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 Maps, Figures and
“Myth and Culture”

MAPS
1. Greece and the Near East, pages 108–109
2. Greece and Asia Minor, pages 410–411
3. The Return of Odysseus, page 533
4. The Labors of Heracles, page 565
5. The Voyage of the Argo to Colchis, page 617
6. Map of the World According to the Ideas of Hecataeus of Miletus,
page 625
7. Roman Italy and Sicily, page 675
8. Map of Early Rome, page 692
9. Greece, Crete and the Aegean, inside back cover

FIGURES
1. Genealogy of the Gods, inside front cover
2. Timeline of Historical Events and Authors, pages 54–55
3. Descendants of Chaos, page 64
4. Children of Ge and Uranus, page 65
5. Descendants of the Titans, page 67
6. Family of Prometheus, page 85
7. Lineage of Major Deities, page 118
8. Plan of the Temple of Zeus, page 124
9. Descendants of the Sea, page 175
10. Descendants of Medusa, page 175
11. Plan of the Parthenon, page 181
12. Sectional Drawing of the East End of the Parthenon, page 182
13. The Children of Cadmus, page 306
14. The Kings of Thebes, page 416
15. Descendants of Chthonius, page 420
16. The Dynasties of Thebes, page 421
17. The House of Atreus, page 447
vii
viii Maps, Figures and “Myth and Culture”

18. The Royal House of Troy, page 482

19. The Ancestry of Perseus, page 552
20. The Ancestry of Heracles, page 563
21. The Royal Families of Athens, page 591
22. Plan of the Erechtheum, page 592
23. The Ancestry of Jason, page 616

MYTH AND CULTURE

1. The Palace at Cnossus, page 42
2. Saturn Devouring His Children, page 74
3. The Altar of Zeus at Pergamon, page 90
4. Raphaël and Poussin, page 172
5. Athena Parthenos and Pallas Athena, page 184
6. Pygmalion and the Image, page 198
7. Images of Apollo, page 272
8. The Niinnion Pinax and the Celebration of the Mysteries
at Eleusis, page 352
9. Ovid and the Iconography of the Rape of Europa, page 418
10. Two Returns of Odysseus, page 536
11. The Temple of Zeus at Olympia and its Sculptural Program, page 570
12. The Rape of Lucretia, page 704
 Preface

IT IS NOW MORE than forty years since the manuscript of Classical Mythology
was submitted to the publishers. The original authors have now revised the book
through nine more editions while keeping their research in the field current.
Our work is conceived as a comprehensive source where one may go to explore
in depth the nature of the Greek and Roman deities and the heroes and heroines
of saga; in a few words, a fundamental text for the serious study of the subject of
classical mythology. Yet we also have intended to provide a fertile source where
one may nourish a sympathetic understanding of the great mythological heritage
bestowed by classical antiquity. We also consider the great influence of classical
mythology upon diverse artistic forms (painting, sculpture, literature, music, op-
era, dance, theater, and cinema) to be a most enjoyable and rewarding subject, too
important to be ignored. Although this influence becomes the focus of the chap-
ters in Part Four (The Survival of Classical Mythology), it permeates all aspects
of our presentation throughout. The tenacious persistence of Greek and Roman
mythology undeniably remains vital and pervasive in our contemporary world.
Greek and Roman myths, of indelible beauty and with great power to inspire,
present a particularly fertile and inexhaustible venue for the appreciation of the
cultural, intellectual, and artistic history of Western civilization.
Originally, Professor Morford and Professor Lenardon each undertook the
major responsibility for certain sections—Professor Lenardon wrote Part One
(Chapters 1–16) and Chapter 28 in Part Four, and Professor Morford wrote Parts
Two and Three (Chapters 17–26) and Chapter 27 in Part Four. We have continued
to use this approach, although in subsequent revisions all three authors have
contributed freely throughout the book.

Translations
Successive revisions have been extensive and far-reaching, in grateful response
to the many sensitive and appreciative critics over these many years. They have
consistently encouraged us to remain firm in our conviction that the literary
tradition of Greek and Roman mythology must always remain primary, but they
have also confirmed our need and desire to incorporate, in so far as possible,
additional comparative and interpretative approaches and more far-reaching
evidence from other sources such as archaeology.
Translations of the ancient authors remain extensive, and none has been
deleted from this edition. The majority of them throughout the book (except for
Chapters 26 and 27) are by Professor Lenardon, including all thirty-three of the
ix
x Preface

Homeric Hymns; all the important passages in Hesiod’s Theogony and Works and
Days; and excerpts (many of them substantial) from Homer, Aeschylus, Sopho-
cles, Euripides, Herodotus, Plato, and, in Latin, Ovid and Vergil. These texts
are interspersed with interpretative commentary and analysis to elucidate their
mythological and literary significance and afford insightful and challenging av-
enues of interpretation.
Shorter excerpts from many other authors are included, such as the lyric po-
ets, the pre-Socratic philosophers, Pindar, and Lucian; and the Latin authors Sta-
tius, Manilius, and Seneca.
All translations are our own.

Spelling
Consistency in spelling has proven impossible to attain. In general, we have ad-
opted Latinized forms (Cronus for Kronos) or spellings generally accepted in
English-speaking countries (Heracles, not Herakles). Since non-Latinized spell-
ing of Greek names has become fashionable, we include an appendix listing
Greek spellings of important names with their Latinized and English equiva-
lents, which will serve as a paradigm of the principles of transliteration.

Art Program
Every aspect of Classical Mythology’s design and richly rewarding art program
has been given great care and attention as we prepared the tenth edition. To the
abundance of color illustrations that first appeared in the ninth edition, we have
added another forty new images.
The illustrations have been an integral part of the work since its inception. Pro-
fessor Morford was originally responsible for their selection and for the captions
in the first eight editions; for the ninth edition, the first to appear in full color, the
opinions of the many colleagues and reviewers also informed our selections. All
three authors have taken part in the selection of illustrations for this new edition,
a process that has often required painful decisions about what to leave out, but
one that has also led generally to a consensus about what to include. Professor
Morford and Professor Sham have divided the responsibility for writing the new
captions. Robert Lenardon was responsible for the illustrations that have been
added to Chapter 28. We are especially grateful to Michelle Koufopoulos, editorial
assistant at Oxford University Press, and researcher Francelle Carapetyan for their
persistence in obtaining permissions from copyright holders. As with the ninth
edition, the Lexicon Iconographicum Mythologiae Classicae has been an invaluable
resource, and as before Professor Morford’s own research and visits to museums
and exhibitions have been a fruitful source for our selections.
An Instructor’s Resource DVD that includes all of the images reproduced in
this book is available to adopters for classroom use.

New to the Tenth Edition

• NEW feature: “Myth and Culture” The visual program of the tenth edition
is further enriched by a new feature entitled “Myth and Culture.” In twelve
illustrated essays throughout the text, “Myth and Culture” allows a close
 Preface xi

and careful comparative study of the ways in which mythical figures and
episodes have been depicted by different artists in a variety of media. Profes-
sor Sham was responsible for the new “Myth and Culture” feature.
• NEW Chapter 25: “Greek Mythology in the Roman World” Professor Mor-
ford has completely refashioned the former Chapter 25, “Greek and Roman
Legends in Ovid’s Poetry,” and incorporated that material into a much larger
and more comprehensive discussion about the influence of Greek myth on
Roman culture, art, architecture, and literature.
• Professor Lenardon has made revisions, additions, and improvements
throughout the text as the result of careful reading to ensure clarity. He has
also updated all the bibliographies, including CDs and DVDs.

Supplements
The tenth edition of Classical Mythology offers a complete suite of ancillaries for
both instructors and students: a teacher’s manual (with outlines of each chap-
ter), commentaries, translations, and test bank; a supplemental volume, Now
Playing, which presents a critical selection of film, dance, and music on mythical
themes; and a popular, comprehensive Companion Website (www.oup.com/
us/morford), which students will find invaluable as a useful study aid for the
richness and variety of its offerings (for more on this free service, see page xv).
Oxford University Press also extends discounted packaging for customers
wishing to assign Classical Mythology with any Oxford World’s Classic text
(www.oup.com/us/owc). For more information, please contact your Oxford Uni-
versity Press sales representative at 1-800-445-9714.

Now Playing
Designed specifically to accompany Classical Mythology and prepared by Pro-
fessor Sham, Now Playing: Learning Classical Mythology Through Film illustrates
how classical myths have inspired new adaptations in film, dance, and music,
with descriptions from a wide selection of films and television episodes. Each
entry provides a preview of each work, designed to inform an appreciation of the
material, an extended treatment of individual scenes, and questions for discus-
sion or written homework assignments. Both instructor and student editions are
available.

