida Atlantic University Kristy L. vanMarle,

University of Missouri Simine Vazire, University of California, Davis
Shaun Vecera, University of Iowa

Anré Venter, University of Notre Dame

Angela Vieth, Duke University

Athena Vouloumanos, New York University

Judith ter Vrugte, University of Twente

Angela Walker, Quinnipiac University

Benjamin Walker, Georgetown University

Elaine Walker, Emory University

Brian Wandell, Stanford University

Kenneth A. Weaver, Emporia State University

Kevin Weinfurt, Duke University

Rajkumari Wesley, Brookdale Community College

Fred Whitford, Montana State University

Doug Whitman, Wayne State University

Gordon Whitman, Old Dominion University

Karen Wilson, St. Francis College

Nicole L. Wilson, University of California, Santa Cruz Clare Wiseman,

Yale University Al Witkofsky, Salisbury University

Heather Cleland Woods, University of Glasgow

Vanessa Woods, University of California, Santa Barbara John W.

Wright, Washington State University Jill A. Yamashita, California
State University, Monterey Bay Dahlia Zaidel, University of California,
Los Angeles Dasa Zeithamova-Demircan, University of Oregon THE
NORTON EDITORIAL TEAM In the modern publishing world,
where most books are produced by large multinational corporations
that focus primarily on the bottom line, W. W. Norton stands out as a
beacon to academics and authors, both for remaining committed to
the best-quality publications and for providing outstanding team
members to help ensure that quality. Norton’s employees own the
company, and therefore every individual who worked on this book
has a vested interest in its success; that personal connection shows
in the great enthusiasm the team members brought to their work.

The past five editions of Psychological Science would simply not exist
without Sheri Snavely. Sheri has reinvented the book over and over
again by inspiring authors to bring their own vision to the text. We
are grateful to Sheri for inviting us into the Norton family for this
edition and encouraging us at each step in the process to let our
voices and perspectives shine through. We deeply valued Sheri’s
guidance and her attention to both the student and instructor
experience of the text.

We are forever indebted to senior developmental editor Beth

Ammerman for her seamless and collaborative editing. A great editor
is most often invisible to the reader, so we wish to inform readers:
When the prose in this revision sings, it is because of Beth.

We are grateful to media editor Kaitlin Coats and her team, assistant
media editor Emilia Pesantes and associate media editor Christina
Fuery, for creating and producing first-rate digital tools to support
both students and instructors. They worked on the ebook and
InQuizitive online assessment; a myriad of top-quality instructor
resources, test questions, and video; and the exciting new 3D brain
and neuron animations. We appreciate all their efforts to ensure
these tools give instructors the highest-quality materials they need
to teach the course and to give students every opportunity to learn
challenging topics interactively and effectively.

Many others also provided crucial support. Assistant editor Chloe

Weiss kept the project running smoothly and managed our rigorous
editorial review program, allowing us to revise chapters based on
high-quality extensive feedback from professors in the field. She also
worked tirelessly to ensure that the book’s content and illustration
program is inclusive, reflecting today’s psychologists and psychology
students in all their variety. Project editor Linda Feldman patiently
saw this project through from start to finish. We are grateful for her
sharp eyes and attention to detail, making sure every change in the
pages was made and finding ways to include all our material while
still having clean and spacious pages. Photo editor Ted Szczepanski
did a wonderful job of researching and editing all the photos in the
book and finding excellent photos that reflect real people from a
wide array of identities. Production managers Eric Pier Hocking, Sean
Mintus, and Richard Bretan made sure all the trains ran on time so
the book and resources were ready for instructors to consider for
their courses. Art director Lissi Sigillo worked her magic in creating a
design that was both beautiful and accessible to a variety of
learners. Head of design at W. W. Norton, Debra Morton Hoyt,
worked to give us a beautiful cover that mirrors the energy and fresh
perspective of the new edition.

THE NORTON SALES AND MARKETING TEAM Thanks to the

book’s marketing manager, Casey Johnson, for analyzing the market
and using her substantial sales experience as the basis for putting
together a cutting-edge and informative marketing campaign. She
understands what instructors and students need to be successful
and is doing a marvelous job of making sure the book’s message
reaches travelers and professors. A big thank-you to psychology
sales specialist Dorothy Laymon, our boots on the ground for rallying
the troops, doing countless presentations, and understanding so
intuitively the challenges that instructors and students face today. In
fact, we are grateful to the whole psychological science sales team—
travelers, managers, science specialists, media specialists, and
institutional sales group. Indeed, the entire sales force, led by Erik
Fahlgren and Dennis Fernandes, has supported this book and is
distinguished by their knowledge of psychology and consultative
partnerships with instructors.
Digital Tools for Instructors
and Students
The Psychological Science teaching and learning resources give you
all the tools you need to increase student retention, understanding,
and engagement.

InQuizitive

Created by a cognitive psychologist, InQuizitive adaptive

assessment is built on evidence-based principles of learning,
including retrieval practice, learning by doing, and metacognitive
monitoring. Personalized question sets target students’ individual
areas for improvement, and formative answer-specific feedback
helps them understand core concepts. Game-like elements and a
variety of interactive question types maximize engagement.

