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spore variety (Microsporon Audouini) and 14 per cent, the large spore (Megalosporon
Endothrix). In 10 specimens favus fungus (Achorion Schönleinii) was found.
III. Conjunctivitis and Ophthalmia Neonatorum.—87 films sent by the Council's
medical inspectors under the Midwives Act from eye discharges of new-born infants
were examined and the gonococcus was identified in 13 (15 per cent.). In 51 no
organisms could be recognised and the remainder showed chiefly Gram positive
cocci (pneumococci or staphylococci) and diphtheroid or coliform bacilli in a few cases.
IV.—Ten specimens of faeces from patients, suffering from diarrhoea or dysenteric
symptoms at Colney Hatch Mental Hospital, were examined, but no specific organisms
of the dysentery or typhoid group or dysenteric amoebæ were found.
V.—Ten specimens of urine were examined chemically or microscopically and
by culture.
VI.—Serum agglutination tests were applied to 9 specimens of blood from
patients at Colney Hatch Mental Hospital and proved positive to B. typhosus in
4 cases and to B. paratyphosus in one case.
VII.—Other material examined included blood for malarial parasites, pus
films and 8 specimens of sputum, in 2 of which tubercle bacilli were found.
VIII.—Cerebrospinal Fluid.—A total of 84 specimens was examined and reported
on chemically, cytologically and bacteriologically, the majority having been sent
by the Fulham Infirmary, St. James's Hospital, Balham and St. Pancras Hospitals
and coming from cases of :—
(a) Tuberculous Meningitis.—In 22 specimens from 19 cases differential
diagnosis was made by finding tubercle bacilli (in 10) or by the chemical and
cytological characters of the lymphocyte cell deposit—confirming the provisional
diagnosis made in hospital in 10 cases, and correcting the suggested
diagnosis, of cerebrospinal or pneumococcal meningitis, cerebral abscess,
encephalitis lethargica or mastoid disease, put forward in 9 cases.
(b) Other forms of Meningitis.—In 19 specimens from 16 cases as the result
of cytological and cultural examination the causative organism proved to be pneumococcus
in 8, the streptococcus in 2, B. influenzae in 2, and the meningococcus
giving rise to chronic post-basic meningitis with hydrocephalus in 2. There
was also one case of serous meningitis associated with mastoid disease and
one case of chronic syphilitic meningitis, in which the laboratory supported
the clinical diagnosis.
(c) Encephalitis Lethargica.—The negative characters of the cerebrospinal
fluid and subsequent clinical course of the case confirmed the diagnosis
in 10 out of 14 cases. The other 4 proved to be cases of pneumonia, infective
endocarditis, cerebral tumour and nephritis, in all of which examination of the
cerebro-spinal fluid would afford no assistance except to exclude meningitis.
(d) Cerebral Disease.—The cerebrospinal fluids from 15 cases, including
general paralysis of the insane, neuro-syphilis, dementia, melancholia, epilepsy,
cerebral softening, thrombosis and tumour, were examined and the diagnosis
was assisted by exclusion of acute inflammatory lesions, and in the cases of
cerebral syphilis was confirmed by the lymphocytosis and protein excess.
(e) Diseases of the Spinal Cord.—Examinations of the cerebrospinal
fluid assisted in the diagnosis of 6 cases, which included amyotrophic lateral
and disseminated sclerosis, paraplegia and spinal caries, and osteoma of the
vertebral column.
(f) General Diseases.—(8 specimens) in which the provisional diagnosis,
on clinical grounds, of meningitis, was not supported by the results of examination
of the fluids, and which proved by subsequent events to be cases either of
uraemia, broncho-pneumonia, pneumonia, septicaemia or rickets with tetany,
the meningitic symptoms associated with the various disorders being described
as " meningismus."
Ten special visits were paid in various parts of London, at the call of private