Summary.—The principal features in this case may now be recapitulated:
1. Two pathological conditions were present together in the pia-arachnoid, one recent, the other of old standing.
(a) A leucofibrinous exudation into the meshes of the pia-arachnoid existed, distributed in an irregular manner. The exudation contained diplococci agreeing in morphological appearances, staining reactions,(5) and cultural characters with Fraenkel's Diplococcus pneumoniæ. Similar micro-organisms were present in the lymph covering the ependyma of the ventricles. The subjacent cerebral cortex appeared free from gross change when stained by v. Giesen's method.
(b) The pia-arachnoid, on microscopical examination, was found to be thickened and infiltrated with cells having abundant cytoplasm, these changes being such as are commonly associated with chronic brain atrophy and excess of fluid in the subarachnoid space and ventricles.
2. The leptomeningitis occurred in conjunction with suppuration of the liver substance. There was a papilloma at the opening into the duodenum of the ductus communis choledochus, which was dilated, as was also the gall-bladder, which contained gall-stones. The head of the pancreas was the seat of chronic pancreatitis. The foci of suppuration in the liver contained diplococci resembling those present in the pia-arachnoid, and were probably the source of the infection of this membrane.
3. During life any symptoms which may have been attributable to the condition of the pia-arachnoid were obscured by those due to the abdominal lesions.
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