Norton Teaching Tools

Norton Teaching Tools are your first stop when looking for
creative resources to design or refresh your course. The Norton
Teaching Tools site is a searchable, sortable database of resources
for engaging students in active and applied learning, in the
classroom or online. Norton Teaching Tools for Psychological Science
include Active Learning + Lecture PowerPoints, Activities and
Demonstrations, Class Discussion Topics, Suggested Video Links, and
much more.
Another random document with
no related content on Scribd:
organs, as the lung, the testicle, the liver, the spleen, etc. The
dependence of miliary tuberculosis of the pia upon previously-
existing caseous or other inflammatory deposits in some part of the
body is acknowledged by most modern pathologists. Seitz3 states
that out of 130 cases, with autopsies, of adults, upon which his work
is based, such deposits were found in 93.5 per cent. General
constitutional weakness, either congenital or resulting from grave
disease or from overwork, from insufficient or unwholesome food,
and from bad hygienic surroundings, also favors the deposit of
tubercle in the meninges. Sometimes two or more predisposing
causes exist at once. Thus, a child born of tuberculous parents may
be fed with artificial diet instead of being nursed, or may live in a
house whose sanitary condition is bad. Hence the disease is
common among the poor, although by no means rare in the higher
classes of society. In some cases it is difficult or impossible to assign
any predisposing cause. A single child out of a numerous family may
be stricken with the disease, while the rest of the children, as well as
the parents and other ascendants, are healthy. For instance, while
writing this article I had under observation a little boy six years old
whose parents are living and healthy, with no pulmonary disease in
the family of either. The only other child, an older brother, is healthy.
While apparently in perfect health the child was attacked with
tubercular meningitis, and died in seventeen days with all the
characteristic symptoms of the disease. At the autopsy there was
found much injection of the cerebral pia everywhere, a large effusion
of lymph at the base of the brain and extending down the medulla,
abundance of miliary tubercles in the pia and accompanying the
vessels in the lateral regions of the hemispheres, lateral ventricles
distended with nearly clear fluid, ependyma smooth, choroid
plexuses covered with granulations, convolutions of brain much
flattened. Careful investigation, however, will usually enable us to
detect some lurking primary cause, either in the family predisposition
or in the history of the patient himself.
3 Die Meningitis Tuberculosa der Erwachsenen, von Dr. Johannes Seitz, Berlin, 1874,
p. 317.
Season appears to have but little influence on the production of the
disease. The largest number of cases is observed during winter and
spring, owing doubtless to the influence of the temperature and
weather, and to the exclusion from fresh air, in favoring the
development of tubercle and the scrofulous diathesis. Males, both
children and adults, are somewhat more frequently attacked than
females.

In regard to the exciting causes it may be said that where a

disposition to the deposit of tubercle exists, anything which tends to
lower the vitality of the individual is likely to hasten the event. In
infants with hereditary tendency to tubercle, an improper diet is
especially liable to develop meningeal tubercle. In older children,
besides unwholesome or insufficient food and unfavorable hygienic
surroundings, the acute diseases common to that period of life, such
as the eruptive fevers, intestinal disorders, whooping cough, etc.,
often act as immediate causes. Sometimes the development of the
disease may be traced to over-stimulation of the nervous system by
excessive study, often aided by imperfect ventilation or overheating
of the school-room. Caries of the temporal bone from disease of the
middle ear may act as an immediate cause of tubercular meningitis,
although simple meningitis is of course a more frequent result of that
condition. The disease has been known to follow injuries of the head
from blows or falls. In a larger number of cases the exciting cause is
not discoverable, especially when the meningeal affection is simply
an extension of the disease from some other part of the body, as the
lungs, the bronchial or mesenteric glands, etc. This is often the case,
both in adults and in children, when tubercular meningitis
complicates pulmonary consumption.

SYMPTOMS.—The disease is most frequently observed in children

between the ages of two and seven years. It is much less common in
adults, who are generally attacked between the ages of twenty and
thirty years. In the majority of cases the invasion of the malady is
preceded by a prodromic stage, usually occupying from a few days
to several weeks, though sometimes extending over a considerably
longer period. This stage probably represents the process of deposit
of miliary tubercles in the pia mater before their presence has given
rise to much structural change in the tissue. The characteristic
symptoms of the prodromic stage consist chiefly in an alteration of
the character and disposition of the patient, varying in extent in
different cases. In general, it may be said that he becomes sad,
taciturn, apathetic, irritable, indisposed to play, often sitting apart
from his companions, gazing in a strange way into vacancy. There is
diminution or loss of appetite and some emaciation. He is restless at
night, is disturbed by nightmare, or grinds his teeth. The digestion is
deranged. Usually there is constipation, but occasionally diarrhœa,
or these conditions may alternate with each other. Squinting and
twitching of the facial muscles are sometimes noticed. Headache
may occur early in this stage, but it is usually observed later, and it
then forms a prominent symptom. Vomiting is also frequent, usually
not preceded by nausea, sometimes provoked by sudden
movement, as in sitting up in bed, and is apt to occur when the
stomach contains little or no food. These symptoms vary much in
degree, and they are often so slight that they pass unnoticed by the
parents or friends. Occasionally the patient, if a child, will manifest a
strange perversity or an unusual disobedience, for which he is
perhaps punished under the belief that his misconduct is intentional.
In older children and in adults delirium, especially at night,
sometimes followed by delusions which may be more or less
permanent, is frequent at this stage. The above symptoms often
remit from time to time, and during the interval the patient may seem
to have recovered his health. The prodromic symptoms are rarely
altogether wanting in children, although they may have escaped
notice from lack of opportunity of observation on the part of the
physician. On the other hand, as Steffen4 justly observes, the most
characteristic symptoms may be present, and lead even an
experienced observer to a confident diagnosis of tubercular
meningitis during the early stage of a case of typhoid fever or of
cerebral congestion without tuberculosis.
4 “Meningitis Tuberculosa,” by A. Steffen, in Gerhardt's Handb. der Kinderkrankheiten,
5 B., 1ste Abth., 2te Hälfte, p. 465.
For convenience of description it is customary to divide the disease
proper, after the prodromal period, into three stages—viz. of
irritation, compression, and collapse. In some cases it is not difficult
to observe these divisions, but it must be borne in mind that in others
the symptoms do not follow any regular sequence, so that no
division is possible. In infants profound slumber may be the only
morbid manifestation throughout the entire disease. Steffen records
such a case, and I have seen two similar ones.

