3i6 Hermann Michael Biggs 



It is further the opinion of the writer that many of the cases 

 of cerebral meningitis would prove to be of the cerebro-spinal 

 type at the autopsy, if the spinal cord were removed and ex- 

 amined. In the usual routine of autopsy work, owing to the 

 time and labor involved, the spinal cord is not removed, un- 

 less there have been some symptoms pointing to disease in 

 the spinal canal. The operator examines the portion of the 

 cord accessible from the cranial cavity, and in the absence of 

 gross evidences of disease here the remainder is not removed. 

 As a matter of experience the writer can affirm that there is 

 not infrequently an abundant exudation in the dorsal and 

 lumbar portions of the spinal pia, when the cervical portion is 

 free, and when the clinical history has given no indication of 

 the involvement of the spinal meninges. 



In the present series there are eighteen cases, of which six 

 were cases of cerebro-spinal and twelve of cerebral lepto-men- 

 ingitis. In only three of the series was the meningitis secondary' 

 to traumatism or to disease of the cranial bones or soft parts 

 about the head. Of the cerebral cases one was primary and 

 eleven were secondary to some local or general acute infec- 

 tious process. A more or less complete bacterial examination 

 was made in seventeen of the cases. 



There has been a general feeling among medical writers 

 that acute cerebral lepto-meningitis in adults is very common- 

 ly secondary to otitis media or disease of the soft parts about 

 the head or cranial bones. These cases do not wholly confirm 

 this view. In only two was the inflammation of the pia second- 

 ary to an otitis media and in one probably to a scalp wound. 

 In the other cases the disease occurred primarily or was sec- 

 ondary to some general infectious disease. In the twelve cases 

 of acute cerebral lepto-meningitis, the bacterial examination 

 gave : 



In one case pure cultures of the anthrax bacillus ; 



In one case the Bacillus coli commiinis ; 



In one case the B. coli communis with Proteus vulgaris (the 

 latter was probably due to a contamination). 



In four cases the Pneumo bacillus of Fraenkel ; 



In two the Streptococctis pyogenes ; 



