320 Hermann Michael Biggs 



hospital. Temp, at time of admission 102^^, P. 76, R. 18. 

 He soon regained consciousness, but seemed nervous and 

 stupid. He complained of no headache nor pain in neck or 

 extremities. There was a foetid discharge from the left ear, and 

 his tongue was dry, brown furred and tremulous. His temp, 

 ranged from 102-1037% during the next three days, pulse from 

 80-go, resp. 16-25. Rigidity of the neck developed on the day 

 following his admission and gradually increased. On the 

 second day he became stupid and difficult to arouse and 

 seemed to have some loss of power on the left side. On April 

 i4tlihe became comatose. On April rsth the temperature varied 

 from 102-103, the respirations became rapid and superficial (30- 

 40) and the pulse 100 to 130. Operation was advised in hope 

 of finding a cerebral abscess and relieving pressure by evac- 

 uation of the pus. An operation was performed by Dr. J. 

 D. Br}'ant. The .skull was opened above and posterior to 

 left external auditory meatus ; the dura was found free from 

 inflammatory exudate but with only slight pulsation, and the 

 convolutions under it seemed flattened and the brain substance 

 rather soft. An aspirating needle was passed into the lateral 

 ventricle and about 7 ounces of slightly blood stained fluid 

 withdrawn. Pulsation of the dura became much more marked 

 after removal of the fluid. A small drainage tube was then 

 inserted into the lateral ventricle, and the external wound 

 closed. He rallied very little from the operation and died 

 about 7 hours afterward. 



Autopsy : — An abundant fibrino-purulent meningitis was 

 found at the base. The pia of the convexity v.'as not affected. 

 The ventricles were much dilated with blood stained serum, 

 and the ependynia was granular and thickened. There was a 

 miliary tuberculosis of both lungs. The prostate contained 

 a large abscess which had ruptured into the peritoneum and 

 then became encapsulated. There was also extensive tuber- 

 cular ulceration in the ileum. 



The bacteriological examination in this case showed the 

 presence of a mixed infection. The Staphylococcus pyogenes 

 aureus was among the organisms found. Notwithstanding 

 the extensive tuberculosis of other organs the meningitis was 

 not of tubercular origin. 