First Stage: The interval between the prodromic period and the first
stage is usually so gradual that no distinction between the two can
be detected. In other cases the disease is ushered in suddenly by
some striking symptom, such as an attack of general convulsions,
with dilated pupils and loss of consciousness. This is not often
repeated, though partial twitchings of the limbs or of the muscles of
the face may follow at intervals. In young children a comatose
condition, with unequal pupils, is apt to take the place of these
symptoms. The principal phenomena of the first stage are headache,
sensitiveness to light and sound, vomiting, and fever. The latter
varies much in intensity from time to time, but is not usually high, the
temperature seldom rising above 103° F., and usually, but not
always, higher at night than in the morning; but there is no
characteristic curve. The pulse varies in rate, but is usually slow and
irregular or intermittent. The respiration is irregular, with frequent
sighing. The tongue is dryish and covered with a thin white coat. The
bowels are costive. Delirium is frequent at night, and the sleep is
disturbed, the patient tossing about and muttering or crying out. The
eyes are half open during sleep. These symptoms become more
marked from day to day. The pain in the head is more frequent and
severe; the patient presses the hands to the forehead or rests the
head against some support if sitting up. During sleep he occasionally
utters a loud, sharp cry, without waking. There is increasing apathy,
and some intolerance of light, shown by an inclination to turn toward
the wall of the room or to lie with the face buried in the pillow. The
appetite is lost, the constipation becomes more obstinate, the
slowness and irregularity of the pulse persist. With the rapid
emaciation the belly sinks in, so that the spinal column can be easily
felt. Soon the child falls into a state of almost continual somnolence,
from which, however, he can be awakened in full consciousness,
and will answer correctly, generally relapsing again immediately into
slumber. His restlessness diminishes or ceases altogether, and he
lies continuously on the back with the head boring into the pillow. He
becomes more passive under the physician's examination, in strong
contrast to his previous irritability. At the end of a week or more from
the beginning of this stage symptoms of irritation of some of the
cerebral nerves begin to show themselves, in consequence of
pressure from the increasing exudation at the base of the brain and
into the ventricles. Strabismus (usually convergent), twitching of the
facial muscles and grimaces, grinding of the teeth, or chewing
movements of the mouth are noticed. The somnolence deepens into
sopor, from which it becomes more and more difficult to arouse the
patient, who gradually becomes completely insensible.

Notwithstanding the alarming and often hopeless condition which

this assemblage of symptoms indicates, intervals of temporary
amendment not unfrequently take place. The child may awake from
his lethargy, recognize those about him, converse rationally, take his
food with relish, and exhibit such symptoms of general improvement
that the parents and friends are led to indulge in fallacious hopes,
and sometimes the physician himself ventures to doubt the accuracy
of his diagnosis. Such hopes are of short duration; the unfavorable
symptoms always return after a brief interval. The duration of the first
stage may be reckoned at about one week.

Second Stage: This period is not separated from the preceding one
by any distinct change in symptoms. The patient lies in a state of
complete insensibility, from which he can no longer be aroused by
any appeal. The face is pale or of an earthen tint, the eyes are half
closed. If the anterior fontanel be still open, the integument covering
it is distended by the pressure beneath. Often one knee is flexed, the
opposite leg extended; one hand applied to the genitals, the other to
the head. Sometimes one leg or arm is alternately flexed and
extended. The head is apt to be retracted and bores into the pillow.
The pupils are dilated, though often unequal and insensible to light:
the sclerotica are injected; a gummy exudation from the Meibomian
glands forms on the edges of the lids. The patient sighs deeply from
time to time, and occasionally utters a loud, piercing cry. Paralysis,
and sometimes rigidity of one or more of the extremities, are often
observed, and occasionally there is an attack of general convulsions.
The pulse continues to be slow and irregular, the emaciation
progresses rapidly, and the abdomen is deeply excavated. The
discharges from the bladder and rectum are involuntary. The
average duration of the second stage is one week.

