322 Hermann Michael Biggs 



The simultaneous involvement in an acute inflammation of 

 so many of the serous membranes is of rare occurrence. Rup- 

 ture of the spleen is described in most text-books as occurring 

 in several diseases. In a rather large pathological experience, 

 however, the writer has never seen any other instance of spon- 

 taneous rupture of the spleen. 



Cases VI to IX Inclusive. — Acute Lobar Pneumonia with 



Acute Cerebral Lepto- Meningitis due to the Pneumobacillus 



of Fraenkel. 



The cases of acute lobar pneumonia associated with second- 

 ary meningitis were four in number. The meningitis affected 

 both the convexity and base in all the cases. In three of 

 these, cultures made from the meningeal exudate showed the 

 presence of the pneumo-bacillus of Fraenkel in pure form. 

 In the fourth case, unfortunately, no bacteriological examina- 

 tion was made, but there is no doubt that it was quite similar 

 to the other cases. The clinical history of these cases differs 

 from that of pneumonia uncomplicated by meningitis only in 

 the more pronounced character of the cerebral symptoms after 

 the third or fourth day, i. e., delirium, rigidity of the back of 

 neck, muscular twitchings, contracted pupils, etc., and the 

 higher average range of temperature. 



Attention is also directed here to the occurrence of acute 

 primary lepto-meningitis due to the pneumo-bacillus of 

 Fraenkel, the lungs not being involved. This organism is 

 more frequently found than any other, as the causative agent 

 in cerebral and cerebro spinal meningitis. 



CASES OF CEREBRO-SPINAL LEPTO-MENINGITIS. 



During the period referred to, 14 cases of cerebro-spinal 

 meningitis occurred in the writer's service in only 6 of which, 

 however, were bacteriological examinations made. In three 

 of these six cases, the cultures remained sterile ; in one the 

 pneumococcus of Fraenkel developed ; in one the staphy- 

 lococcus pyogenes ; and in one there was a mixed infection. 



The history in most of these cases was that commonly 

 found in cerebro-spinal meningitis. The temperature range 

 varied greatly ; in some of the cases running uniformly low, 

 reaching 103 rarely or not at all, and in other cases running 

 very high, varying between 104 and 107. The pulse rate was 