Instructor’s Resource DVD

Available to adopters and designed to facilitate instruction, the Instructor’s
Resource DVD provides full-color digital files for the nearly 200 illustrations,
twenty-two figures, and eight maps in the text.

Acknowledgments
We have received help and encouragement from many colleagues, students, and
friends over the years and generous support from numerous people involved
xii Preface

in editorial development, production, and publication of the ten editions of this

book. To all who have contributed so much, we are deeply grateful.
In particular, for this edition we are thankful to Barbara Polowy, director of
the Hillyer Art Library at Smith College, and to the following reviewers for criti-
cism and specific suggestions:

Corey E. Andrews Janice Siegel

Youngstown State University Hampden-Sydney College
Terri R. Hilgendorf Richard A. Spencer
Lewis & Clark Community College Appalachian State University
Allan Johnston Carolyn Whitson
Columbia College Metropolitan State University
Sherri Mussatto
Rose State College

This new edition would not have been possible without the enthusiastic and
vigorous support of John Challice, Higher Education Publisher at Oxford Univer-
sity Press. Others vital to us at the Press who also deserve our sincere thanks are:
Charles Cavaliere, Executive Editor; Meg Botteon, Senior Development Editor;
Lisa Grzan, Production Manager; Sarah Vogelsong, Copyeditor; Heather Dub-
nick, Proofreader; Susan Monahan, Indexer; David Bradley, Production Editor;
and Michele Laseau, Art Director.
Charles Alton McCloud has continued to share his expertise in music, dance,
and theater, as he has done from the beginning.

Mark P.O. Morford

Robert J. Lenardon
Michael Sham
 About the Authors

MARK MORFORD is Professor Emeritus of Classics at the University of

Virginia, where he joined the faculty in 1984 after teaching for twenty-one years
at The Ohio State University and serving as chairman of the Department of
Classics. He also served as Kennedy Professor of Renaissance Studies at Smith
College, where he holds a research appointment in the Mortimer Rare Book
Room of the Neilson Library. As vice president for education of the American
Philological Association, he actively promoted the cooperation of teachers and
scholars in schools and universities. Throughout his fifty years of teaching he
has been devoted to bringing together teachers of classical subjects and teachers
in other disciplines. He has published books on the Roman poets Persius and
Lucan and the Renaissance scholar Justus Lipsius (Stoics and Neostoics: Lipsius and
the Circle of Rubens), as well as many articles on Greek and Roman literature and
Renaissance scholarship and art. His book The Roman Philosophers was published
in 2002, and he is currently working on a new book, The Ancient Romans.

ROBERT LENARDON is Professor Emeritus of Classics at The Ohio State

University, where he was on the faculty for twenty-five years and served
as director of graduate studies in classics. He has taught at several other
universities, including the University of Cincinnati, Columbia University, and
the University of British Columbia. He was a visiting fellow at Corpus Christi
College, Cambridge University, and has written articles on Greek history and
classics and a biography, The Saga of Themistocles. He has served as book review
editor of the Classical Journal and presented radio programs about mythology in
music, a subject dear to his heart. The afterlife of classical subjects and themes in
literature, music, film, and dance has also become favorite areas of teaching and
research. For the fall semester of 2001, he was appointed Visiting Distinguished
Scholar in Residence at the University of Louisville, Kentucky. His translations
from the Greek Anthology have been set to music by Gerald Busby, in a work
entitled Songs from Ancient Greek, for tenor and piano (premiere, Carnegie Hall,
2005). He is currently completing a history, Hubris: The Persian Wars against the
Greeks.

MICHAEL SHAM is Professor of Classics at Siena College, where for the past
twenty years he has developed a small but vigorous program. He is currently
Chair of the Department of Modern Languages and Classics at Siena College.
Throughout his teaching career he has been dedicated to bringing the value
of a classical education to a wider audience. He has worked to bring together

xiii
xiv About the Authors

scholars, writers, and artists across traditional academic disciplines to explore

the continually renewed vitality of the classical tradition. He has written
and spoken on a wide range of scholarly interests, including the influence of
Ovid’s Metamorphoses on contemporary American poets and the adaptation
and production of Greek tragedy for the contemporary stage. He has himself
written an adaption of Euripides’ Iphigenia in Aulis to some acclaim. He was a
contributing author to A Companion to Classical Mythology (Longman, 1997). He
is responsible for the Companion Website, the Instructor’s Manual for Classical
Mythology, and the Now Playing supplement. He is currently working on a book
about the influence of the lliad and Odyssey on contemporary culture.
 About the Website

We have consistently, deliberately, and conscientiously developed the website as

a valuable pedagogical resource to be used in conjunction with the text of this
book, and many of our readers have expressed their gratitude. Therefore, we
never intend to insert a box at the end of each chapter with a few names or topics
singled out at random as important—such a futile and vain attempt would be not
only misleading but virtually useless because of the complexity of our subject.
The flashcards (on the website) for each chapter identify the significant names
and key terms and also include audio pronunciations (which are essential today,
since pronunciation of classical names is a nightmare for students and mispro-
nunciation has too often become the norm for everyone, except for a few).
Here are the vital pedagogical features of the website:

• Pronunciations: Names are first introduced with a guide to pronunciation,

followed by their Greek spelling and Roman equivalent, for example, Athena
[a-thee’– na] or Athene (Minerva). An interactive audio guide to pronuncia-
tion has been added (MP3 files).
• Summaries: Chapter-by-chapter summaries include synopses of lengthy
translations, such as those of the Homeric Hymns and Greek drama.
• Translations: In successive editions of the book we have removed a few of
our earlier translations to make space for new ones. All translations deleted
from any edition of the text appear on the website (e.g., two of Lucian’s sat-
ires about the Underworld, Homer’s account of Proteus, Mimnermus’ poem
about Helius, and Seneca’s depiction of Tantalus).
The sections of Hesiod’s Theogony that are excerpted and discussed in the
book are presented as a continuous text for reference and study, including
lines 1–115, concerning the Muses, which appeared in the seventh edition and
were deleted from the text.
Many more translations are also included that have never appeared in the
book, such as Vergil’s account of Orpheus and Eurydice (narrated by Aris-
taeus), which offers rewarding comparison with Ovid’s version found in the
text, and Catullus’ powerful depiction of Cybele and Attis. These are easily
accessed, like all the other translations and material on the website.

• Ancient Sources: A comprehensive list of precise references to the ancient

authors for the myths and legends, deities, and heroes offers ready access to
the primary sources.

xv
xvi About the Website

• Works of Art: We have harnessed the potential of the Internet to search out
resources of every sort, particularly in the visual arts. We have included on
the website a section entitled Representations in Art in which we discuss the
pervasive influence of mythological themes on the visual arts from antiquity
to the present day. From Chapters 3–26 we highlight the most important
contributions to the visual arts inspired by classical mythology. This section
contains links to a wide selection of works available for viewing on the web,
so that students may study this artistic legacy for themselves.
• Bibliographies and Discographies: The bibliographies are much more ex-
tensive than could possibly be included in a textbook. We have enlarged all
the bibliographies, which include works in music, dance, and film on CD and
DVD. All are keyed to each chapter for easy reference.
• Comparative Mythology: We have included a wide variety of concise essays
on themes relating to the study of comparative mythology, including Indian,
Norse, and Celtic mythology.
• Maps: To provide a tool for the study of the geography of the ancient world,
we have included all the maps from the text of the tenth edition, both in
labeled and blank versions. In addition, the website for the tenth edition in-
cludes interactive maps that allow students to engage with six of the eight
maps in a dynamic fashion.