Third Stage: No special symptoms mark the passage of the second

stage into the third, which is characterized by coma, with complete
resolution of the limbs. The constipation frequently gives place to
moderate diarrhœa. The distended fontanel subsides, and often
sinks below the margin of the cranial bones. A striking feature of this
stage is a great increase in the rate of the pulse, the heart being
released from the inhibitory influence of the par vagum in
consequence of the complete paralysis of the latter from pressure.
The pulse varies in rapidity from 120 to 160 or more in the minute.
For the same reason the respiration also increases in frequency,
though not to the same degree. The eyelids are widely open; the
pupils are dilated and generally motionless, even when exposed to a
bright light. The eyes are rolled upward, so that only the lower half of
the iris is visible; the sclerotica is injected from exposure to the air
and dust. Convulsions may occur from time to time. Death
terminates the painful scene, usually in from twenty-four to forty-
eight hours, but sometimes the child lives on for days, unconscious,
of course, of suffering, though the afflicted parents and friends can
with difficulty be brought to believe it.

Certain points in the symptomatology of tubercular meningitis

demand especial consideration.

I have already observed that the division of the disease into definite
stages is purely arbitrary, and is employed here merely for
convenience of description; in fact, few cases pursue the typical
course. A period of active symptoms and another of depression can
often be observed, but these frequently alternate. Stupor and
paralysis may characterize the early stage, and symptoms of
irritation, with restlessness, screaming, and convulsions,
predominate toward the end. Certain characteristic symptoms may
be wholly or in part wanting, such as vomiting, constipation, or
stupor.

The temperature shows no changes which are characteristic of the

disease. Throughout its whole course it varies from time to time,
without uniformity, except that it usually rises somewhat toward
night. It seldom exceeds 102° or 103° F., unless shortly before
death, when it may rise to 104° F., or even higher, and may continue
to rise for a short time after death.

During the premonitory stage the pulse offers no unusual

characteristics. Its frequency is often increased, as is usual in any
indisposition during the period of childhood, but it preserves its
regularity. Toward the close of this period, and especially during the
first stage of the disease proper, a remarkable change takes place. It
becomes slow and irregular, the rate often diminishing below that in
health. The irregularity varies in character; sometimes the pulse
intermits, either at regular or irregular intervals. An inequality in the
strength of different pulsations is also observed. These peculiarities
of the circulation are due to the irritation of the medulla and the roots
of the par vagum, by which the inhibitory function of that nerve upon
the action of the heart is augmented. During the last period, on the
other hand, the increasing pressure on the vagus paralyzes its
function, and the heart, freed from its control, takes on an increased
action, the pulse rising to 120 beats, and often many more, in the
minute. Robert Whytt, in his interesting memoir,5 dates the beginning
of the second stage from the time that the pulse, being quick but
regular, becomes slow and irregular; the change again to the normal
frequency, or beyond it, marking the commencement of the third
stage.
5 “An Account of the Symptoms in the Dropsy of the Ventricles of the Brain,” in the
Works of Robert Whytt, M.D., published by his son, Edinb., 1768, p. 729.
In the early stage the respiration presents nothing abnormal, but
when the pulse becomes slow and irregular the breathing is similarly
affected. Sighing is very common in the prodromal period and first
stage. Toward the end of the second stage the increasing paralysis
of the respiratory centre gives rise to the phenomena known as the
Cheyne-Stokes respiration, consisting of a succession of respiratory
acts diminishing in force until there is a complete suspension of the
breathing, lasting from a quarter to three-quarters of a minute, when
the series begins again with a full inspiration. In general, the
variations in the rate of the respiration follow those of the pulse,
though the correspondence is not always exact.

In the early stage of the disease the pupils are usually contracted
and unequal. They are sluggish, but still respond to the stimulus of
light. At a later period they become gradually dilated, and react even
more slowly to light or not at all, the two eyes often differing in this
respect. Ophthalmoscopic examination frequently shows the
appearance of choked disc and commencing neuro-retinitis. In rare
cases tubercles are seen scattered over the fundus of the eye. They
are about the size of a small pin's head, of a yellowish color, and of
sharply-defined contour. Neuro-retinitis and choked disc are not, of
course, pathognomonic of tubercular meningitis, and choroidal
tubercles are so rarely seen as to be of little avail in diagnosis. In
fact, they are less frequent in this disease than in general
tuberculosis without meningitis. In twenty-six cases of tubercular
meningitis examined by Garlick at the London Hospital for Sick
Children they were found only once.6 The effect upon the conjunctiva
of the unclosed lids has been already described.
6 W. R. Gowers, M.D., Manual and Atlas of Medical Ophthalmoscopy, Philada., 1882,
p. 148. See, also, Seitz, op. cit., p. 347; Steffen, op. cit., pp. 452 and 472; and
“Tubercle of the Choroid,” Med. Times and Gazette, Oct. 21, 1882, p. 498.

The tongue is somewhat coated soon after the beginning of the

disease, and the breath is offensive. The appetite is lost, and there is
decided emaciation in many cases during the prodromic period. The
thirst is usually moderate. Vomiting is one of the most constant
symptoms during the first period, and its occurrence on an empty
stomach is characteristic of tubercular meningitis. It is not usually
preceded by nausea, and often takes place without effort, by mere
regurgitation, the rejected fluid consisting chiefly of bile mixed with
mucus. Although constipation is the most common condition in the
early stage, and is often rebellious to treatment, yet in some cases
diarrhœa is observed, which may mislead the physician in respect to
the diagnosis. From the beginning of the second stage, and
sometimes earlier, the discharges from the bowels and the bladder
are involuntary.

