[Reprinted from The Medical News, December 29, 1894.] 
MENINGITIS COMPLICATING INFLUENZA; 
AUTOPSY. 
By HERMAN B. ALLYN, M.D., 
OF PHILADELPHIA ; 
INSTRUCTOR IN PHYSICAL DIAGNOSIS, UNIVERSITY OF PENNSYLVANIA. 
The patient was a man eighty-two years old, a 
widower, temperate, and of excellent habits. He had 
enjoyed good health until the past five years, in which 
time he is said to have had one or two illnesses in which 
he became violently delirious. He has for several years 
suffered with vertigo, dyspepsia, lumbago, and constipa- 
tion, largely the result of a general arterio-sclerosis. He 
presented mitral and aortic systolic murmurs not asso- 
ciated with any edema. On March 9, 1894, I found 
him suffering with influenza, brought to him, no doubt, 
by another member of the family, who, suffering with 
the disease, had returned a few days before from a dis- 
tant city. The patient complained of headache, sore- 
throat, and cough, but especially of the cough, and of 
severe pain on the right side, anteriorly at about the 
seventh rib. This spot was extremely tender as well as 
painful. There was pain also in the back and in the left 
side of the abdomen. There was general bronchitis. On 
account of the fever and severe pain in the right side 
it was feared that a pleurisy or pleuro-pneumonia might 
develop, but no dulness or friction-sounds appeared. 
Gradually the patient became more and more delirious 
at night. The delirium would begin in the afternoon 
and last until morning, when he would become rational, 
but not uninterruptedly. He seemed to feel worse when 2 
he was lying down, and it was with great difficulty that 
he was kept in bed. Sleep was in short snatches, and 
was very uneasy. At times he was violent, and once 
he tried to jump out of the window. His most constant 
delusions were that he was away from home and that he 
was compelled to work at night in a mill, although, as 
he would explain to me pitifully, " I am no longer strong 
enough for such hard work!" Bromids, chloral, mor- 
phin, sulphonal, and trional were successively tried in 
an effort to overcome persistent insomnia and to lessen 
delirium ; each drug failed in turn, and was discontinued. 
Finally, hyoscin hydrobromate, in doses of gr. re- 
peated once when necessary, proved comparatively satis- 
factory. It was given in the latter part of the afternoon 
and at night. 
At first the man took sufficient nourishment, but in the 
last two weeks of his life it was difficult to get him to 
take anything. During most of his time, especially 
during the last week, his arms and legs would twitch, 
and they were kept pretty constantly in motion. His 
urine contained only a small amount of albumin. 
Through some oversight it does not seem to have 
been examined for casts, or the record has not been 
preserved. Previous to the last illness the urine con- 
tained neither albumin nor casts. During the last week 
of his life his urine was passed involuntarily in bed, 
and his bowels were not moved. During this time coma 
succeeded gradually upon delirium, and the patient re- 
mained in bed. He seemed to have pain when moved, 
and to be disagreeably conscious of touch when no 
longer able to see or hear. He died in coma, April 7, 
about one month, therefore, from the beginning of his 
influenza. 
The autopsy was performed thirty-six hours after 
death by Dr. W. S. Carter and myself. The lungs were 
found normal. The heart-muscle was soft and friable ; 
the mitral orifice was dilated, while the aortic cusps had 3 
on them a few atheromatous nodules. The left ventricle 
was somewhat dilated and hypertrophied. The liver 
was fatty and cirrhotic. The kidneys were contracted; 
they contained a few old infarcts and one recent infarct 
and a few minute cysts. The cortex was much shrunken, 
especially in the left kidney. The right suprarenal body 
was replaced by an old cyst enclosing rough, brownish 
material. The colon contained a number of scybalous 
masses. There was no peritonitis. The stomach was 
not examined. The spleen was not enlarged. The 
cortex of the brain showed much injection of the ves- 
sels and opacity of the pia and arachnoid, which were 
somewhat adherent to the brain-substance. The lymph- 
spaces were dilated and prominent. A gelatinous sub- 
stance was seen over the cortex. There was no pus. 
At the base of the brain the changes were the same, but 
without the gelatinous substance. The arteries of the 
circle of Willis were atheromatous, and a few minute 
aneurisms were visible. The lateral ventricle was 
dilated. The cortical brain-substance was of deeper 
color than normal. 
In The Medical News, May 14, 1892, I reported 
three fatal cases of cerebro-spinal meningitis, with 
autopsies. In these cases the clinical history was very 
different from that of influenza. In the case just re- 
ported the ordinary symptoms of influenza were well 
marked, and other members of the family suffered with 
it in its ordinary catarrhal form.