We encourage readers to discover for themselves the many riches and re-
wards that can be found on the website, which has been designed to complement
Classical Mythology: www.oup.com/us/morford.
 PART ONE

The Myths of Creation:

The Gods

William Blake, The Ancient of Days

 PART ONE
Myths of Creation: The Gods

1 Interpretation and Definition of Classical Mythology 3

2 Historical Background of Greek Mythology 40
3 Myths of Creation 61
4 Zeus’ Rise to Power: The Creation of Mortals 84
5 The Twelve Olympians: Zeus, Hera, and Their Children 117
6 The Nature of the Gods and Greek Religion 140
7 Poseidon, Sea Deities, Group Divinities, and Monsters 168
8 Athena 179
9 Aprodite and Eros 193
10 Artemis 227
11 Apollo 251
12 Hermes 285
13 Dionysus, Pan, Echo, and Narcissus 304
14 Demeter and the Eleusinian Mysteries 339
15 Views of the Afterlife: The Realm of Hades 359
16 Orpheus and Orphism: Mystery Religions in Roman Times 388
 1
Interpretation and Definition
of Classical Mythology
PHAEDRUS: Tell me, Socrates, was it not somewhere around here by the stream
of Ilissus that Boreas is said to have carried off Oreithyia?
SOCRATES: That’s the story.
PHAEDRUS: It was around here, wasn’t it? At any rate, the stream is beautiful,
pure and clear, and perfect for young girls to play along.
SOCRATES: No, it was down farther. . . . There is an altar there to Boreas, I
think.
PHAEDRUS: I didn’t know that. But tell me, Socrates, by Zeus, do you believe
this story is true?
—PLATO, Phaedrus 229b

THE IMPOSSIBILITY OF ESTABLISHING a satisfactory definition

of myth has not deterred scholars from developing comprehensive
theories on the meaning and interpretation of myth, often to provide
bases for a hypothesis about its origins. Useful surveys of the principal
theories are readily available, so we shall attempt to touch upon only a
few theories that are likely to prove especially fruitful or are persistent
enough to demand attention. One thing is certain: no single theory of
myth can cover all kinds of myths. The variety of traditional tales is
matched by the variety of their origins and significance; as a result,
no monolithic theory can succeed in achieving universal applicability.
Definitions of myth will tend to be either too limiting or so broad as to
be virtually useless. In the last analysis, definitions are enlightening
because they succeed in identifying particular characteristics of differ-
ent types of stories and thus provide criteria for classification.
The word myth comes from the Greek word mythos, which means
“word,” “speech,” “tale,” or “story,” and that is essentially what a myth
is: a story. Some would limit this broad definition by insisting that the
story must have proved itself worthy of becoming traditional.1 A myth
may be a story that is narrated orally, but usually it is eventually given
written form. A myth also may be told by means of no words at all, for

3
4 Chapter 1 I NTERPRETATION AND D EFINITION OF C LASSICAL MYTHOLOGY

example, through painting, sculpture, music, dance, and mime, or by a combina-

tion of various media, as in the case of drama, song, opera, or the movies.
Many specialists in the field of mythology, however, are not satisfied with
such broad interpretations of the term myth. They attempt to distinguish “true
myth” (or “myth proper”) from other varieties and seek to draw distinctions in
terminology between myth and other words often used synonymously, such as
legend, saga, folktale, and fairytale.2

True Myth or Myth Proper and Saga or Legend

As opposed to an all-encompassing definition for the general term myth, true
myth or myth proper is used for stories primarily concerned with the gods and
humankind’s relations with them. Saga or legend (and we use the words in-
terchangeably) has a perceptible relationship to history; however fanciful and
imaginative, it has its roots in historical fact.3 These two categories underlie the
basic division of the first two parts of this book into “The Myths of Creation: The
Gods” and “The Greek Sagas.”

Folktales and Fairytales

In addition to these two categories there are folktales, which are often stories of
adventure, sometimes peopled with fantastic beings and enlivened by ingenious
strategies on the part of the hero or heroine, who will triumph in the end; their
goal is primarily, but not necessarily solely, to entertain. Many of the characters
and motifs in folktales are familiar to us all. They are found in both oral and
written literature throughout the world, from ancient to the present time, and in-
evitably will be a source of inspiration for the future, for example, the monstrous
giant, the wicked sorceress, the distraught maiden in peril and the special pow-
ers of her savior, the wicked sisters, mistaken identity, the imposition of labors,
the solving of riddles, the fulfillment of romantic love, and on and on. Among
the many folktales in this book, the tale of Cupid and Psyche (see p. 218) offers a
particularly splendid example. It begins “once upon a time” and ends “happily
ever after.”
Fairytales may be classified as particular kinds of folktales, defined as “short,
imaginative, traditional tales with a high moral and magical content”; a study by
Graham Anderson identifying fairytales in the ancient world is most enlighten-
ing.4 It is impossible to distinguish rigidly between a folktale and a fairytale,
although perhaps a fairytale is often created especially for the young.

The Problems Imposed by Rigid Definitions

Rarely, if ever, do we find a pristine, uncontaminated example of any one of these
forms. Yet the traditional categories of myth, saga, and folktale are useful guides
for any attempt to impose some order upon the multitudinous variety of classi-
cal tales.5 How loose these categories are can be seen, for example, in the legends
of Odysseus or of the Argonauts, which contain elements of history (saga) but
are full of stories that may be designated as myths and folktales. The criteria for
definition merge and the lines of demarcation blur.
 Myth and Religion 5

Myth and Truth

Since, as we have seen, the Greek word for myth means “word,” “speech,” or
“story,” for a critic like Aristotle it became the designation for the plot of a play;
thus, it is easy to understand how a popular view would equate myth with fic-
tion. In everyday speech the most common association of the words myth and
mythical is with what is incredible and fantastic. How often do we hear the ex-
pression, “It’s a myth,” uttered in derogatory contrast with such laudable con-
cepts as reality, truth, science, and the facts?
Therefore important distinctions may be drawn between stories that are per-
ceived as true and those that are not.6 The contrast between myth and reality has
been a major philosophical concern since the time of the early Greek philosophers.
Myth is a many-faceted personal and cultural phenomenon created to provide a
reality and a unity to what is transitory and fragmented in the world that we expe-
rience—the philosophical vision of the afterlife in Plato and any religious concep-
tion of a god are mythic, not scientific, concepts. Myth provides us with absolutes
in the place of ephemeral values and with a comforting perception of the world
that is necessary to make the insecurity and terror of existence bearable.7
It is disturbing to realize that our faith in absolutes and factual truth can be
easily shattered. “Facts” change in all the sciences; textbooks in chemistry, phys-
ics, and medicine are sadly (or happily, for progress) soon out of date. It is embar-
rassingly banal but fundamentally important to reiterate the platitude that myth,
like art, is truth on a quite different plane from that of prosaic and transitory
factual knowledge. Yet myth and factual truth need not be mutually exclusive,
as some so emphatically insist. A story embodying eternal values may contain
what was imagined, at any one period, to be scientifically correct in every fac-
tual detail; and the accuracy of that information may be a vital component of its
mythical raison d’être. Indeed one can create a myth out of a factual story, as a
great historian must do: any interpretation of the facts, no matter how credible,
will inevitably be a mythic invention. On the other hand, a different kind of artist
may create a nonhistorical myth for the ages, and whether it is factually accurate
or not may be quite beside the point. A case for discussion is presented by the
excerpts from the historical myth of Herotodus, which is translated in Chapter 6.
Myth in a sense is the highest reality; and the thoughtless dismissal of myth
as untruth, fiction, or a lie is the most barren and misleading definition of all.
The dancer and choreographer Martha Graham, sublimely aware of the timeless
“blood memory” that binds our human race and that is continually evoked by
the archetypal transformations of mythic art, offers a beautifully concise sum-
mation: as opposed to the discoveries of science that “will in time change and
perhaps grow obsolete . . . art is eternal, for it reveals the inner landscape, which
is the soul of man.”8

Myth and Religion

As we stated earlier, true myth (as distinguished from saga and folktale) is pri-
marily concerned with the gods, religion, and the supernatural. Most Greek and
Roman stories reflect this universal preoccupation with creation, the nature of
god and humankind, the afterlife, and other spiritual concerns.
6 Chapter 1 I NTERPRETATION AND D EFINITION OF C LASSICAL MYTHOLOGY

Thus mythology and religion are inextricably entwined. One tale or another
may have been believed at some time by certain people not only factually but also
spiritually; specific creation stories and mythical conceptions of deity may still
be considered true today and provide the dogma for devout religious belief in a
contemporary society. In fact, any collection of material for the comparative study
of world mythologies will be dominated by the study of texts that are, by nature,
religious. Greek and Roman religious ceremonies and cults were given authority
by myths that inspired belief and therefore afford a recurrent theme in chapters to
follow; among the examples are the worship of Zeus at Olympia, Athena in Ath-
ens, and Demeter at Eleusis, as well as the celebration of other mystery religions
throughout the ancient world. The ritualist interpretation of the origins of mythol-
ogy is discussed later in this chapter. Greek religion is discussed in Chapter 6.

Mircea Eliade
Mircea Eliade, one of the most prolific twentieth-century writers on myth, lays
great emphasis upon the mystical in his conception of myth seen as a tale satis-
fying the yearning of human beings for a fundamental orientation rooted in the
religious aura of a sacred timelessness. This yearning is fully satisfied only by
stories narrating the events surrounding the beginnings and origins of things.
Eliade believes that God once in a holy era created the world and this initial
cosmogony becomes the origin myth, the model for creations of every kind and
stories about them. He conceives, for example, of a ritual or rite having been per-
formed in a sacred place in this sacred timelessness quite beyond the ordinary or
profane space in which we live. His concept develops a complex mysticism that is
difficult. Like a religious sacrament, myth provides in the imagination a spiritual
release from historical time. This is the nature of true myths, which are funda-
mentally paradigms and explanations and most important to an individual and
society.9 This definition, which embraces the explanatory nature of mythology,
brings us to another universal theory.