DURATION.—The duration of tubercular meningitis, apart from the

prodromic period, which often can hardly be determined, averages
from two weeks to two weeks and a half. In exceptional cases death
may take place in a few days or a week, and occasionally a patient
may linger for several weeks,7 the difference being apparently due to
the rapidity of the tubercular deposit and of the resulting
inflammation and exudation. The patient usually takes to his bed at
the beginning of the first stage, but he may be up during a part of the
day until the beginning of the second. In rare instances the child will
be about, and even out of doors, until a few days before death.
7 Such a case is reported by Michael Collins in the London Lancet, March 8, 1884.

PATHOLOGICAL ANATOMY.—The essential lesion of tubercular

meningitis consists in a deposit of miliary tubercles in the pia mater
of the brain, giving rise to inflammation of that membrane and
exudation of serum and pus. In the early stage both surfaces of the
pia are reddened and more or less thickened, and present an
opaline appearance, while between them—that is, in the meshes of
the pia—we find a colorless and transparent fluid which is effused in
greater or smaller amount, resembling jelly when viewed through the
arachnoid. These conditions are sometimes observable on the
convexity of the hemispheres, but are much more abundant on the
lateral surfaces, and especially at the base. More distinct evidence of
inflammation is shown by the presence of a yellowish or greenish-
yellow creamy deposit on the surface of the pia, consisting chiefly of
pus, which is also much more abundant at the base than elsewhere,
especially about the optic commissure, infundibulum, pons Varolii,
and the anterior surface of the medulla. The cranial nerves may be
deeply imbedded in the deposit, which often extends into the fissure
of Sylvius, gluing together the adjacent surfaces of the lobes, and
accompanies the vessels, forming narrow streaks along the sides of
the brain up to the convexity.

The miliary tubercles or granulations consist of semi-transparent

bodies, grayish or whitish in color, varying in size from that of the
head of the smallest pin, indeed almost invisible to the naked eye, to
that of a millet-seed (whence their name). Larger masses are
frequently seen, formed by the aggregation of smaller granulations.
The tubercles are usually found on the inner surface of the pia,
always in the immediate neighborhood of the blood-vessels, which
they accompany in their ramifications, and are also scattered, in
greater or less numbers, throughout the purulent exudation from the
surface of the pia. They are most abundant at the base of the brain,
ascending the sides along the course of the vessels. Sometimes,
though rarely, they are more abundant on the convexity. The total
number varies; it is usually very large, but sometimes only a limited
number exists, even in well-marked cases, and along with intense
inflammation of the pia. The granulations are found in different
degrees of development—sometimes all of them similar in color,
size, and consistency, at others in various stages of fatty
degeneration. The distribution may be symmetrical in the two
hemispheres or irregular. Under the microscope (after suitable
preparation of the part) the bacillus tuberculosus in considerable
numbers may be found in the pia, in places adjacent to the
arterioles.8
8 See a case reported by Y. Dawson in the London Lancet, April 12, 1884, in which
tubercles were visible only by the microscope with numerous bacilli.

The ventricles of the brain are usually distended with a clear or

opalescent, rarely bloody, fluid, the amount of which generally
corresponds to the intensity and extent of the meningeal
inflammation, although sometimes it is not above the normal
quantity. The two lateral ventricles are affected in an equal degree;
the third and fourth ventricles are more rarely implicated. According
to Huguenin,9 it is doubtful whether acute inflammation of the
ependyma takes place in tubercular meningitis. Steffen also10 says
that the ependyma is not inflamed, and that it is not the seat of the
deposit of tubercles. This latter statement is denied by other
authorities, and Huguenin is inclined to believe that they may exist in
that membrane. In the following case, under my care, abundant
granulations were found on the surface of the ependyma:
9 G. Huguenin, op. cit., p. 499.

10 Op. cit., p. 449.

Olaf M—— (male), æt. 8 years, born in Denmark, entered

Massachusetts General Hospital Sept. 13, 1881. Maternal
grandmother died of consumption; paternal grandfather lived to the
age of ninety-five years. One brother had some disease of hip.
Patient was the child of poor parents and lived in an unhealthy
suburb of Boston. During the two preceding winters he had a bad
cough. He was apparently well till four weeks before his entrance,
when he complained of bellyache, and became listless, but he was
out of doors ten days before he came to the hospital. It was noticed
that he was sensitive to sound. No vomiting, no diarrhœa, no
epistaxis, no cry; some cough. He had been somnolent, and was
observed to swing his arm over his head while asleep. June 14,
when first seen by me, he was lying on his back, unconscious, eyes
half closed, pupils dilated, jaw firmly closed, much emaciated, belly
retracted, left leg occasionally flexed and extended. No priapism.
The optic discs were reddened. June 15, there is some intelligence,
he answers questions; keeps one hand on the genitals. June 16,
pupils contracted, does not swallow. June 18, left eye divergent,
conjunctiva injected, whole surface livid, cries out occasionally. Died
at midnight.

