CEREBRO-SPINAL MENINGITIS 143 



Thus herpetic eruptions manifest themselves at the 

 peripheral endings of some of the lesser nerve trunks on 

 a level with the particular spinal area of the central nervous 

 system involved, or a pneumonia will display itself on 

 the invasion of the pneumogastric trunk, or an endo- 

 cardial ulceration may appear, or a gastro-enteric catarrh 

 may assert itself, each affording or providing outlets 

 "along the lines of least resistance," for the escape of the 

 over-compressed and contaminated cerebro-spinal fluid, 

 with its toxins and live disease germs. 



We would, therefore, premise that if the course of 

 individual cases of this disease be carefully analysed and 

 studied from this point of view, it will be found that in 

 almost every instance of complication the complication 

 so called succeeds, or apparently only synchronises with, 

 but does not precede ; in other words, it will be found 

 that the primary disease was, and is, the cerebro-spinal 

 meningitis, all which is determined, we hold, by an orderly 

 sequence of pathological events. 



At the same time, in our process of analysis and study 

 of individual cases, we must not lose sight of the possi- 

 bility of the sequence of these pathological events being 

 reversed, and of our finding that the pneumococcus quite 

 appropriately named in this case of pneumonia found 

 its way from the pulmonary terminal ends or endings of 

 the pneumogastric nerves, or other nerves involved in 

 particular cases, along the surrounding neurilemmar inter- 

 spaces of these nerves into the cerebro-spinal cavity. 



Thus we may conclude that in the absence of nasal, 

 pharyngeal, cutaneous, or other discharges, overpressure, 

 arising from the continually swelling contents of the 

 cerebro-spinal cavity resulting from the rapid growth and 

 accumulation of its pathological contents, must be relieved 

 by a passage or passages being found for their evacuation, 

 and thus, also, we find that the particular paths or nerve 

 trunks alluded to afford the next easiest exits to the 

 natural great cerebro-spinal lymph exits. 



The pulmonary points of exit being, not on to a free 

 surface externally, but into the texture of vital organs or 

 the lining membrane or surface of partially closed or 

 narrow tubes, we are forced to recognise that the difficulty 