Myth and Etiology

There are some who maintain that myth should be interpreted narrowly as an
explication of the origin of some fact or custom. Hence the theory is called etio-
logical, from the Greek word for cause (aitia). In this view, the mythmaker is a
kind of primitive scientist, using myths to explain facts that cannot otherwise
be explained within the limits of society’s knowledge at the time. This theory,
again, is adequate for some myths, for example, those that account for the origin
of certain rituals or cosmology; but interpreted literally and narrowly it does not
allow for the imaginative or metaphysical aspects of mythological thought.
Yet, if one does not interpret etiological (“the assignment of causes or ori-
gins”) too literally and narrowly but defines it by the adjective explanatory, inter-
preted in its most general sense, one perhaps may find at last the most applicable
of all the monolithic theories. Myths usually try to explain matters physical,
emotional, and spiritual not only literally and realistically but also figuratively
and metaphorically as well. Myths attempt to explain the origin of our physi-
cal world: the earth and the heavens, the sun, the moon, and the stars; where
 Myth and Psychology: Freud and Jung 7

human beings came from and the dichotomy between body and soul; the source
of beauty and goodness, and of evil and sin; the nature and meaning of love;
and so on. It is difficult to tell a story that does not reveal, and at the same time
somehow explain, something; and the imaginative answer usually is in some
sense or other scientific or theological. The major problem with this universal
etiological approach is that it does nothing to identify a myth specifically and
distinguish it clearly from any other form of expression, whether scientific, re-
ligious, or artistic—that is, too many essentially different kinds of story may be
basically etiological.

Rationalism Versus Metaphor,

Allegory, and Symbolism
The desire to rationalize classical mythology arose far back in classical antiq-
uity, and is especially associated with the name of Euhemerus (ca. 300 B.C.), who
claimed that the gods were men deified for their great deeds (see Chapter 27,
especially p. 716). The supreme god Zeus, for example, was once a mortal king
in Crete who deposed his father, Cronus. At the opposite extreme from Euhem-
erism is the metaphorical interpretation of stories. Antirationalists, who favor
metaphorical interpretations, believe that traditional tales hide profound mean-
ings. At its best the metaphorical approach sees myth as allegory (allegory is to
be defined as sustained metaphor), where the details of the story are but symbols
of universal truths. At its worst the allegorical approach is a barren exercise in
cryptology: to explain the myth of Ixion and the centaurs in terms of clouds and
weather phenomena is hardly enlightening and not at all ennobling. (For Ixion
and the Centaurs, see pp. 122 and 379.)

Allegorical Nature Myths: Max Müller

An influential theory of the nineteenth century was that of Max Müller: myths
are nature myths, all referring to meteorological and cosmological phenomena.
This is, of course, an extreme development of the allegorical approach, and it is
hard to see how or why all myths can be explained as allegories of, for example,
day replacing night or winter succeeding summer. True, some myths are nature
myths, and certain gods, for example Zeus, represent or control the sky and other
parts of the natural order; yet it is just as true that a great many more myths have
no such relationship to nature.10

Myth and Psychology: Freud and Jung

Sigmund Freud
The metaphorical approach took many forms in the twentieth century through
the theories of the psychologists and psychoanalysts, most especially those of
Sigmund Freud and Carl Jung. We need to present at least some of their basic
concepts, which have become essential for any understanding of mythic cre-
ativity. Freud’s views were not completely new, of course (the concept of “deter-
minism,” for example, “one of the glories of Freudian theory” is to be found in
8 Chapter 1 I NTERPRETATION AND D EFINITION OF C LASSICAL MYTHOLOGY

Aristotle),11 but his formulation and analysis of the inner world of humankind
bear the irrevocable stamp of genius.
Certainly methods and assumptions adopted by comparative mythologists—
the formulations of the structuralists and the modern interpretation of myth-
ological tales as imaginative alleviating and directive formulations, created to
make existence in this real world tolerable—all these find a confirmation and
validity in premises formulated by Freud. The endless critical controversy in our
post-Freudian world merely confirms his unique contribution.
Among Freud’s many important contemporaries and successors, Jung (deeply
indebted to the master, but a renegade) must be singled out because of the par-
ticular relevance of his theories to a fuller appreciation of the deep-rooted re-
curring patterns of mythology. Among Freud’s greatest contributions are his
emphasis upon sexuality (and in particular infantile sexuality), his theory of the
unconscious, his interpretation of dreams, and his identification of the Oedipus
complex (although the term complex belongs to Jung). Freud has this to say about
the story of King Oedipus:
His fate moves us only because it might have been our own, because the oracle
laid upon us before our birth the very curse which rested upon him. It may be that we
are all destined to direct our first sexual impulses toward our mothers, and our first
impulses of hatred and resistance toward our fathers; our dreams convince us that
we were. King Oedipus, who slew his father Laius and wedded his mother Jocasta, is
nothing more or less than a wish-fulfillment—the fulfillment of the wish of our child-
hood. But we, more fortunate than he, in so far as we have not become psychoneurot-
ics, have since our childhood succeeded in withdrawing our sexual impulses from our
mothers, and in forgetting the jealousy of our fathers . . . As the poet brings the guilt
of Oedipus to light by his investigation, he forces us to become aware of our own inner
selves, in which the same impulses are still extant, even though they are suppressed.12
This Oedipal incest complex is here expressed in the masculine form, of a man’s
behavior in relationship to his mother, but it also could be expressed in terms of
the relationship between daughter and father; the daughter turns to the father as
an object of love and becomes hostile to her mother as her rival. This is for Jung
an Electra complex.
Dreams for Freud are the fulfillments of wishes that have been repressed and
disguised. To protect sleep and relieve potential anxiety, the mind goes through
a process of what is termed dream-work, which consists of three primary mental
activities: “condensation” of elements (they are abbreviated or compressed), “dis-
placement” of elements (they are changed, particularly in terms of allusion and a
difference of emphasis), and “representation,” the transmission of elements into
imagery or symbols, which are many, varied, and often sexual. Something simi-
lar to this process may be discerned in the origin and evolution of myths; it also
provides insight into the mind and the methods of the creative artist, as Freud
himself was well aware in his studies.13
Thus Freud’s discovery of the significance of dream-symbols led him and
his followers to analyze the similarity between dreams and myths. Symbols are
many and varied and often sexual (e.g., objects like sticks and swords are phal-
lic). Myths, therefore, in the Freudian interpretation, reflect people’s waking ef-
forts to systematize the incoherent visions and impulses of their sleep world. The
patterns in the imaginative world of children, savages, and neurotics are similar,
and these patterns are revealed in the motifs and symbols of myth.
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 8 A case of this kind is cited in the article “Pathologie des Méninges” in Nouv. Dict. de
Méd. et de Chirurg. pratiques, Paris, 1876, vol. xxii. p. 101.

9 Traité clinique et pratique des Maladies des Vieillards, par M. Durand-Fardel, Paris,
1854, p. 283.

The exciting causes comprise injuries to the head, both with and
without fracture; strong muscular effort, as in lifting, straining at stool
or in labor; powerful action of the heart in cases of hypertrophy. An
interesting case is reported10 by S. G. Webber of Boston, in which
the effusion was evidently caused by vomiting; a clot of blood
covered the greater part of the posterior two-thirds of the right
hemisphere. Sometimes meningeal hemorrhage may arise from the
bursting of an intracerebral apoplexy into the arachnoid cavity, as in
a remarkable case occurring in the practice of Morris Longstreth of
Philadelphia, of bilateral effusion.11 Outside the dura, corresponding
with the left middle cerebral lobe, was a considerable amount of
blood connected with a fracture of the skull, and on the right side a
large quantity of blood in the cavity of the arachnoid, originating in
the middle lobe, which was torn up. The patient had fallen in the
street; he was stupid, there was no paralysis, active delirium came
on, followed by coma and death in twenty-four hours. Here was
cerebral apoplexy bursting into the cavity of the arachnoid on the
right side, and causing the fall, which was the occasion of the
fracture and hemorrhage on the left side.
10 Boston Med. and Surg. Journal, Jan. 17, 1884.