FIG. 30.
Autopsy.—General lividity of surface, much emaciation. Much fine
arborescent injection on outer surface of dura mater. Numerous
Pacchionian bodies. Yellow matter beneath arachnoid along course
of vessels on each side of anterior lobes. Abundant fine granulations
along course of vessels on each anterior lobe, on upper margins of
median fissure, along fissure of Sylvius, and on choroid plexuses.
Very little lymph at base of brain. Six or eight ounces of serum from
lateral ventricles, and abundant fine transparent granules over
ependyma of both. Numerous opaque granulations in pia mater of
medulla oblongata. Surface of right pleura universally adherent.
Mucous membrane of bronchia much injected; a considerable
amount of pus flowed from each primary bronchus. No tubercles in
lungs nor in peritoneum. No ulcerations in intestines. No other
lesions.

The choroid plexuses are generally involved in the inflammatory

process, and are sometimes covered with yellow purulent
exudations. As in the above case, large numbers of tubercles may
be found in them, notwithstanding the opinion of Huguenin that their
number is always small.

The substance of the brain in the vicinity of the tubercular deposit is

generally found in a more or less œdematous condition, owing to the
obstruction of the circulation resulting from compression of the
vessels by the tubercles and effused lymph. Softening, sometimes
even to diffluence, not unfrequently occurs in the neighborhood of
the deposit, probably from ischæmia (necrobiosis). If there be any
considerable amount of exudation in the ventricles, the convolutions
are flattened by compression against the cranial bones.

The above-described lesions are not confined to the brain, but may
extend to the cerebellum, the pons, the medulla, and the spinal cord.
If examinations of the latter were more frequent in autopsies of this
disease, we should doubtless find, as has been done in some
instances, that the membranes often show the characteristic
alterations of tubercular meningitis, and even the presence of
granulations in the cord itself. The lesions may extend throughout
the cord, and are especially noticed in the dorsal region and in the
vicinity of the cauda equina. Their presence explains some of the
symptoms evidently due to spinal origin, such as retraction of the
head with rigidity of the neck and of the trunk, contractions of the
limbs, tetanic spasms, priapism, paralysis of the bladder and rectum,
etc., which are common in simple spinal meningitis.
The deposit of miliary tubercles in the pia mater, with little or no
accompanying meningitis, is met with in rare instances. The
tubercles are few in number, but vary in dimensions, being
sometimes united together in masses of considerable size, which are
frequently encysted. Beyond thickening and opacity of the
membrane, their presence seems to excite but little inflammatory
reaction, but they are generally accompanied by ventricular effusion
which by its pressure gives rise to characteristic symptoms.

The principal lesions found in other organs of the body consist of

tubercle in various stages of development, caseous matter, diseases
of the bones, etc. Miliary granulations are chiefly seen in the lungs,
peritoneum, intestinal mucous membrane, pleura, spleen, liver, and
kidneys. The bronchial and mesenteric glands often contain caseous
masses, some of which are broken down and suppurating. The
testicles sometimes present the same appearances. In adults, the
most frequent lesion which is found external to the brain is
pulmonary tuberculosis in a more or less advanced stage. Tubercles
are also sometimes present in the eye. Angel Money11 states that out
of 44 examinations made at the Hospital for Sick Children, London,
the meninges were the seat of gray granulations in 42. The choroid
(one or both) showed tubercles 14 times (right 3, left 5, both 6), and
11 times there were undoubted evidences of optic neuritis. Twice the
choroid was affected with tubercle when the meninges were free; in
one of these instances there was a mass of crude tubercle in the
cerebellum; in the other, although there were tubercles in the belly
and chest, there were none in the head. So that 12 times in 42 cases
of tubercles in the meninges there were tubercles in the choroid—i.e.
about 31 per cent.
11 “On the Frequent Association of Choroidal and Meningeal Tubercle,” Lancet, Nov.
10, 1883.

DIAGNOSIS.—In many cases tubercular meningitis offers but little

difficulty in the diagnosis. Although the symptoms, taken singly, are
not pathognomonic, yet their combination and succession, together
with their relation to the age, previous health, and antecedents of the
patient, are usually sufficient to lead us to a correct opinion. The
prodromic period of altered disposition (irritability of temper or
apathetic indifference), headache, constipation, vomiting, and
emaciation, followed by irregularity and slowness of the pulse,
sighing respiration, sluggishness and irregularity of the pupils; the
progress from somnolence to unconsciousness and coma; the
sudden lamentable cry; the convulsions and paralysis; the return of
rapid pulse and respiration in the last stage,—are characteristic of no
other disease. Our chief embarrassment arises during the insidious
approach of the malady, before its distinctive features are visible or
when some important symptom is absent. Its real nature is then apt
to be overlooked, and, in fact, in some cases it is impossible to
decide whether the symptoms are indicative of commencing cerebral
disease, or, on the other hand, are owing to typhoid fever, to a
simple gastro-intestinal irritation from error in diet, to worms in the
alimentary canal, to overwork in school, or to some other cause.
Under these circumstances the physician should decline giving a
positive opinion until more definite signs make their appearance. It
must be remembered that very important symptoms may be absent
in cases which are otherwise well marked. In all doubtful cases the
family history should, if possible, be obtained, especially whether
one or both parents or other near relatives have been consumptive
or have shown symptoms of scrofula or tuberculosis in any form, and
whether the patient himself has signs of pulmonary tuberculosis, of
enlarged or suppurating glands, or obstinate skin eruptions. The
presence or history of those conditions would add greatly to the
probability of tubercular meningitis.

