SEVENTY-ONE CASES 
OF 
CEREBRO-SPINAL meningitis 
BY 
FRANCIS H. WILLIAMS, M.D. 
REPRINTED FROM 
THE MEDICAL AND SURGICAL REPORTS OF THE 
BOSTON CITY HOSPITAL, 
JANUARY, 1898 
MUNICIPAL PRINTING OFFICE 
1898 
BOSTON SEVENTY-ONE CASES 
OF 
CEREBRO-SPINAL meningitis 
FRANCIS H. WILLIAMS, M.D. 
BY 
REPRINTED FROM 
THE MEDICAL AND SURGICAL REPORTS OF THE 
BOSTON CITY HOSPITAL, 
JANUARY, 1898 
BOSTON 
MUNICIPAL PRINTING OFFICE 
1898 SEVENTY-ONE CASES OF CEREBRO-SPINAL 
MENINGITIS. 
By Fbancis H. Williams, M.D. 
It is not my intention to consider here the various epidemics 
of cerebro-spinal meningitis that have occured since 1805 in 
the United States and other countries, nor the recognition in 
recent years of a diplococcus as a cause of this serious malady 
hut with the kind permission of the medical staff of the Bos- 
ton City Hospital, to give an outline of the cases that have 
entered their services, as well as my own, between January 
1, 1897, and December, 1897, seventy-one in all. The 
records are in many instances incomplete for various rea- 
sons ; many patients do not speak English or they may 
be brought to the hospital in an unconscious condition 
and unaccompanied by friends. The tabulation by localities 
shows that one part of the city has not been markedly more 
affected than another. The patients have been youths and 
adults, as children have been sent to the Children’s Hospital. 
The mortality has been nearly 61 per cent.; forty-nine died; 
twenty-two recovered. 
The disease has been characterized by sudden onset; the 
most constant symptom has been headache, associated usually 
with some tenderness to pressure in the neck or pain on 
movement there or retraction of the neck. Delirium occurred 
in most of the cases, vomiting was a frequent symptom and 
strabismus, failure of the pupils to react, nystagmus, diplopia, 
or optic neuritis have been often noted. The temperature 
was very irregular, and this want of regularity is quite char- 
acteristic of the disease. The pulse in some cases was rapid, 
in others it was less than normal, and in still others it was 
slower than the symptoms present would lead one to expect. 
In nineteen cases there was herpes labialis. 
The leucocytes were counted in thirty-two cases, and in twelve 
of these there were at some period of the disease less than 4 
10,000 ; this was true in four of the fatal cases, but a subse- 
quent count in three gave a great increase in numbers; in 
the fourth there was no subsequent count. If, therefore, the 
leucocyte count when used in the diagnosis of cerebro-spinal 
meningitis, gives no leucocytosis, a second count should be 
made. In thirteen cases, more than one count was made and 
the subsequent count or counts showed a marked increase in 
the leucocytes in the six fatal cases (three of these have been 
alluded to above) ; in the remaining seven that recovered 
there was a striking decrease in five, no change in one, and 
in the seventh the decrease was followed by an increase and 
this again was succeeded by a diminution. These cases indi- 
cate that the leucocyte count may sometimes assist in the 
prognosis. 
The serum test for typhoid fever was tried in ten cases 
and was positive in one only, that of a negro. 
Lumbar puncture was done in forty cases, and judging 
from these this puncture does no harm and it readily estab- 
lishes the diagnosis when fluid containing the organisms is 
found; it is sometimes very serviceable for diagnosis as 
often there is no history and the symptoms may be few. It 
should be borne in mind that the bacterial examination may 
give a negative result even in cerebro-spinal meningitis 
unless the test is made by those who have had much experi- 
ence. The operation for lumbar puncture, under strict anti- 
septic precautions, is readily done by using a small trocar to 
tap the sac surrounding the spinal cord and drawing off 
some of the fluid; the point of insertion is between the third 
and fourth lumbar vertebrae. I have usually chosen a point 
slightly lower than the lowest part of the spinous process of 
the second lumbar vertebra, and one inch outside of it, and 
inserted ti small sized trocar, somewhat downward and 
inward to a depth of rather more than two inches. I have 
always used a trocar instead of a needle, as the latter is 
liable to be bent or broken off, and is too small to allow the 
thick pus that is present in some cases to flow through it easily. 