11 Ibid., Dec. 28, 1882.

In young children, especially in the new-born, meningeal

hemorrhage may follow difficult and instrumental labor, either from
injury to the skull or from delay in the establishment of respiration, as
in breech presentation, though it sometimes occurs in cases in which
the labor has been normal. In a case of breech presentation under
my care in 1873 the child, a female weighing nine pounds, did not
cry or breathe for some minutes after birth, although delivery had not
been much delayed. Soon afterward it was noticed that it did not
move the right arm, although it moved the hand and the fingers. In
the course of twenty-four hours, during which time it cried much
more than usual, it became comatose, and remained so until its
death, three days after birth. The whole surface was livid, and the
child had two or three short convulsions. At the autopsy a clot about
the size of a grape was found in the pia mater on the upper surface
of the cerebellum, in the immediate vicinity of the pons Varolii. The
brain was so soft that the amount of injury received by the
cerebellum could not be exactly ascertained, but it was probable that
the clot extended into the fourth ventricle.

Thrombus of the sinuses of the dura mater, and less frequently of the
cerebral arteries, is the origin, in a considerable number of cases, of
meningeal hemorrhage in children, in consequence of pressure upon
the delicate vessels of the membranes caused by the obstructed
circulation. Bouchut12 reports an observation of hemorrhage
produced in this way.
12 E. Bouchut, Clinique de l'Hôpital des Enfants maladies, Paris, 1884, p. 263. See,
also, Steffen, op. cit., p. 352.

SYMPTOMS.—In some cases the attack is preceded by indications of

congestion, such as headache, vertigo, staggering, confusion of
ideas, noises in the ears, feeling of weight in the head, delirium,
stupor. At the time of the attack the patient frequently complains of
severe pain in the head, just as in cerebral hemorrhage, and then
falls to the ground with complete loss of consciousness. Sometimes
the symptoms come on gradually. Hemiplegia occurs in a notable
proportion of cases. Convulsions may occur at any time after the
attack. In Webber's case, already referred to, the first symptom was
sharp pain in the head and neck; this was followed by very severe
headache and pain on motion of the head. Intelligence gradually
diminished; on the sixth day there was almost no consciousness,
and the patient died in about eight days. She had occasional
spasms, in which both eyes were turned toward the left in extreme
conjugate deviation, and the left side of the face was distorted. The
spasms were followed by suspension of respiration for nearly a
minute, cyanosis, and paralysis of the left hand and leg. Both the
nature of the lesion and its seat were correctly diagnosticated during
the patient's lifetime.

As a rule, the condition of unconsciousness continues up to the time

of death, but in some cases there are intermissions during which the
patient responds to questions more or less promptly. Death takes
place at a period varying between a few hours and several days.
Durand-Fardel13 reports a case in which the patient lived a month
from the first attack, with preservation of the intellect and of motion.
An inmate of the Home for Aged Women in Boston, eighty-eight
years old, previously in good health, complained of severe pain in
the head one morning before rising. She took her breakfast in bed,
and immediately afterward vomited copiously. From that moment she
became insensible, and remained so until her death, seven days and
three hours afterward. During this time there was no stertor. No
decided paralysis could be discovered, but there was some rigidity of
the left arm. At the autopsy an effusion of blood was found in the
arachnoid cavity extending from below upward on each side to a
level with the top of the ear. There was a large amount of blood at
the base of the brain, and both lateral ventricles were distended with
bloody serum. The vessels were generally in an atheromatous
condition. There was no laceration of the brain. The source of the
hemorrhage could not be ascertained. In such a case the condition
of the patient in respect to power of movement often cannot be
ascertained with certainty, in consequence of the abolition of
consciousness. Complete muscular resolution is most common
when the effusion is bilateral, but when the hemorrhage is limited to
one side more or less paralysis of the opposite limbs may exist.
Should the blood make its way into the spinal canal, it might give rise
to special symptoms, but this is not probable in view of the large
amount of the cerebral effusion under the circumstances, which
would produce complete insensibility or speedily cause death by
pressure on the medulla.
13 Op. cit., p. 202.
The temperature of the body immediately after a copious cerebral or
meningeal hemorrhage falls below the normal point, and remains so
for several hours, after which it rises, its degree varying according to
circumstances. In fatal cases the elevation is extreme, and remains
so until death. If the patient recover, it gradually returns to the normal
standard.

Vomiting is a frequent symptom at the beginning of the attack, just as

in intracerebral hemorrhage, owing probably to compression of the
pneumogastric by the effusion at the base of the brain. In Webber's
case the vomiting was evidently the cause of the hemorrhage, and
not its consequence, since it had been a frequent symptom for
several days before the attack, and was probably due to the
presence of a calculus in the pelvis of the right kidney, which was
found at the autopsy, and there was no blood at the base of the
brain.

PATHOLOGICAL ANATOMY.—The chief points of interest in the morbid

anatomy relate to the seat and source of the effusion, the amount
and condition of the blood, the state of the vessels and that of the
brain, including the ventricles. In respect to the seat, the hemorrhage
may occupy the space between the cranial bones and the dura
mater; it may be found on the lower surface of the latter, in the
arachnoid cavity, or in the meshes of the pia mater, the so-called
subarachnoid space. Blood found upon the outer surface of the dura,
between that membrane and the bones, is almost always the result
of traumatic causes, such as blows or other injuries, with or without
fracture, or of caries of the skull. If below the dura, but between that
and the so-called parietal layer of the arachnoid, the lesion comes
under the title of pachymeningitis interna, already described as an
inflammatory disease of the dura with hemorrhagic effusion. The
arachnoid cavity and meshes of the pia are by far the most common
situations in which the blood is found in meningeal hemorrhage. The
origin of the effusion is either the rupture of a capillary aneurism of
one of the arterioles of the membrane or of one of the vessels
themselves in consequence of atheromatous or other degenerations
of its walls. On account of the minute size of the vessels it is seldom
possible to discover the exact point at which the rupture took place.
In rare instances the source of the hemorrhage is within the brain,
the blood being forced through the cerebral tissue, either into the
meshes of the pia or upon the surface of that membrane. The
amount of hemorrhage varies according to conditions which are
mostly unknown, but is probably dependent upon the size of the
ruptured vessel and the conditions under which the accident occurs,
such as muscular effort, cardiac action, etc. In some cases it is so
small as to give rise to no definite symptoms, as is evident from post-
mortem examinations of those who have died from other causes. In
these cases there may be either a single effusion or several. The
amount is largest when the arachnoid cavity is the seat of the
extravasation. The blood, which may be either liquid or more or less
coagulated, according to the time which has elapsed since the
hemorrhage, is usually found upon the convexity of the hemispheres,
most frequently on one side only, and oftenest on the left. But if the
rupture have taken place at the base, it often ascends on each side,
as in a case mentioned above. Where a large vessel has given way,
its contents may cover a great part of the surface of the brain. The
coagulum is found in a thin layer, which at the end of a few days is
covered with a transparent envelope, evidently composed of a
deposit or separation of fibrin. Should the patient survive long
enough, this membrane may become organized, receiving vessels
from the adjacent pia, and in turn become the seat of new
hemorrhages, exactly as in the hæmatoma of internal
pachymeningitis. In cases in which absorption of most of the fluid
part of the effusion takes place, the membrane remains more or less
dense and vascular, and usually contains a small quantity of
recently-effused blood within its meshes. Small cysts, containing
transparent or reddish-brown serum, are also occasionally observed
enclosed between the layers of the membrane. In very young
children, whose fontanels are not yet ossified, these cysts
sometimes attain to a large size, containing several pints of fluid,
which is more or less limpid from absorption of the coloring matter of
the blood, constituting the so-called dropsy of the arachnoid.14 The
convolutions of the brain are more or less flattened according to the
amount of the effusion, and the cortical substance is correspondingly
anæmic from pressure. The blood may make its way, if extravasated
in large quantities, into the ventricles, over the medulla, into the
spinal arachnoid cavity, or even into the central canal of the spinal
cord. The arteries of the brain, especially at the base, are frequently
in a state of atheromatous degeneration, and thrombi often occupy
the sinuses of the dura mater.
14 Charles West, M.D., Lectures on the Diseases of Childhood and Infancy, 6th ed.,
London, 1874, p. 62. These large cysts are much more frequently (perhaps solely)
found in cases of hemorrhagic pachymeningitis. (See Barthez and Sanné, op. cit., vol.
i. p. 157.)

