“…In their series of 16 cases of pneumococcal meningitis treated with penicillin Cairns, Duthie, Lewin, and Smith (1944) had one case of obstruction of the aqueduct of Sylvius, but this was apparently due to pressure of an abscess. Evans (1944) saw no such condition in his small series of cases of purulent meningitis. The likelihood of the development of such a fibrinous exudate in the early stages of the infection would seem to be another reason for treating all cases of pneumococcal meningitis with penicillin as early as possible a procedure already recommended by Cairns et al in their paper.…”