The present treatment of the disease is wholly unsatisfac- 
tory ; but the fact that we have the means of making an 
early diagnosis in many cases, offers the hope that better 
treatment may be found. a 
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+ 
Jap. 
2 
Jos. P. 
27 
5 days 
+ 
+ 
2-5th d. 
9,000 
Jan. 5 
Feb. 
8 
49 
lday 
18 “ 
Alcoholic excess. 
Retrac. 
+ 
+ 
+ 
Feb. 10 
Feb. 17 
10 
40 
Headache. 
+ 
Retrac. 
+ 
Right 
side. 
Paralysis day before 
death. 
Mar. 
5 
John F. 
31 
14 “ 
Alcoholic. Malaise. 
+ 
Retrac. 
18,800 
March 13, 
dry tap. 
Apr. 10 
mastoids. 
« 
6 
Mike M. 
17 
10 “ 
+ 
Pain, 
+ 
+ 
Diplopia, 
ptosis, 
Mar. 8, 
March 15,' 
slightlv 
Mar. 21 
Cephalic cry. 
retrac. 
left ear, 
second- 
8,200 
double 
Mar. 11, 
turbid, no 
optic 
ary to 
16,000 
Vlar. 15, 
pus, mono 
leucocytes. 
neuritis. 
mening. 
22,000 
« 
9 
C. H. 
25 
lday 
Found unconscious. 
+• 
Retrac. 
+ 
Mar. 21 
Muse, rig., struggling, 
slept after puncture. 
(( 
10 
Alfred B. 
6 w’ks 
Headache, occip. and 
eery. 
+ 
Slight 
retrac. : 
+ 
Slight optic 
neuritis. 
March 10, 
3 ij turbid, 
Apr. 10 
Tenderness over spine. 
diplococci. 
«< 
10 
Richard S. 
23 
10 days 
2 “ 
Headache. 
+ 
+ 
Yio-' 
lent. 
+ 
Apr. 6 
Mar. 16 
Tuberculin, no reaction. 
11 
Sophie M. 
17 
Chill; headache. 
+ 
Pain. 
Diplopia, 
strabismus, 
4tli dy. 
31,000 
March 14, 
3ij turbid, 
—1 
ptosis. 
diplococci. 
<< 
11 
Frank R. 
23 j 
2 “ 
Alcohol, stupid. 
+ 
+ 
Strabismus. 
Tongue 
to left. 
7,490 
M arch 20, 
3 ij clr. sterile. 
Apr. 3 
1 
« 
17 
Celia McC. 
25 
4 “ 
Indef. pain, vomiting. 
+ 
Tender. 
+ 
....i 
Nystag., 
diplopia. 
2 dry taps. 
Apr. 2 
Epistaxis. 
nerve. 
« 
18 
S. P. 
33 
18 “ 
+ 
Stiff, 
+ 
March 21, 
pus cells. 
Mar. 22 
Headache. 
retrac. 
+ 
; 
+ 
Strabismus, 
nystag. 
Purpuric 
spots on 
19 
Chas. K. 
15 
25 “ 
+ 
March 20, 
gj turbid, 
Mar. 22 
r. knee, 
wrist, 
forearm, 
elbows. 
Herpes 
diplococci. 
labialis. 
« 
20 
Porter, A. S. 
37 
7 “ 
Headache gen. pains. 
+ 
+ 
+ 
Mar. 24, 
March 23, 
3iv turbid. 
Mayl7 
Well, except some mental 
symptoms. 
14,000 
(( 
25 
Jessie E. 
17 
4 “ 
Headache gen. pains. 
Pain, 
+ 
+ 
+ 
Mar .26 
retrac. 
„ 
30 
Martin C. 
19 
5 “ 
Headache. 
+ 
Stiff, 
+ 
+ 
SI. optic 
neuritis. 
Deafness 
Herpes 
labialis. 
9,350 
Apr.19 
Well. 
retrac. 
from 
mening. 
u 
30 
Thos. T. 
27 
8 “ 
Malaise, headache, deli- 
rium.. 
+ 
Strabismus. 
Herpes 
labialis. 
April 1, 
21,600 
April 1, turbid. 
Apr. 2 
retrac. 
Mertie K. 
33 
3 “ 
Vomiting, occip. head- 
ache 
+ 
Stiff. 
.... 
+ 
+ 
Strabismus. 
April 3, 
no fluid, 
Apr. 5 
,< 
5 
15 
1 day 
2 dav« 
-4- 
t + 
+ 
+ 
+ 
Apr. 5 
Apr. 6 
5 
Mike M. 
