A Bacterial Study of Acute Meningitis 321 



Cask V. — Streptococcus Septiccemia, {Acute Double- Pleuritis, 

 Pericarditis and Meningitis, Rupture of the Spleen), due 

 to the Streptococcus Pyogenes. 



J. M., aet. 41, sailor, was admitted April 6, 1892. The his- 

 tory given showed that he had been suffering from cough, ac- 

 companied by an irregular type of fever with frequent chills for 

 about two weeks previous to admission. He was markedly 

 alcoholic when admitted; temperature loi, pulse no, res- 

 pirations 26. The following morning, T. 104^(5-, P. 108. Phy- 

 sical examination showed the presence of abundant subcrepitant 

 and small mucous rales to be heard over both lungs, most 

 marked over the left upper lobe. The temperature gradually 

 rose to 105 y's" at ii p. m., P. 112, R. 30. He was delirious and 

 unable to swallow, and his respirations were rapid and labored. 

 Under stimulants and antipyritics the temperature dropped to 

 103^ at t p. m., on April 8th ; the rales had diminished, the 

 respirations were easier and the delirium less marked. At 9 

 a. m., April 9th, Temp. 102 j'v P. 102, R. 26, and nurse re- 

 ported that he was much improved, the delirium had disap- 

 peared and he was able to take nourishment by mouth. At 

 9.45 a. m. he was seized with an attack of vomiting and 

 partly raised himself up in bed, when he became suddenly pale 

 fell back unconscious and died a few minutes later. 



Autopsy : — A large amount of fluid and partly clotted 

 blood was found in the peritoneal cavity. On careful search 

 for the source of this hemorrhage, a rupture was found in the 

 lower internal surface of the spleen about one inch and a half 

 in length. The spleen was large, soft and contained numer- 

 ous hemorrhagic infarctions. There was also an acute inflam- 

 mation of the pleura on both sides, of the pericardium and of 

 the pia of the brain attended with an abundant sero-fibrino- 

 purulent exudation. 



Bacteriological examination showed the presence of the 

 Streptococcals pyogenes in pure form in the spleen and pial exu- 

 date. In the blood from the heart there were some other or- 

 ganisms associated with it. This was undoubtedly a case of 

 streptococcus septicaemia, and was probably such from the be- 

 ginning, although the diagnosis during the two weeks illness 

 before admission to the hospital had been malarial fever. 



