Tuberculous meningitis complicated by purulent meningitis is a rare event. In a search through the literature I have been able to find records of twenty-one cases only. Paisseau and Tixier1 reviewed the subject in 1909 and collected nine cases, adding one of their own. They, however, overlooked six cases reported, respectively, by Heiman,2 Lenhartz,3 Heubner4 (three cases) and Kneass and Sailer.5 Since 1909 two more cases have been reported by Guinon and Grenet,6 and Dupérié.7 To these should be added three cases from the records of the Babies' Hospital and the one here presented in detail.
The organism found in these instances of mixed infection were the meningococcus, the pneumococcus, the streptococcus, M. tetragenus, the colon bacillus and an unclassified Gram-negative diplococcus growing freely on all media. In no case was B. influenzae found. Nine of the twenty-one cases were due to the