View report page

41
tubercle bacilli ; (b) supported in 7 by the marked lymphocytosis and amount
of albumin (average -19 per cent. Aufrecht); (c) negatived in 14 (no tubercle
bacilli: no lymphocytosis : no excess of albumin).
Ultimate diagnosis.—Tuberculous meningitis 14 (11 verified postmortem,
3 post-mortem refused). Other conditions revealed by subsequent
course of 13 cases:— Meningeal hæmorrhage, endocarditis, cancer of breast,
encephalitis, mastoid disease, cerebral tumour, influenza and meningismus
(6 cases).
(b) Encephalitis lethargica.—12 specimens. Suggested diagnosis was
(a) supported in 6 cases by laboratory report (slight or absent lymphocytosis,
albumin average -04 per cent. (Aufrecht), bacteriologically negative); (6)
doubtful in 4; (c) negatived in 2 cases (by finding tubercle bacilli, lymphocytosis
and excess albumin).
Ultimate diagnosis.—Encephalitis (5 cases), cerebral tumour (2 cases),
melancholia, tuberculous meningitis(2 cases) , uraemia, neurasthenia.
(c) Meningitis (other than tuberculous).—18 specimens from 16 cases.
Suggested or doubtful diagnosis was (a) confirmed in 5 cases by laboratory
report, viz., influenzal (B. influenzae found), cerebrospinal (meningococcus
found), chronic post basis meningitis with hydrocephalus, septic (post
mastoid) in 2 cases ; (b) doubtful in 5 cases ; (c) negatived in 8 cases.
Ultimate diagnosis,—Meningitis (post-mortem confirmation of laboratory
report) in 5 cases, cerebral or meningeal haemorrhage (3 cases), cerebral
tumour, mastoid disease, mental deficiency, meningismus (5 cases).
(d) Cerebral diseases (21 specimens of 19 cases).—(a) General paralysis
and dementia (12); (6) Cerebral meningeal haemorrhage (6); (c) Abcess
and mastoid disease (2); (d) Uræmia (1). The suggested diagnosis was
(a) supported by laboratory report in 11 cases ; (6) doubtful in 9 cases ;
(c) negatived in 1 case.
Ultimate diagnosis.—General paralysis and dementia (9 cases), haemorrhage
or thrombosis (5 cases), encephalitis, congenital syphilis, chronic
alcoholism, abscess and uraemia.
(e) Spinal diseases (4 specimens).—Tabes-dorsalis, lateral sclerosis,
pressure on nerve roots. Laboratory reports supported diagnosis in only
one case, the remaining 3 were doubtful.
Ultimate diagnosis.—Tabes, lateral sclerosis, sciatica and pyelitis.
(v.) Examination of Milk and Ice Creams.
Milk.—Estimation was made of the number of organisms in 10 specimens
of fresh milk (6 samples), and dried milk (4 samples).
Ice Creams.—24 samples examined in June and July.
(a) Bacteriological.—Counts obtained ranging from 108 to 1,722,000
organisms per c.c. Presence of lactose was demonstrated in every sample.
(b) Chemical.—None of the common preservatives detected.
(c) Microscopical.—Dust particles, sand, carbon, vegetable fibre (linen,
cotton and woollen fibres). No indication of cow dung.
(vi.) Miscellaneous.—
(a) Urine.—9 specimens examined chemically and microscopically,
from cases of albuminuria and pyuria among school children.
(b) Fœces.—4 specimens from patients at Colney Hatch Mental
Hospital were examined for organisms of the dysentery and enteric groups
with negative results.
(c) Pus.—(1) two specimens from tuberculous abscess—no tubercle
bacilli found—one sterile, the other yielded staphylococcus on culture.
(2) a case of pyorrhoea which yielded streptococcus.
(d) Blood cell counts of two school teachers for evidence of anaemia,
one of pernicious type.