DIAGNOSIS.—The distinction between meningeal hemorrhage and

cerebral apoplexy is always difficult, and in the majority of cases
impossible. Sudden pain in the head, vomiting, and lowering of the
bodily temperature (the thermometer should be placed in the
rectum), followed by loss of consciousness, are strongly suggestive
of hemorrhage within the cranium, either cerebral or meningeal. If
these symptoms are followed by coma and resolution without
obvious paralysis, the diagnosis would be almost impossible
between intra- and extra-cerebral extravasation. If the loss of
consciousness be not complete, so that the presence or absence of
paralysis can be ascertained, we can sometimes distinguish the
situation of the hemorrhage. Right-sided hemiplegia, with paralysis
of the face or tongue, or with aphasia, is most probably owing to
hemorrhage or embolism somewhere in the left motor tract, and
hence within the brain. If the absence of paralysis can be certainly
ascertained, the probabilities are in favor of meningeal apoplexy.
Convulsions affecting the face or limbs of one side would point to
irritation of the cortical centres of those parts, and so far to
extravasation on the surface of the brain (on the opposite side), as in
Webber's case. Where the amount of hemorrhage is small it
furnishes no diagnostic indications. In the case of new-born children
the presumption is in favor of meningeal effusion.

PROGNOSIS.—If the effusion be considerable in amount, as indicated

by prolonged coma with resolution, the issue is almost inevitably
fatal, though life is occasionally prolonged for a surprising length of
time. Slight hemorrhages are doubtless recovered from, but there
are no means for their certain diagnosis.

TREATMENT.—The treatment, which is essentially the same as that for

cerebral congestion, has for its object the arrest of the hemorrhage,
and, if that can be effected, the absorption of the effused blood. In
view of the former, the patient's head should be elevated and kept
cool by the application of ice. Unless the bowels have previously
been freely moved, saline laxatives, followed by enemata if
necessary, must be given. The state of the bladder must be carefully
attended to. Liquid nourishment alone, in moderate quantities at
regular intervals, is permissible, with stimulants if there be signs of
exhaustion. For the absorption of the effusion mild counter-irritation
to the scalp and the administration of the iodide of potassium may be
employed.

Congestion of the Cerebral Pia Mater.

The pia mater consists of two layers, separated by a loose

connective tissue. The outer layer, being that which was formerly
called the visceral layer of the arachnoid, is stretched smoothly over
the convolutions of the brain without dipping into the sulci; the inner
layer is closely connected with the surface of the brain, whose
inequalities it follows. The two layers are more firmly united together
over the convolutions than between them; in the latter situation the
connection is loose, and the space which separates the surfaces is
called the meshes of the pia. The membrane extends into the
ventricles, investing the ependyma and the choroid plexuses, and
over the medulla oblongata and spinal cord. In the normal condition
it is loosely attached to the brain, from which it can be stripped off
without loss of substance. The meshes of the pia, together with the
ventricles, constitute a series of cavities connected with each other,
containing a variable amount of cerebro-spinal fluid, and they
communicate with the lymph-spaces surrounding the blood-vessels.
Pressure within the cranial cavity, from congestion of the vessels or
from the products of inflammation, is thus relieved in a measure by
displacement of the cerebro-spinal fluid, which is driven out through
the perivascular lymph-spaces.

Congestion or hyperæmia of the pia mater probably never occurs

independently of that of the external surface of the brain, on account
of the intimate vascular connection of the two. In the adult it can only
exist to a limited extent, on account of the unyielding nature of the
cranial walls and of the limited compensatory action of the cerebro-
spinal fluid. In young children the incomplete ossification of the skull
and the delicate structure of the vessels are more favorable to
congestion.

ETIOLOGY.—The causes of hyperæmia of the pia mater are in the

main the same as those of congestion of the dura.

SYMPTOMS.—Since congestion of the pia always coexists with that of

the corresponding part of the external portion of the brain, it is
impossible to separate the symptoms belonging to each. They are
therefore usually included under the head of Cerebral Congestion, to
which article the reader is referred.

PATHOLOGICAL ANATOMY.—Arterial hyperæmia of the pia is seldom

discovered after death, the elasticity of the vessels causing
transudation of the fluid part of the blood through their walls. Venous
congestion of the pia is more frequently noticed, usually in
connection with that of the dura, the sinuses with their accompanying
veins being distended with blood, and in cases of long standing often
containing thrombi. Simple hyperæmia of the pia being rarely or
never fatal of itself, these appearances are usually accompanied by
those of inflammation of the membrane or of the cortical layer of the
brain (effusion of lymph or pus), or by hemorrhage.

TREATMENT.—In a case of suspected congestion of the pia the

treatment would be the same as that of cerebral congestion.
 Inflammation of the Cerebral Pia Mater.

SYNONYMS.—Meningitis, Leptomeningitis, Acute non-tubercular

hydrocephalus.

Meningitis (by which is generally understood inflammation of the pia)

appears under an acute, a chronic, and an epidemic form. The latter,
being a zymotic disease, is described in a separate article, to which
the reader is referred.

ETIOLOGY.—Meningitis occurs both as a primitive disease and as

secondary to other affections. The former is rare, the latter is more
frequent. The causes of idiopathic meningitis are for the most part
unknown. Exposure to the sun's rays and excessive indulgence in
alcoholic liquors are thought to excite it in some instances. It has
been known to follow blows and falls on the head which have
produced no injury to the skull. It is rather more commonly observed
in early manhood than at other periods of life. Secondary meningitis
may follow injury or disease of the cranial bones or of the dura, and
of the brain. A frequent cause is extension of disease of the ear to
the membranes and substance of the brain. The reader is referred to
the article on MEDICAL OTOLOGY for information concerning the
symptoms of that formidable complication. Certain diseases are
known to be occasionally complicated with meningitis—acute
articular rheumatism; erysipelas of the scalp and of the face; Bright's
disease, especially the chronic interstitial form; peritonitis; ulcerative
endocarditis; pyæmia; the eruptive fevers; the puerperal state; and
syphilis. Meningitis following or complicating acute rheumatism is
generally supposed to be not uncommon, but the number of cases in
which the existence of inflammation of the meninges has been
proved by autopsy is small. Fuller,15 along with three cases in which
dissection showed suppurative inflammation of the pia, cites several
others in which no cerebral disease was found after death, although
the symptoms gave every indication of it. True meningitis is rare in
chronic Bright's disease, the symptoms resembling it being caused,
in the majority of cases, by uræmia. Meningitis complicating
pneumonia is also rare, although cerebral symptoms are common
enough in that disease, especially in young children with
inflammation of the upper lobes. C. Neuwerk16 reports seventeen
cases of purulent meningitis complicating acute pneumonia. It was
more frequent in men, especially in alcoholic subjects, than in
women. The meningitis was generally total. The lungs were in a
state of gray or yellow hepatization.
15 H. W. Fuller, M.D., On Rheumatism, Rheumatic Gout, and Sciatica, 3d ed.,
Philada., 1864, p. 271. See also E. Leudet, Clinique médicale de l'Hôtel Dieu de
Rouen, Paris, 1874, p. 133.

16 Deutsches Archiv für klin. Med., xxix., 1881, p. 1; and Schmidt's Jahrbücher, Band
cxcviii., 1883, Nov. 5.

SYMPTOMS.—The symptoms of acute leptomeningitis vary much in

the course of the disease. This is readily explained by the complex
character of the functions of the parts involved in the inflammation. It
may be assumed that the cortical layer of the brain is implicated in
every case unless of the most transient and limited kind; the
substance of the brain, cerebellum, and medulla are subjected to
pressure from the afflux of blood, from the effused lymph and pus,
and from the accumulation of serum in the ventricles; the cranial
nerves are exposed to pressure from the deposit of lymph, which
may give rise to irritation or to suspension of function or both; parts
at a distance from the seat of lesion may be functionally disordered
by reflex action through communicating filaments. Finally, the
general system suffers from the effects of the high fever upon the
blood and the nutrition.

It is customary to speak of a stage of excitement followed by one of

depression as characteristic of the course of the disease; but
although active symptoms generally prevail in the early period, to be
succeeded later by coma and paralysis, this disposition is by no
means uniform. Sometimes sopor and paralysis constitute almost
the only symptoms throughout the disease—this is especially noticed
in infants—or active delirium and convulsions may persist until the
fatal termination. More frequently the two conditions alternate
several times with each other. A prodromic period of short duration, a
few hours or a day or two, is sometimes observed in primitive
meningitis, the patients complaining of headache, vertigo, vomiting,
restlessness, or lassitude. Infants are irritable or drowsy, with heat of
the head, quick pulse, and occasional vomiting. In secondary
meningitis this period is usually masked by the symptoms of the
primitive disease. In the majority of cases the beginning of acute
meningitis is abrupt. Rigor is sometimes the first symptom observed,
and in children is usually represented by a convulsion. More
commonly, however, the disease is ushered in by severe headache,
which is often referred to the forehead. The head is hot, the face is
flushed, the eyes are brilliant, the pupils are contracted, the pulse is
quick and hard, the temperature high (104° F. or upward). The
patient is wakeful, restless, and irritable, sensitive to light and to
sound. The skin is hyperæsthetic, especially that of the legs. There
may be wandering or even active delirium. Vomiting is not
unfrequent. There is thirst, but no desire for food. The urine is scanty
and high-colored, the bowels constipated. These symptoms
gradually increase in intensity, especially the pain in the head and
the delirium, and in many cases they are followed by convulsions, at
first in the form of twitchings of the facial muscles or of the limbs,
grinding the teeth, etc., which give place to tonic contractions of the
limbs or of the trunk, often confined at first to one or both members
of the same side, but afterward becoming general; the flexors of the
forearms and of the legs are most usually affected. The upper dorsal
muscles may become contracted, so that the head is drawn
backward, and more rarely trismus occurs.

