CASE HISTORY

Previous history "C3" with rheumatism during the War. Four years ago left hemiplegia due to high blood pressure; headache since. Chest trouble with cough on and off for a year. Last Christmas had what appears to have been a pneumonia. End of Jan pleuritic pain in left chest with fever, sputum and sweating. On examination: acutely ill. Consolidation of the left lower lobe, incomplete resolution in right lower lobe, residual left hemiplegia particularly face and arms. BP 170; 90 with no congestive failure. Not strong mentally. General improvement in the ward but the chest remained in much the same condition with evidence of imperfectly resolved lower lobes. X-ray confirmed this and stated: 1. Effusion left costo-phrenic angle. 2. Consolidation left lower zone. 3. Consolidation right middle and lower zones, 4. Calcareous deposits in right upper zone. 11.2.39 two rigors. 22.2.39 fresh infection. Herpes T 102. Pulse rapid and full, toxic. 23.2.39 worse. 24.2.39 Pneumococcal meningitis developed. Group 6B pneumococcus M & B started. 25.2.39 Incontinent. Kernig positive; semiconscious; Cheyne-stokes breathing. 26.2.39 Regained consciousness following M & B. 28.2.39 Died.

Clinical diagnosis: Unresolved pneumonia and pneumococcal meningitis.

PATHOLOGY

Brain 220mmx165mmx80mm. The specimen consists of the vertex of the brain which is covered with an enormous amount of thick yellow pus, except over the occipital poles. The purulent exudate is tracking along the extremely congested vessels in the sulci and at times covers even the surface of the gyri. At autopsy the slightly dilated ventricles were filled with pus.