35 
, Pain hack and legs; 
headache, delirium 
+ 
Retrac. 
April 6, 
g ii purulent 
fluid. 
« 
6 
Alex. McC. 
V 
Nystag. 
4_ 
April, 9, 
dry tap. 
Apr. 9 
24 
1 day 
Sore throat, headache. 
+ 
+ 
+ 
mastoids. 
+ 
Unconscious, restless. 
17 
Art. McK. 
Apr.17 
Stiff. 
+ 
Sterile. 
17 
John S. 
24 
3 days 
Headache. 
+ 
+ 
+ 
Apr.23 
1. elbow, 
buttocks. 
18 
Pat. O’B. 
26 
3 day 
Severe headache, 
vomiting;. 
+ 
Stiff 
4- 
1 
~’tosis. . 
Small amount 
June 26 
1 
1." ‘' 
„ 
18 
Geo. K. 
50 
3 “ 
Delirum 
■ + 
optic neu- 
ritis, strabis. 
April 16, 
diplococci. 
no reaction. 
« 
21 
Pet. McG. 
29 
4 “ 
Chill, headache, deli- 
+ 
Retrac. 
+ 
+ 
April 22, 
giv turbid, 
rium. 
diplococci. 
«< 
21 
Chris. D. 
19 
3 “ 
Headache, chill. 
+ 
Rigid. 
+ 
+ 
Pain over 
Herpes 
lab. 
Turbid fluid. 
June 8 
mastoids. 
« 
22 
Emma N. 
36 
10 “ 
Chill, pain in back, 
+ 
Stiff. 
+ 
Herpes 
lab. 
Apr. 30, 
24,500 
Diplococci. 
June 5 
headache. 
« 
22 
Daniel M. 
28 
4 “ 
Headache, pain in 
+' 
Stiff, 
+ 
Apr. 27, 
11,400 
3 times, 
1 puss cells. 
May 22 
abdomen, delirum. 
retrac., 
opistho 
2 diplococ., 
tonos. 
3 sterile. 
« 
26 
Geo. W. 
28 
2 “ 
Headache, vomiting. 
-f 
Rigid, 
+ 
+ 
Conjuncti- 
vitis. 
+ 
April 28, 
few drops 
Apr. 29 
tender- 
over 
ness. 
whole 
bloody 
body 
marked. 
fluid. 
« 
30 
James W. 
27 
11 “ 
Sore throat, headache, 
+ 
Retrac. 
.+ 
May 8 
vomiting. 
rigidity. 
conjuncti- 
vitis. 
pus cells. 
May 
4 
James C. 
16 
3 “ 
Headache, vomiting, 
+ 
Retrac. 
Herpes 
labialis. 
May 29 
vertigo. 
ten der- 
ness 
neck 
and 
back. 
<• 
Andrew H. 
27 
4 “ 
Pain in legs, vomiting, 
+ 
Stiff. 
+ 
Ptosis. 
Compl 
r. -sid’d 
Herpes 
labialis. 
May 9, 
60 cc. turb. 
May 29 
nose bleed. 
paral. 
diplococci 
12 
Thomas D. 
40 
3 “ 
Headache, sore throat. 
+ 
Pain, 
+ 
External 
Deafn’s. 
May 13 and 
19, dry taps. 
May 19 
Reflexes absent. 
tender. 
strabis. r. 
labialis. 
« 
14 
Cassie McG 
23 
3 “ 
Headache,pain in neck. 
+ 
Stiff, 
May 15, 
diplococci. 
May 15 
pain. 
«< 
17 
John S. 
27 
Pain in neck and legs, 
+ 
Pain, 
+ 
+ 
Herpes 
labialis. 
May 20, 
diplococci. 
June 3 
headache. 
stiff. 
« 
5 
Thomas S. 
35 
5 “ 
Pain in back, head- 
+ 
Stiff. 
+ 
Herpes 
labialis. 
May 7, 
dry tap. 
May 22 
ache, chills. 
« 
17 
Henry H. 
58 
3 “ 
Headache, vomiting, 
+ 
Stiff, 
retrac. 
+ 
Right 
leg. 
_L 
May 18, post 
mortem, dip. 
May 18 
abd. pain. 
•< 
21 
Everett M. 
26 
14 “ 
Pain in back, headache. 