The diseases for which tubercular meningitis is most liable to be

mistaken are acute simple meningitis, typhoid fever, acute gastro-
intestinal affections, eclampsia of infants and children, worms in the
intestines or stomach, the hydrencephaloid disease of Marshall Hall,
and cerebro-spinal meningitis.

Acute meningitis is distinguished from the tubercular disease by its

sudden invasion without prodromatous stage, by the acuteness and
intensity of the symptoms, the severity of the headache, the activity
of the delirium, the greater elevation of the temperature, and by its
brief duration, which rarely exceeds one week. In those exceptional
cases of tubercular meningitis in which the prodromal period is
absent or not observed and the course is unusually rapid, it would be
perhaps impossible to distinguish between the two diseases. A
family history of tubercle, or the discovery of the granulations in the
choroid by ophthalmoscopic examination, might save us from error
under such circumstances. The great rarity of idiopathic simple
meningitis should be remembered. Meningitis from disease of the
ear sometimes resembles the tubercular affection, but the history of
the attack, usually beginning with local pain and otorrhœa, will in
most cases prevent any confusion between the two forms of
disease.

The early period of typhoid often bears considerable resemblance to

that of tubercular meningitis. Headache, languor, restlessness, and
mild delirium are common to both. Typhoid can be distinguished by
the coated tongue, the diarrhœa, the enlargement of the spleen, the
tympanites, abdominal tenderness and gurgling, the eruption, and,
above all, by the characteristic temperature-curve, which, if
accurately observed, is conclusive. The course of typhoid fever is
comparatively uniform, while that of tubercular meningitis is often
extremely irregular. It should not be forgotten that the two diseases
may coexist.

The presence of worms in the alimentary canal may cause

symptoms somewhat like those of tubercular meningitis, and the
symptoms of the latter disease are occasionally erroneously
attributed to those parasites. The administration of an anthelmintic,
which should never be omitted in doubtful cases, will clear up all
uncertainty.

Cerebro-spinal meningitis is usually an epidemic, and therefore not

likely to be confounded with the tubercular disease. In sporadic
cases it can be recognized by its sudden onset and acute character,
by the eruption, and by the prominence of the spinal symptoms.
The so-called hydrencephaloid disease of Marshall Hall is a
condition of exhaustion and marasmus belonging to infancy, caused
by insufficient or unsuitable nourishment, by diarrhœa, and by the
injudicious depletive treatment so much in vogue in former times,
when the affection was much more common than at present. Some
of its symptoms, such as sighing respiration, stupor, pallor, and
dilated pupils, bear a certain resemblance to those of tubercular
meningitis, though it would be more easily confounded with chronic
hydrocephalus. The absence of constipation, headache,
convulsions, and vomiting, and the favorable results of suitable
nourishment and stimulants, serve to distinguish it from cerebral
disease.

Eclampsia, or sudden convulsion, is common in infants and young

children, and, since the occurrence of a fit may be the first or the
most striking symptom in tubercular meningitis, it is important to
ascertain its origin. In the majority of cases convulsions in children
arise from some peripheral irritation, such as difficult dentition,
worms in the alimentary canal, constipation, fright, etc., acting
through the reflex function of the spinal cord, which is unusually
sensitive in the early period of life. The absence of previous
symptoms, and the discovery of the source of the irritation, with the
favorable effect of its removal by appropriate treatment, will in most
cases suffice to eliminate structural disease of the brain. In others
we must withhold a positive opinion for a reasonable time in order to
ascertain whether more definite symptoms follow. Convulsions also
occasionally form the initial symptom of the eruptive fevers,
especially scarlatina. Here the absence of prodromal symptoms, and
the speedy appearance of those belonging to the exanthematous
affection, will remove all sources of doubt. Convulsions, with or
without coma, occurring in the early stage of acute renal
inflammations, may simulate the symptoms of tubercular meningitis.
An examination of the urine will show the true nature of the disease.

In addition to the above diseases there are some cerebral affections

of uncertain pathology which resemble tubercular meningitis, but
which are not generally fatal. As Gee justly remarks,12 “Every
practitioner from time to time will come across an acute febrile
disease accompanied by symptoms which seem to point
unmistakably to some affection of the brain, there being every
reason to exclude the notion of suppressed exanthemata or
analogous disorders. After one or several weeks of coma, delirium,
severe headache, or whatever may have been the prominent
symptom, the patient recovers, and we are left quite unable to say
what has been the matter with him. To go more into detail, I could not
do otherwise than narrate a series of cases which would differ from
each other in most important points, and have nothing in common
excepting pyrexia and brain symptoms. There is, generally,
something wanting which makes us suspect that we have not to do
with tubercular meningitis. Brain fever is as good a name as any
whereby to designate these different anomalies; cerebral congestion,
which is more commonly used, involves an explanation which is
probably often wrong, and certainly never proved to be right.” No
doubt such cases are occasionally cited as examples of recovery
from tubercular meningitis.
12 “Tubercular Meningitis,” by Samuel Jones Gee, M.D., in Reynolds's System of
Medicine, Philada., 1879, vol. i. p. 832.

