The Operative Treatment of Meningitis

was hopeless. Where the infection is diffuse the prognosis is still very bad. But we have learnt that if in the earliest stage, when the trouble is still, we hope, circumscribed, we can remove the infective focus, the patient's chances of recovery are by no means poor. This emphasises the importance of deciding, quite at the beginning of any case of meningitis, whether an otorrhoea may be the fons et origo mali, and whether operative treatment should be undertaken ; for aural disease is known to cause a large proportion, perhaps the majority, of all cases of septic meningitis. The decision as to operation may have to be taken before it is possible to determine whether the meningitis is a septic one : to wait until a doubtful case is certain is to throw away the best chance of