1 82 CLINICAL BACTERIOLOGY AND ILEMATOLOGY 



of such simple constitution as the cerebro-spinal fluid. It is 

 occasionally of value in patients found unconscious. In one 

 such case I was able to exclude uraemia definitely, though the 

 urine contained albumen and casts : it turned out to be a case 

 of poisoning. In uraemia there is often the additional advan- 

 tage of its affording* a relief to some of the symptoms. Fur- 

 ther details are outside the scope of this work. 



(d) Bacteriological. The chief organisms which cause 

 acute meningitis are given in the following* table, which is 

 modified from one given by Osier : 



Primary (i.e., not dependent on an obvious lesion elsewhere in the body). 



1. Cerebro-spinal fever 



(a) Sporadic 1 



/x.\ T- -j 5-Weichselbaum s diplococcus, or menmgococcus. 



(b) Epidemic] 



2. Pneumococcic 



(a) Pneumococcic infection of meninges alone, not de- 



pendent on disease of distant parts of the body. 



(b) Pneumococcic infection of meninges occurring as |> Pneumococcus. 



part of a general septicaemia without obvious I 

 primary lesion. / 



Secondary. 



A. To direct extension from local disease of the cranium, middle ear, 



fossae, spinal column, etc. 

 Pneumococcus. 

 Staphylococci. 

 Streptococci, etc. 



B. To septicaemic infection due to disease in a distant part of the body. 



(a) Pneumococcic 



Secondary to pneumonia, endocarditis, etc. 

 Pneumococcus. 



(b) Pyogenic 



Secondary to abscesses, etc., and occurring as a part of a general 

 infection. 



Staphylococci. 

 Streptococci, etc. 



(c) Gonorrhceal 



Secondary to gonorrhoea. 

 Gonococcus (rare). 



(d) Tuberculous 



Secondary to tuberculosis of other regions. 

 Tubercle bacillus. 



