A Bacterial Study of Acute Meningitis 323 



usually rapid before the end. Rigidity or stiffness in the 

 back of the neck, retraction of the head, contracted pupils, de- 

 lirium, coma, and incontinence of urine and faeces were uni- 

 formly present. In a small proportion of cases there was a 

 petechial eruption on the trunk or on both trunk and extremi- 

 ties. Albuminuria was almost invariably present, and in one 

 case there was also glycosuria and haematuria. There was 

 usually hyperaesthesia of the skin and muscles, and in two 

 cases well marked opisthotonos. Paresis or paralysis, involv- 

 ing small groups of muscles or those of one side, was common. 

 The pupils were contracted, dilated, or irregular. Early 

 there was increased sensitiveness to light, and later there was 

 often loss of accommodation and loss of corneal reflex. There 

 seemed to be no constant relation between the amount of 

 exudation found after death and the severity or character of 

 symptoms shown during life. The duration of the cases 

 which terminated fatally varied between 36 hours and 10 or 

 12 days. In only one clearly defined case of cerebro-spinal 

 meningitis did recovery take place. In this the temperature 

 for several days ran between 104° and 106° F. 



It has been rare in the writer's experience to see cases of 

 cerebro-spinal meningitis at any other season of the year than 

 during the spring months, and these cases are almost in- 

 variably primary and develop suddenly without any ascer- 

 tainable cause. 



In several of the cases in which no culture tubes were in- 

 oculated or in which those inoculated remained sterile, cover- 

 glass preparations made from the meningeal exudate showed 

 the presence of diplo-cocci. 



Aside from the cases presented in this paper in which a bac- 

 terial examination was made, during the same period there oc- 

 curred in the writer's service nearly 20 other cases of cere- 

 bral and cerebro-spinal meningitis, including several of 

 syphilitic or tubercular origin in which there was no bacterial 

 examination, making a total of nearly 40 cases, most of which 

 occurred in four months of hospital service. This fact is noted 

 to direct attention to the prevalence of meningitis at the pe- 

 riods referred to and to justify the following observations 

 which have been suggested by the study of this series of cases. 