+ 
Stiff. 
+ 
Herpes 
labialis 
May 22, 
dry tap. 
It 
22 
Con’r O’B. 
25 
2 “ 
Headache,gen. pains. 
+ 
Stiff. 
+ 
Slight 
strabis. 
May 25, 
32,000 
+ 
May 24, 
diplococci. 
May 25 
<• 
13 
Julius E. 
58 
3 wks 
Drowsiness ; indef. 
Tend’r, 
+ 
Ptosis, 
4_ 
May 19 
Hydrocephalus. 
hist. 
stiff. 
left pupil 
smaller, 
neither 
react. 
« 
24 
Jane O’C. 
13 
2 days 
Pain in back. 
Retrac. 
+ 
+ 
+ 
+ 
■ 
May 26 
May 31 
„ 
30 
Win. B. 
17 
4 “ 
Frontal headache 
+ 
Slight 
retrac. 
stiff. 
Internal 
May 31, 
diplococci. 
strabismus. 
X 
30 
John McC. 
35 
6 “ 
Pain in bones, chill. 
+ 
Pain, 
+ 
June 28 
Chill on 27th; pulse and 
temp. rose. 
stiff. 
diplococci. 
it 
31 
Eugene L. 
37 
3 wks 
Vomiting, headache, 
pain in small of back 
+ 
Stiff. 
+ 
June 6 
rigid. 
and legs. 
June 8 
John L. 
29 
A week before entrance 
Stiffness 
Mild 
3 days 
before 
2nd day 
mark ed 
2nd day, 12 
cc.; cloudy 
July 4 
drank to excess; 3 
of neck, 
at en- 
actions. 
days before entrance 
pain in 
tr’ce. 
entrance 
herpes. 
serum. Pus 
delirious at night. 
back. 
suddenly 
and diplococci. 
deaf. 
„ 
:1 
Tillian B. 
30 
Semi-conscious at en- 
Some re- 
4th 
+ 
After first week patient 
improved steadily. 
trance; no history. 
traction. 
day. 
small; no 
reaction. 
cloudy fluid. 
« 
12 
Martha M. 
16 
2 days ago headache, 
+ 
Retrac- 
Normal. 
Herpes 
on lips, 
Knee-jerks diminished. 
yesterday vomiting 
tion. 
15, left 
and retraction. Pain 
Tender- 
facial. 
ears and 
along whole spine. 
ness. 
/ 
neck. 
« 
17 
Frank T. 
25 
3 days ago, chill, fol- 
+ 
Stiffness. 
+ 
Post-mortem, 
5cc.; fluid 
June 18 
June 18, no indication of 
lowed by vomiting, 
Pain on 
almost continuous 
rotation. 
containing 
delirious. Uncomfort- 
diplococci 
able on account of pain 
headache, stiff ness 
neck and back, sore- 
ness of limbs. Yes- 
terday delirious. 
* 
intracell. 
in back and limbs. Sud- 
denly the patient be- 
came cyanosed and died 
in a few minutes. 
II 
20 
Ernest L. W. 
27 
1 week ago a chill last- 
+ 
Pain on 
N ormal. 
Herpes, 
labialis, 
June 17. 
Disch. 
Aug. 11 
No serum reaction. June 
28, patient much im- 
ing about 1 hour, fol- 
lowed by headache 
move- 
mentor 
21, 
15,800; 
and nausea; next day 
pres- 
June 
intense headache, de- 
lirious that night. 
Stiffness of neck and 
sure. 
26, 
9,800. 
rium; July 26, patient 
up for short time; J uly 
30. nain in right knee, 
back; soreness in 
some effusion, subsided 
limbs. 
in about three months. 
II 
28 
Peter M. 
24 
7 days 
Chill and vomiting 7 
+ 
Slight 
stiffness. 
Normal. 
Reflexes normal at en- 
trance. Incontinence 
days ago; 2 chills 
29, 
since; severe occipi- 
tal headache pain ex- 
tending down spine. 
Delirious 3 days be- 
fore entrance. 
11,200; 
July 9, 
14,200. 
urine July 5. Head 
constantly turned to 
left. 
,< 
29 
James G. 
25 
3J w’ks 
Weakness, headache, 
+ 
Stiffness; 
July 3, 
7000 
Dis- 
charge 
vomiting. 
pain on 
Flexion. 
July 15 
July 
5 
Laurence H. 
38 
Delirious. 
Normal. 