A diminution in the rapidity of the pulse, which may fall to the normal
rate, or even below that, notwithstanding the persistence of the high
temperature, indicates the beginning of the stage of depression. This
change is sometimes sudden, though more often gradual in its
approach. The activity of the delirium subsides, giving place to a
somnolence which may seem to the inexperienced observer a
favorable indication, but which soon deepens into coma. The face
becomes pale, the features are sunken. Only an occasional grimace
or a movement of the hand to the head shows that the patient is to
some extent conscious of suffering. This condition may alternate with
the previous one from time to time, the comatose state being
interrupted by noisy delirium and tonic or clonic convulsions, or even
a partial return of consciousness, giving rise to fallacious hopes on
the part of the friends, and sometimes deceiving the physician
himself into a belief that a favorable issue is at hand. Before long,
however, the symptoms of brain-compression become permanent.
The rigidity of the limbs gives place to complete resolution. The
patient lies absolutely unconscious, with dilated pupils. The pulse
becomes again rapid in consequence of compression of the medulla,
and thread-like and irregular; for the same reason the respirations
increase to 40, 50, or 60 in the minute. The sphincters are relaxed,
and the patient dies without any recurrence of the active symptoms.
In rare cases recovery takes place, although almost never after the
symptoms of compression have continued without interruption for
any considerable length of time. Moreover, it is seldom that recovery
takes place in the adult without leaving some traces of permanent
damage, such as general debility, paralysis of one or more limbs,
deafness, mental weakness, epilepsy, etc. Many cases of general
paralysis of the insane and other forms of so-called mental disease
are the result of meningitis.

DURATION.—In the adult usually the disease lasts about a week or ten
days; exceptionally, it may last two or three weeks.

COURSE.—In young children the course of meningitis differs

somewhat from that which is observed in adults, though the
symptoms are essentially the same. It is more sudden in its onset
and shorter in its duration. The prodromal stage may be brief or
hardly noticeable; but in older children restlessness, sensitiveness to
light and sound, wakefulness, slight twitchings of the features or of
the limbs, a half-open condition of the eyelids during sleep,
occasional vomiting, etc., are more commonly noticed. Convulsions
are more common than in the adult, and sometimes constitute the
chief symptom. They may be confined to a single extremity, but in
general they shift from one limb to another. The muscles of the
eyeball are usually implicated, causing strabismus. Retraction of the
head is rarely absent, especially in young infants. These convulsions
are almost always tonic, but occasionally they alternate with clonic
ones. Distension and increased pulsation of the anterior fontanel is
always observed in infants a few months old affected with this
disease. When meningitis is secondary to some other disease, the
first symptom noticed in children is apt to be vomiting, with delirium.
According to Steffen, pneumonia is the disease most frequently
complicated with meningitis in children. As in tubercular meningitis,
the most prominent symptom may be mere sopor, sometimes with
intervals of intelligence. Simple meningitis in children is generally a
rapid disease, proving fatal in most cases within a week, and
sometimes even in a few hours. Exceptionally, it may last much
longer. A case occurring in a girl six years old, the duration of which
was fifty-five days, is reported by J. Bokai, Jr.;17 the diagnosis was
substantiated by autopsy. Another case, which recovered after seven
weeks, is mentioned by Henoch.18
17 Jahrb. f. Kinderkrankheiten, N. F., xviii. 1, p. 105; and Schmidt's Jahrb., 1882, No.
6, p. 269.

18 Eduard Henoch, Vorlesungen über Kinderkrankheiten, Berlin, 1881, p. 277.

PATHOLOGICAL ANATOMY.—The lesions, which are rarely general, may

occupy a greater or less extent of the membrane. They are usually
disposed symmetrically with regard to the two hemispheres, or
occupy corresponding regions of the base. The vessels are in the
beginning of the disease distended, the finest ramifications being
injected, giving a red color to the membrane, which varies in different
places from crimson to light pink. The perivascular spaces of the
larger vessels are filled with a grayish or yellowish fluid composed of
extravasated liquor sanguinis and white blood-corpuscles. The
meshes between the two layers of the pia are soon infiltrated with
pus, and the thickened membrane can be stripped off from the
surface of the brain, which is, however, adherent to it in places and is
torn in the process. Sometimes a thin layer of pus, which can be
scraped off with the knife, is found upon the surface of the pia. The
extent of the lesion varies much in different cases. It may be
confined to a limited region of the hemispheres, or it may spread to
the fissure of Sylvius, where two surfaces become adherent.
Sometimes the concrete pus and fibrin are deposited in thick masses
upon the base of the brain, often completely surrounding the cranial
nerves, and even the medulla. The inflammation may extend to the
lateral ventricles, which become filled with a turbid fluid containing
pus-cells, and sometimes wholly purulent. The choroid plexuses are
often covered with flecks of pus. When the distension of the
ventricles is very great, the gyri of the brain are more or less
flattened by compression against the cranium, and the outer layer of
the cerebral substance is bloodless and œdematous. The cerebral
sinuses are distended with blood, and frequently contain thrombi due
to an early stage of the inflammatory process, besides recent
coagula.

DIAGNOSIS.—The diagnosis of acute meningitis is often difficult, and

sometimes impossible, especially in the early stages, when the line
between congestion and inflammation cannot be drawn, and in
complicated cases. The typical symptoms are sudden and acute
pain in the head, with sensitiveness to light and sound, contracted
pupils, rapid pulse, and vomiting, followed by delirium, convulsions,
and coma. If these symptoms were observed in an individual
previously in good health, they would be strongly suggestive of the
disease, and yet many of them are often present in the beginning of
pneumonia, erysipelas, typhoid, typhus, and other eruptive fevers,
uræmia, and poisoning from narcotic substances. Hence it is
important to eliminate these sources of error before coming to a
conclusion, and a neglect of this precaution is a not infrequent
source of error in the diagnosis. A careful examination of the urine
will generally enable us to exclude uræmia. The presence or
absence of the eruptive fevers can usually be determined by the
attendant circumstances, and yet cases of scarlatina, typhoid fever,
variola, etc., beginning with active cerebral symptoms, are
sometimes hastily pronounced to be meningitis by inexperienced
observers. In poisoning by narcotics the history will often aid us in
the diagnosis; moreover, except in the case of opium, the pupils are
dilated instead of being contracted. In traumatic cases, with fracture
of the cranial bones, it is always difficult, and often impossible, to
distinguish between the symptoms of meningitis and those due to
other lesions. In concussion without fracture we must be guided in
our diagnosis by the same rules as in idiopathic cases. The
distinction between extreme congestion of the pia mater and
meningitis must be based chiefly upon the duration of the symptoms.
The former is usually brief in its course; the latter lasts one or two
weeks, and in cases which recover is often followed by after-effects
which are more or less permanent in their duration, such as paralysis
or rigidity of the limbs, mental defects, etc. Rapid recovery from the
acute symptoms would be strongly suspicious of congestion, and
doubtless in many such cases the treatment has been credited with
a success to which it was not entitled. The diagnosis from tubercular
meningitis will be reserved for the article on that disease.

PROGNOSIS.—Acute meningitis is fatal in the majority of cases,

though recovery is possible. A gradual diminution of the severity of
the symptoms, especially in respect to temperature, pulse, pain in
the head, and other cerebral phenomena, would afford
encouragement, but we must not trust too much to the brief
appearances of amendment so often observed.

