1 42 PHYSIC 



the olfactory nerves, bulbs, and tracts, as well as through 

 the glosso-pharyngeal pituitary tracts, and thence by con- 

 tinuity into the cerebro-spinal fluid, where they grow and 

 flourish and perpetuate themselves, as in a prepared cul- 

 tural medium, until the whole fluid becomes invaded, 

 contaminated, and used up, so to speak, by the succeeding 

 generations of this rapidly multiplying organism and its 

 toxins. 



During this process we may take it that the germina- 

 tion, growth, and decay of the neurococcic bacilli, and 

 the accumulation of their consequent toxinal lymph ele- 

 ments, are effected at the expense and to the detriment 

 of the proper lymph contents of the cerebro-spinal cavity, 

 and that the toxins resulting from the manifold activity 

 involved therein accumulate and attach themselves to the 

 peripheral or meningeal surfaces of the cerebro-spinal 

 cavity, or gravitate to or towards its most dependent parts, 

 there setting up pathological changes or mechanically 

 blocking more or less entirely the various intra-spaces 

 and inter-spaces into which they are divided, and destroy- 

 ing the continuity and patency of their canals. 



What, therefore, have hitherto been regarded as exu- 

 dates must thus be looked upon as deposits^ and the more 

 or less turbid, muddy, or consistent character of the fluid 

 withdrawn as a diagnostic expedient by lumbar puncture 

 of the cord may be used to determine the greater or lesser 

 degree of microbic development and decay undergone in 

 the particular case and at the particular stage of the disease 

 at which it has been withdrawn. 



It may here be observed that the state of things above 

 described may begin and end within the brain and cord 

 and the meninges, terminating, in a small minority of 

 cases, favourably, but, in the great majority of cases, 

 fatally. 



However the cases may terminate, whether fatally, as 

 is their wont, or favourably, as it is just possible they 

 may do, we see that, in the course of a great many cases, 

 the pathological process extends itself in other directions, 

 and that these other directions will be found to coincide 

 with the direction or course of the greater and lesser nerve 

 trunks. 