Normal. 
Herpes 
July 8, 
July 18, 6cc.; 
+ 
Pulse rapid, temperature 
at en- 
15,600 
cloudy fluid, 
irregular. Discharged 
trance. 
Pure culture 
diplococci, 
! intra cell. 
Aug". 31, still not clear 
mentally. 
« 
6 
George E. F. 
26 
2 days 
Vomiting and severe 
headache. 
+ 
12, d. slight 
int. strabis 
Herpes 
labialis 
July 7, 
16.400 
Aug.17 
13.400 
+ 
From July 18-24, coma- 
tose, high temperature; 
weak, death expected 
hourly. July 26, temp, 
dropped to normal; 
patient improved. Aug. 
7, delirious. From Aug. 
22, improved steadily, 
mentally and physi- 
cally. Nov. 27, well ex- 
cept bed-sores on heefs. 
<< 
6 
Jennie T. E. 
27 
3 days before entrance 
Pain. 
July 7, 
Divergent 
July 7, 
29,400 
+ 
July 9-14, continued 
steady improvement. 
patient lost child 6 
whitish cloudy 
years old of cerebro- 
strabis. 
Julv 9, 
fluid, shows 
Discharged Aug. 11, 
spinal meningitis 
after illness of 12 
hours. Patient deli- 
14,(300 
July 19, 
9,400 
diplococci. 
well. 
rious, pain in back of 
neck, vomiting since 
death of child. Did 
not know she had 
lost her child until re- 
covery. 
„ 
6 
Blanche L. 
18 
Sick for 2 weeks, deliri- 
ous most of time. 
-f 
Stiff, 
pain on 
Taste 
im- 
15,700 
strabis. 
Pain in top of head. 
move- 
Double 
pared. 
ment. 
optic 
neuritis. 
„ 
7 
Wm. B. R. 
52 
Sick one week, deliri- 
ous at entrance. 
Stiff, 
+ 
+ 
July 8, 
7,000 
+ 
July 
14 
Delirious, July 11. 
% 
tender- 
ness. 
July 11, 
18,400 
u 
9 
Salvatore M. 
16 
15 days ago, chills, 
headache, fever; 10 
+ 
Retrac. 
+ 
July 10, 
12,000 
July 12, 10 
cc. clear 
July 
14" 
pain on 
days ago severe pain 
in back of neck, re- 
flexion. 
fluid, small 
am’t gray 
traction, delirious, 
ttocculent 
unconscious. 
sediment. 
li 
12 
Mary C. 
46 
10 days ago nausea 
and vomiting, occipi- 
tal headache, pain in 
+ 
Diplopia 
+ 
July 
25 
Knee-jerks absent. July 
18,facial paralysis almost 
gone. July 20, patient 
tender- 
ness. 
facial. 
19,600 
back of neck; weak, 
Rota- 
much improved. July 24, 
in bed a few days, 
tion and 
patient weaker, rational. 
then up; took to bed 
5 days ago, pains 
have increased. 
flexian; 
painful. 
II 
24 
Josephine H. 
32 
Vomiting and severe 
-f 
Herpes 
labialis. 
July 25 
13,800 
Disch. well, August 14. 
headache since Julv 
2». 
Julv 29 
7,400 
<< 
26 
Edward P. 
32 
July 4, frontal head- 
ache. Semi-consci- 
+ 
J uly 30, 
almost 
-f 
11,500 
-f- 
July 
30 
Pulse 55 at entrance, 
temp. 100°. Serum reac- 
ous at entrance, 
opistho- 
tion positive (negro). 
slight stiffness neck. 
tonos. 
II 
30 
Lottie A. M. 
32 
7 days 
7 days ago severe pain 
in" left side. Diar- 
+ 
Pain. 
Diplopia 
slight; 
Aug. 1, 
+ 
Patient improved steadily 
13,200 
Aug. 7, 
13,300 
after admission. Dis- 
rhoea for three days. 
ptosis both 
charged, August 11, well. 
5 days ago severe 
pain in back of neck 
sides. 
and back then severe 
headache. Vomited 
several times before 
entrance. 
Aug 
2 
Thomas R. 
36 
lday. 
Well till yesterday 
evening' suddenly 
Right pupil 
smaller 
Slight 
ptosis 
Aug. 4, 
13,000 
Aug. 7 
Knee-jerks, cremasteric 
and abdominal reflexes 
pus drawn 
dropped back in 
chair, unconscious, 
frothed • at mouth, 
than left. 
both 
eyes. 
out. 
absent. 
cyanotic, this lasted 
fifteen minutes. Re- 
mained unconscious 
till entrance. 
