My topic is the operative treatment of otitic meningitis. By meninigitis I mean here diffuse purulent leptomeningitis, that is, an acute inflammation of the soft membranes of the brain which has produced a cerebrospinal fluid varying from being slightly turbid to mere pus, and containing an excess of polynuclear cells. The so-called serous meningitis and the different forms of local meningitis are, therefore, excluded in this paper.
The operative treatment of otitic meningitis, in contradistinction to operations for other ototic intracranial complications, has made its way very slowly. It was, as you know, initiated about eleven years ago by Macewen of Glasgow, who, in his excellent work on pyogenic diseases of the brain and the spinal cord, published a report of two cases of otitic meningitis in which operation was successfully performed. I do not think, however, that these were genuine cases of diffuse purulent meningitis. Since then, several surgeons