H4 PHYSIC 



and dangers of evacuation of toxic material thus is very 

 great, and that the proneness of the disease to a fatal 

 termination is only too well founded or established. 

 Nevertheless, it would seem that early surgical interference 

 in the shape of lumbar puncture or otherwise affords a 

 hope that we may be able to cope with a condition of 

 things, now recognised as well nigh hopeless, if we be 

 able to establish our diagnosis promptly, and are at liberty 

 to use the appropriate measures before the cerebro-spinal 

 fluid has reached the state of too great turbidity or too 

 diminished fluidity to be withdrawn. 



The above narrative at once suggests that the cause of 

 cerebro-spinal meningitis is none other than the presence 

 of the neurococcus in the congenial medium of the 

 cerebro-spinal fluid, the growth and decay of this organism, 

 and the consequent intoxication, so to speak, of the con- 

 tents of the cerebro-spinal cavity, liquid and solid, with 

 the result that the free surfaces of the involved meninges 

 and neural elements proper become pathologically affected 

 with the organism, its toxins, and residual products. 



The meningeal inflammatory process, with its conse- 

 quences, may thus be regarded as secondary, and, there- 

 fore, that the greater part of the solid admixture or 

 turbidity producing constituents of the cerebro-spinal 

 fluid may be credited to the primary microbic invasion, 

 growth, and decay, with its resulting deposition, the 

 remaining part only being due to an inflammatory exuda- 

 tion from the affected meninges and the deeper seated 

 structures. 



In this connection we are warranted in inferring that 

 the great intra-cranial and intra-spinal lymph spaces, as 

 represented by the ventricles and central canal, cannot fail 

 to be also subsequently, if not simultaneously, invaded 

 by the common microbic enemy, with the result that intra- 

 spatial pressure and toxic action will be set up, together 

 with the secondary inflammatory consequences alluded to, 

 in the discussion of what we may call the extra-spatial form 

 of the disease. 



The same sequence of events may, therefore, be looked 

 for in the latter the intra-spatial as were found to occur 

 in the former the extra-spatial w r ith the exception that 



