THE melanomas that originate in the meninges bear a general structural resemblance to those arising elsewhere, but it is questionable whether they ever metastasise outside the central nervous system. With rare exceptions, however, they have proved fatal. Most cases have clearly been tumours infiltrating t,he brain massively, but in some there was no destruction of brain substance at all, and an attempt is made in this paper to discover whether a benign form of the condition exists. The published case material available for review is now extensive. Jutte (1939) in a critical discussion covering nearly all the earlier literature referred t o 34 definite or probable primary meningeal growths and to 3 possible ones. We see no reason to reject the latter 3 cases, but 2 of the first group, the cases described by Koelichen (1916) and by Garcin et al. (1933) seem to us insufficiently documented to merit inclusion. A fresh survey of the literature reveals 29 additional cases adequately investigated post mortem and 6 possible cases observed surgically ; we have rejected many reports because of the presence of visceral metastases or other reasons. Two further cases of primary meningeal melanoma are described here. CASE REPORTSCase 1 I n September 1953 a 51-year-old woman first noticed numbness and parzesthesia in her left leg and right hand and stiffness of her left leg ; a year later the right foot became numb. Partial Brown-SBquard syndrome with loss of pain sensation up to T 10 and spasticity of the legs was diagnosed but myelography and other investigations failed to reveal the cause ; dextrocardia, was noted. By May 1955 she was worse and complained of headaches and dimness of vision for the first t h e , and there was marked papillcedema on the right side. The cranial nerves were unaffected and the upper limbs were normal ; the lower limbs were weak and spastic and vibration sense was now lost. Remains of the myodil previously injected were scattered in loculi in the lumbar theca and were difficult to move on tilting the patient. Neck stiffness developed and her mental condition became dull ; she was afebrile. The working diagnosis at this time was arachnoiditis of unknown Etiology. Ventriculography was carried out on 28.6.55 ; the ventricles were normal in shape but the cerebrospinal Auid pressure was high. Air would not enter the cisterna magna. Following the ventricular tap the patient became mentally clearer but she never J. PATH. BdCT.-VOL. LXXW (1957) 419

The pathology and histology are reported of five Scots who died of severe pneumonic illnesses after holidays in Spain, three in 1973 and two in 1977. There is strong evidence in favour of all the deaths having been due to the newly discovered Legionnaires' disease (LD) agent. The agent (or its soluble antigen) has been visualised in sections of lung tissue by fluorescent-antibody tests in all cases, and the agent has been identified by the Dieterle silver staining method in small numbers in all cases. Serological testing was possible in three of the patients, and two had very high antibody titres against the LD agent. Apart from the extensive and severe nature of the pathological process there is no feature to distinguish pulmonary infection by this agent from that due to more commonly known bacteria capable of causing lobar pneumonia. The severity and extensive nature of the process is partly a reflection of neglect in seeking treatment until late in the infection, and partly a reflection, as revealed in retrospect, on the use of the wrong antibiotic combination during treatment. Erythromycin has been recommended by other workers as the drug of choice against the LD agent. Infection by this organism is not confined to the USA or to Spain and is indigenous also in the United Kingdom.