TREATMENT.—The indications for treatment are threefold: 1st, to

prevent or arrest the inflammation; 2d, to modify its violence and
shorten its duration when arrest is no longer possible; and 3d, to
place the patient in the best condition to withstand the violence of the
disease and to recover from its effects. It is only by prompt action
that we can hope to attain the first object, that of preventing the
passage of hyperæmia into inflammation. The patient should be
placed in a cool and well-ventilated apartment of good size, from
which a bright light is excluded. His head, moderately raised, should
be kept cool by means of pounded ice enclosed in a rubber bag or a
bladder. One or more leeches, according to his age, should be
applied behind the ears, or blood may be drawn from the temples or
back of the neck by means of cupping. The bleeding should be
encouraged by poultices if necessary, but with young children the
abstraction of blood should be done with caution. An active purge
should be given, such as ten grains each of calomel and jalap,
followed by castor oil or infusion of senna; for children, from three to
six grains, according to age, followed by oil, would be sufficient. The
medicine should be repeated in a few hours if there be no effect.
Counter-irritation by means of blisters is recommended by most
authorities as a valuable aid in the first stage of the disease. Unless
the application be very extensive, it is not likely to be of any avail,
and extensive blistering would hardly fail to greatly reduce the
strength of the patient, and also is likely to irritate the kidneys. There
are no medicines which can be relied upon to arrest the
inflammatory process. Nevertheless, the tincture of aconite-root, in
the dose of from one to three drops, according to the age of the
patient, every two hours, might be given early, with the view of
fulfilling the second indication by its sedative property. The bromide
of potassium or of sodium, combined with small doses of chloral
hydrate or of sulphate of morphia, will also calm the excitement and
pain, and diminish convulsions. The success which sometimes
follows the employment of ergot in the epidemic cerebro-spinal
meningitis warrants its trial. Bartholow recommends the wet sheet
two or three times a day if the temperature is high. Steffen advises
four grains of sulphate of quinine with one grain of salicylate of soda,
from two to four times daily, for young children, and in double these
doses for older ones. The alimentation of the patient should be
carefully attended to during this stage. Nourishing liquid food, such
as milk, gruel, broth, eggs, with stimulants if indicated, should be
given at proper intervals, care being taken not to overload the
stomach, as is frequently done. When the patient can no longer
swallow the food must be given by the rectum. During the stage of
compression it is useless, in the present state of our knowledge, to
expect any benefit from the further administration of drugs, and the
treatment then consists mainly in giving small quantities of food at
regular intervals, and in such external applications as the bodily
temperature may require. The bladder must be relieved by the
catheter when necessary. Simple enemata are generally sufficient to
prevent constipation.
 Chronic Cerebral Meningitis.

Chronic inflammation of the pia mater rarely follows the acute form,
but is generally secondary to other conditions, such as inflammation
and tumors of the dura, tumors and abscess of the brain, disease of
the vessels of the brain, suppurative otitis, and to constitutional
diseases, especially alcoholism, syphilis, and pulmonary
tuberculosis. It is one of the most common lesions found after death
from general paralysis of the insane. As a distinct affection,
unconnected with constitutional disease, it is extremely rare, though
less so, according to Flint,19 than the acute form. He cites a case in
which the symptoms were intermittent. The patient, fifteen years old,
died after a month's illness. The autopsy showed cerebral
hyperæmia, lymph at the base of the brain, and distension of the
ventricles with transparent fluid. There were no tubercles. In most
cases in which the results of chronic meningitis are found after death
the cortical substance of the brain is involved in the disease; hence
the difficulty in defining its symptoms, which are usually extremely
vague, and not always distinctive of cerebral disease. The principal
are pain in the head, vertigo, vomiting, impairment of the memory,
mental apathy, drowsiness, and muscular weakness. The anatomical
changes are thickening and opacity of the membrane by the deposit
of lymph upon its surface and into the connective tissue, adhesions
to the dura and to the cortical substances of the brain, together with
hyperæmia of the latter. These appearances are usually distributed
in irregular patches of greater or less extent.
19 Austin Flint, M.D., Principles and Practice of Medicine, 5th ed., Philada., 1881, p.
701.

The DIAGNOSIS of chronic meningitis is often obscure or impossible.

Long-continued pain in the head, accompanied by vertigo,
impairment of memory, drowsiness, mental apathy, etc., without
paralysis, would be suggestive of it, especially if there were
occasional intermissions of the symptoms. The probability would be
greatly increased if the patient had a syphilitic or alcoholic history.
The diagnosis should exclude tumor of the brain, chronic
pachymeningitis, and chronic hydrocephalus, but as these diseases
are often complicated with chronic meningitis, the distinction might
be very difficult. As already stated, chronic meningitis is almost a
constant lesion in general paralysis, as well as in other forms of
chronic insanity, but there are no special symptoms by which its
presence can be ascertained during life.

TREATMENT.—Our aim should be to relieve pain, diminish congestion,

and favor absorption. Counter-irritation to the head and nucha by
means of small blisters or croton oil should be employed with
moderation. Bromide of potassium, or, if necessary, small doses of
morphia, may be given if the pain be severe. Should there be
symptoms of cerebral congestion, such as acute delirium, flushing,
and heat of head, an ice-bag should be applied to the head and
leeches behind the ears, or blood may be drawn from the temples or
nucha by cupping. As an absorbent the iodide of potassium is much
recommended, but it is not likely to be effectual, except in syphilitic
cases. The bowels should be kept free, but without active purging.
The general health of the patient should be promoted by suitable diet
and regimen, by relief from excitement and fatigue, or by change of
scene and of climate. For the treatment of chronic meningitis
complicating syphilis, alcoholism, and tuberculosis, the reader is
referred to the articles treating of those diseases.

TUBERCULAR MENINGITIS.

BY FRANCIS MINOT, M.D.

DEFINITION.—Inflammation of the pia mater of the brain, with effusion
of lymph and pus, caused by the deposit of miliary tubercles upon its
surface or into its substance.

SYNONYMS.—Scrofulous meningitis, Granular meningitis, Basilar

meningitis, Acute hydrocephalus, Dropsy of the brain.

HISTORY.1—It is only within a comparatively recent time that

tubercular meningitis has been distinguished from other cerebral
diseases. Up to the eighteenth century the term hydrocephalus was
employed not only for the dropsical diseases of the head, including
internal and external hydrocephalus, but also for meningeal
inflammations, both simple and tubercular, and for congestion of the
brain and of the membranes; the accumulation of water in the
ventricles or between the membranes being looked upon as the
disease, and not as one of its consequences. The term was even
applied to external tumors, as cephalæmatoma and caput
succedaneum. We owe the first accurate account of the
symptomatology of acute hydrocephalus, or ventricular dropsy, to
Robert Whytt of Edinburgh, whose remarkable monograph, entitled
Observations on the Dropsy of the Brain, first published in 1768,
after his death, was founded upon the study of 20 cases with 10
autopsies. No addition of importance has been made by later
observers to his graphic description of the disease or to his rules for
its diagnosis. Whytt, however, had no clear notion of its pathogeny,
and it was not till 1815 that Gölis pointed out that acute ventricular
dropsy was a secondary condition depending upon previous
inflammation of the membranes or vessels of the brain.
1 See W. Hughes Willshire's valuable paper, entitled “Historic Data on Scrofulous
Meningitis,” in Brit. and For. Med.-Chir. Review, Oct., 1854.
In 1827, Guersant remarked that the inflammation of the meninges
constituting acute hydrocephalus presented such peculiarities as led
him to denominate it granular meningitis. He did not, however,
connect the granular deposit with tubercle. This was left for
Papavoine to effect, who in 1830 published two cases of tuberculous
arachnitis, in one of which effusion into the ventricles, or
hydrocephalus, existed. The meningeal granulations or tubercles
were described with care, and their coincidence with tuberculous
deposit elsewhere was remarked upon, as also the apparent
occurrence of the former previous to the inflammatory action in the
meninges, and in one case the existence of the tuberculous granules
without the sequence of inflammation. The important pathological
element of acute hydrocephalus thus clearly pointed out by
Papavoine now became apparent to observers, and obtained almost
universal assent. The attention of the profession in this country was
first called to it by W. W. Gerhard of Philadelphia in 1833, in an
admirable paper published in the American Journal of the Medical
Sciences,2 containing the reports of thirty-two cases with autopsies.
In every case but two tubercles were found in other organs besides
the meninges. In one of these two, gangrenous cavities were found
in the lungs without tubercles, though perfectly characterized miliary
tubercles existed in the membranes; in the other case the lungs were
not examined with care, Gerhard not being present at the autopsy.
2 Vols. xiii. and xiv., 1833-34.

Finally, the distinction between tubercular and simple meningitis was

pointed out by Guersant in 1839, and clearly established by Barthez
and Rilliet in 1843 in their systematic work on the diseases of
children; and it was further elucidated by Rilliet in 1847.

ETIOLOGY.—The causes of tubercular meningitis are predisposing

and exciting. Among the former are hereditary tendency to
tuberculosis and to the so-called scrofulous diathesis; the previous
existence of tubercle in any part of the body, especially in the lungs;
and the presence of caseous degeneration in the bronchial, the
mesenteric, and other glands, or in the parenchyma of various