A Bacterial Study of Acute Metiingitis 319 



Cask III.— Acute Lepto- Meningitis following Typhoid Fever, 

 due to the Bacillus Coli Commmiis. 



Male, laborer, aet, 27, admitted March 26, 1892. He had 

 been feeling unwell for about three weeks previous to admis- 

 sion. For the first week after admission temperature ranged 

 from 100 in the morning to 105 in the evening, and April ist 

 dropped to normal in the morning with only a slight evening 

 elevation. April 9th it remained normal throughout the 

 day. On April 12th it rose to 102^% and remained somewhat 

 above normal u'.itil the morning of the i8th, when it com- 

 menced to rise gradually, and on April 20th reached 105. He 

 then began to have a low muttering delirium. During the 

 next week the temp, ranged between io2-i05fV- O" ^P"^ 

 27, 28, and 29 he had quite severe hemorrhages from the 

 bowels and his pulse became rapid and feeble. During these 

 and the following days the delirium continued ; neck became 

 somewhat rigid, and he gradually grew weaker, and died on 

 May 2d. 



Autopsy •.—^\iQ.x^ were found at the autopsy extensive old 

 but unhealed typhoid ulcerations in the lower part of the ileum 

 and an acute lepto-meningitis with a moderately abundant 

 sero-purulent exudation over both the base and convexity of 

 the brain. The ventricles were distended with serum contain- 

 ing a little fibrin and pus. 



On bacteriological examination this exudation was found to 

 contain pure cultures of the Bacillus coli communis. 



In this case organisms {Bacilhis coli cojnmunis) normally 

 present in the intestinal contents had found entrance through 

 the ulcers in the intestines into the blood or lymp currents, had 

 made their way to the cerebral pia and set up there an acute 

 inflammation. This is the first case recorded of a meningitis 

 caused by this organism. 



Case IW.— Acute Lepto-meningitis, {Otitis Media, etc.) due to a 



Mixed Infection. 



G. B., aet. 55, laborer, was admitted April 11, 1892. The 

 history given was that he became unconscious while return- 

 \Xi<y home from work and was brought by an ambulance to the 



