PLATES LXXX1.-LXXXIII.) Part I. Bacteriology.INTEREST in the bacteriology of tuberculous meningitis is centred mainly in the determination of the incidence of the human and bovine types of tubercle bacillus in these cases. In 1934, Griffith, surveying a series of 251 cases collected over a period of 30 years from England and Scotland, noted the relative proportions of human and bovine type infections to be 73.3 and 26.7 per cent. respectively. In Scotland the bovine incidence was 40.5, in England 24.3 per cent. In 1936 Griffith and Menton recorded that 5 of 12 cases investigated in Staffordshire were of bovine origin, while Blacklock and Griffin (1935) found this type in 18 per cent. of 72 cases in the West of Scotland. Munro and Scott (1936) recorded the bovine incidence in a series of 50 cases occurring in the East of Scotland to be 36 per cent. The regional variation in the proportional incidence of the two types is thus seen to be marked, and as it is probably an index of the state of milk supplies, the results of all similar enquiries should be fully recorded. Further points dealt with in this section include the relation of type of * Since 1933 a combined bacteriological, pathological and clinical investigation of certain problems related to tuberculous meningitis has been carried on in Edinburgh. For the sake of completeness the enquiry included as many cases as possible from the principal hospitals in this district, which serve the south-east of Scotland. During the first eighteen months the bacteriology was done by Dr H. J. R. Kirkpatrick : on his departure it was taken over by Dr C. A. Green.Dr Kirkpatrick's results were published in a preliminary communication by Macgregor, Kirkpatrick and Craig (1935) and, except when expressly stated, they are not included in the results given in the bacteriological section of this paper. Results of the pathological studies given in that communication are included in the pathological section of this paper, and the bacteriological findings referred to in that section include Dr Kirkpatrick's cases. The clinical side of the investigation was in the hands of Dr W. S. Craig, who also performed some of the necropsies. Unforeseen circumstances have caused publication of the clinical study to be postponed. This paper presents the results of the bacteriological and pathological investigations. A13
IN 1933 a short report on the treatment of men burned in colliery explosions23 was rendered to the Ministry of Mines by a committee under the Chairmanship of Sir David Wilkie. The report, though concerned mainly with measures to lessen the high death-rate from burns sustained in colliery explosions, contained also some details of an investigation into the causes of death in burns. The observations reported therein were at variance with views which had been expressed in recent literature on the subject, and, as these views have subsequently gained new adherents, it seemed desirable that the work initiated by the committee should be continued and extended. The present paper is a record of the continued investigation into the causes of the systemic disturbances and of death after burns under the conditions of modern methods of treatment. Our study of the clinical course has, it is hoped, provided a fuller description and a clearer definition of its stages than has hitherto been available ; in the section on the pathology of burns, consideration has been given to aspects not previously emphasized. We have recorded our conclusions as to the causes of death after burns, and made some reference to treatment and its future developments. THEORETICAL CONSIDERATIONSIn the following short survey of theoretical aspects, we shall refer only to literature which deals particularly with the causes of the systemic disturbances and of death after burns. A more comprehensive account of the subject may be found elsewhere.2, 99 1 9~ 21, 2 9 It is customary and convenient to discuss the clinical course in respect of stages because at successive periods after injury the systemic disturbances differ in nature and probably in causation. For the purpose of the present discussion we shall employ a classification in common use, whereby the clinical course is divided into four stages. The first is shock, which occupies a variable period during the first twenty-four hours ; the second is toxamia, which may continue till the 4th or 5th day ; the third is sepsis or bacterial intoxication ; and the fourth is healirzg. In this section we shall mention only the aetiology of each stage.I. Shock.-Shock which follows injury by burning so closely resembles shock following severe trauma that there seems no reason to doubt that aetiologically the conditions are essentially similar. The aetiology, however, is not yet fully determined.
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