Mary T. 
17 
Well till this morning. 
Head drawn to right. 
+ 
Sept. 15 
Resist- 
+ 
Sep. 15, 
12,500 
Postmortem, 
few pus cells. 
Sept. 15 
No tenderness of 
ance to 
Culture ster- 
spine, unconscious 
move- 
ile. 
since admission. 
ment. 
<( 
17 
Charlie J. 
21 
3 days ago severe chill, 
frontal headache. 
+ 
Oct. 3 
Aug. 18, 
Herpes 
Sep. 17, 
11,500 
Oct. 1 
Aug. 19, tenderness over 
mastoids. Aug. 18, knee- 
tion; 
Right 
2 days ago, chill vomit- 
tender- 
hemi- 
labialis 
Sen. 18, 
jerks now absent, have 
ing, stiffness of neck. 
ness. 
plegia. 
15,200 
Sep. 20, 
been present till to-day. 
Sept. 28, several chills'. 
12,000 
Oct. 1, 
17,500 
18 
Edward B. 
25 
Divergent 
strabismus. 
Slight 
right 
-J- 
19th 15 cc. 
cloudy fluid, 
Sept. 19 
■ 
Sept. 18, considerable loss 
of power of right arm 
16th, sick during 
derness, 
night, unconcious in 
pain on 
facial. 
pus cells con- 
and right leg. 
mornin g and brought 
turning. 
* 
taining dip- 
Until lumbar puncture 
to hospital. 
, lococci. 
was made the diagnosis 
was uncertain. 
Oct. 
13 
John M. 
34 
Pain in back of head, 
neck and along spine 
+ 
Rigidity 
Mild 
Oct. 13, 
-j- 
Oct 25, patient decidedly 
worse. Nov. 2, still 
16,200 
for two weeks; great 
Oct. 23, 
worse mentally. Nov. 
tenderness to pres- 
■ 
16,700 
Nov. 4, 
6, much better. Nov. 
sure. 
19, severe pain in 
* 
7,200 
back of neck, less ri- 
gidity. Delusions. 
• 
Nov. 25, up a short 
time; reads newspa- 
pers intelligently. 
« 
23 
Pat. M. 
19 
5 days 
+ 
+ 
Mild 
Normal 
Herpes 
labialis 
Oct. 24, 
No fluid 
Nov. 8 
Reflexes normal 
of neck. Vomited 
ness. 
6,600 ' 
once. Head slightly 
Rigid. 
Oct. 28, 
retracted. 
14,500 
Oct. 29, 
14,500 
« 
26 
Joe S. 
23 
11 days 
Began with chill head- 
a c h e, then severe 
+ 
Mild 
Normal 
Oct. 27, 
+ 
Temperature irregular. 
Severe chill daily for 
ness. 
11,000 ’ 
Cultures nega- 
headache and pain 
Rigid. 
Oct. 28, 
tive. 
20 days since Nov. 3 
along spine in cervi- 
9,800 
followed by rise of 
cal and lumbar re- 
Nov. 5, 
temp., 103 to 105; no 
gion. Considerable 
16,450 
plasmodia found. 
swelling and effu- 
Nov. 11, 
Quinine without ef- 
sion in left knee. 
10,500 
feet; Dec. 5, recover- 
ing. 
II 
29 
John W. 
40 
Found unconscious. 
Oct. 29 
* 
ness. 
Smears show 
Retrac- 
abundant pus 
tion. 
cells and lan- 
ceolate d i p- 
lococci; cul- 
tures show 
pneu mococ- 
cus. 
Nov. 
14 
Jos De G. 
35 
2 days 
Two days ago, severe 
headache, fever, 
+ 
+ 
+ 
Nov. 30 
Nov. 26, Patient improv- 
ing. Nov. 29, not so 
traction 
para- 
14,400 ' 
bid fluid. Dip- 
vomited several 
and rig- 
y si s 
Nov.21, 
lococci found. 
well. Nov. 30, uncon- 
times. Chill and se- 
idity. 
right 
18,600 
scious. 
vere occipital head- 
arm 
Nov.27, 
ache. Delirious, 
semi-conscious. 
and leg 
17,600 
Note, -f- = yes.