PROGNOSIS.—Although there are on record undoubted instances of

recovery from tubercular meningitis, yet their number is so small that
practically the prognosis is fatal. It is safe to say that in almost all the
reported cases of recovery the diagnosis was erroneous.13 Even
should the patient survive the attack, he is usually left with paralyzed
limbs and impaired mental faculties, and dies not long afterward from
a recurrence of the disease or from tuberculosis of the lungs or other
organs.
13 Hahn, “Recherches sur la Méningite tuberculeuse et sur le Traitement de cette
Maladie” (Arch. gén. de méd., 4e Série, vols. xx. and xxi.), claims to have cured 7
cases, but of 5 of them there is no evidence that they were examples of tubercular
meningitis at all. The subject of the curability of tubercular meningitis is ably treated
by Cadet de Gassicourt (Traité clinique des Maladies de l'Enfance, vol. iii., Paris,
1884, p. 553 et seq.). His conclusion is that most of the alleged cures are cases of
 meningitis of limited extent, arising from the presence of tubercular tumors, syphilitic
gummata, cerebral scleroses, and neoplasms of various kinds.

TREATMENT.—In view of the fatality of the disease, and of its frequent

occurrence in childhood, the prophylactic treatment is of great
importance. Every effort should be made to protect children whose
parents or other near relatives are tuberculous or scrofulous, and
who are themselves delicate, puny, or affected with any
constitutional disorder, from tubercular meningitis, by placing them in
the best possible hygienic conditions. Pure air, suitable clothing,
wholesome and sufficient food, and plenty of out-of-door exercise
are indispensable. Sedentary amusements and occupations should
be sparingly allowed. Especial pains should be taken to prevent
fatigue by much study, and school-hours should be of short duration.
The hygiene of the school-room is of paramount importance, and if
its ventilation, temperature, and light are not satisfactory, the child
should not be permitted to enter it. The bed-chamber should be well
ventilated night and day. A sponge-bath, cold or tepid according to
the season or to the effect on the patient, should be given daily,
followed by friction with a towel. The bowels must be kept regular by
appropriate diet if possible, or by simple laxatives, such as magnesia
or rhubarb. For delicate, pale children some preparation of iron will
be useful. The choice must be left to the practitioner, but one of the
best in such cases is the tartrate of iron and potassium, of which
from two to six grains, according to the age, may be given three
times daily after meals. Cod-liver oil is invaluable for scrofulous
patients or where there is a lack of nutrition. A teaspoonful, given
after meals, is a sufficient dose, and it is usually taken without
difficulty by children, or if there be much repugnance to it some one
of the various emulsions may be tried in proportionate dose. Along
with this, iodide of iron will in many cases be found useful or as a
substitute for the oil when the latter cannot be borne. It is best given
in the form of the officinal syrup, in the dose of from five to twenty
drops. Change of air is useful in stimulating the nutritive functions,
and a visit to the seashore or mountains during warm weather will
often be followed by general improvement.
Since it is not possible to arrest the disease when once begun, the
efforts of the physician must be directed toward relieving the
sufferings of the patient as far as possible. In the early period the
restlessness at night and inability to sleep will call for sedatives, such
as the bromide of sodium or of potassium, in the dose of ten or
fifteen grains at bedtime or oftener. This should be well diluted with
water, sweetened if necessary. The addition of five to twenty drops of
the tincture of hyoscyamus increases the effect. Sometimes chloral
hydrate, either alone or combined with the bromide when the latter
fails, will procure quiet sleep. From five to ten grains may be given at
a dose, according to the age. Compresses wet with spirit and water
or an ice-cap may be applied to the head if there be much pain in
that region, or it may be necessary to give opium in some of its forms
by the mouth, such as the tincture or fluid extract, in doses of from
one to five drops. Constipation is best overcome by means of
calomel in three- to five-grain doses, to which may be added, when
necessary, an equal amount of jalap powder, or an enema of
soapsuds may be administered. Active purging should be avoided.
Liquid nourishment, such as milk, gruel of oatmeal, farina, or barley,
beef-tea, broths, etc., must be given in moderate quantities at
intervals of a few hours so long as the patient is able to swallow.
Occasional sponging of the whole surface with warm or cool water,
and scrupulous attention to cleanliness after defecation, especially
when control of the sphincters is lost, will add to his comfort. He
should occupy a large and well-ventilated chamber, from which all
persons whose presence is not necessary for his care and comfort
should be excluded. He should be protected from noise and from
bright light, and should lie on a bed of moderate width for
convenience of tending.

There is no specific treatment at present known which is likely to be

of any benefit in this disease, any more than in tuberculosis of other
organs than the brain. Common experience has shown that mercury,
which formerly had so high a reputation in the treatment of cerebral
diseases of early life, not only fails completely, but adds to the
sufferings of the patient when pushed to salivation. The iodide of
potassium is recommended by almost all writers, but, so far as I