View report page

45
fatal and was verified at post-mortem examination in 2 cases, with cerebellar abscess
as well in one case. In the remaining three cases the cerebro-spinal fluid proved
to be normal in composition, and subseouent recovery occurred.
General
paialysis of
the insane.
The cerebro-spinal fluid was examined in fifteen cases in which the diagnosis of
G.P.I, was made on clinical grounds as probable in 13 and doubtful in 2. The
facilities available at St. Thomas' Hospital for testing the Wassermann reaction
and so assisting in the diagnosis of neurosyphilis, proved of much value and
materially helped to confirm the other tests carried out in the Council's laboratory,
which included the colloidal benzoin reaction, a test very nearly as sensitive as the
Wassermann reaction, fully described by G. Guillian and his colleagues in 1922, and
more recently forming the subject of a paper published by J. A. Braxton Hicks and
J. Pearce in the British Medical Journal (February 16th, 1924).
The information resulting from examination of the cerebro-spinal fluid confirmed
the diagnosis of G.P.I in 12 cases. The confirmatory tests included the presence of
globulin in excess in 11 out of 11 tests, positive Wassermann reaction in 9 out of 10
teats (one case of neurosyphilis and alcoholism proving negative in the cerebrospinal
fluid, but positive in the blood), positive colloidal benzoin reaction in 7
out of 8 tests (the 8th yielding positive W.R.), lymphocyte cells in excess of the
normal in 10, with counts varying between 47 and 57 per c.mm. The total protein
content ranged between .016 and .15 per cent, with an average of .076 per cent, (as
compared with the average .01 to .02 in normal fluid).
The diagnosis of G.P.I was contra-indicated in three cases in which the cerebrospinal
fluid examination showed negative W.R. and C.B.R., no excess of globulin
and cells. These cases subsequently proved to be suffering respectively from
laryngitis, dementia, and chronic nephritis with uraemia.
Gross cerebral
lesions.
The cerebro-spinal fluid was investigated in 16 cases, in 12 of which the lesion
proved fatal, and on post-mortem examination was found to be cerebral haemorrhage
in 6, softening due to arterial disease in 3, cerebral tumour in 1, and abscess in 2.
Four cases which recovered or were lost trace of, were diagnosed as cerebral
thrombosis, concussion, meningeal haemorrhage and cerebral tumour respectively.
The scope of tests applied was necessarily limited to the estimation of total protein,
the presence of globulin in normal or excessive amount, the number and character of
cells obtained in count and by centrifugation, to the Wassermann and colloidal
benzoin reactions, as well as to bacteriological examination. Though definite
evidence in favour of or against meningitis or syphilitic lesion may be forthcoming,
other cerebral conditions, except for the presence of blood due to cerebral
haemorrhage, cause but little alteration in the composition of the cerebro-spinal
fluid likely to be of help in diagnosis. Conclusions as to the probable nature
of the case must therefore be based on the clinical evidence supplied, taken in
close conjunction with the results of cerebro-spinal fluid examination.
Cerebral haemorrhage (6).—Original clinical diagnosis : Haemorrhage in 2, menigitis
in 2, cerebral tumour or encephalitis in 1, doubtful in 1. Examination of the
cerebro-spinal fluid contra-indicated meningitis in all, supported or suggested the
probable diagnosis of cerebral haemorrhage in 4, and suggested doubtful encephalitis
in two cases.
Cerebral softening and arteriosclerosis (3).—From examination of cerebrospinal
fluid it was possible to exclude suggested clinical diagnosis of meningitis and
syphilitic lesion.
Cerebral tumour (2).—The diagnosis of encephalitis or syphilitic lesion was not
supported by the cerebro-spinal fluid.
Cerebral abscess (2).—Diagnosis of tuberculous meningitis and cerebral haemorrhage
not confirmed. One case of multiple cerebral abscess was suggested as being
due to syphilitic gummata. (W.R. and C.B.R. positive; protein =.1; globulin in
excess; cells 42 per c.mm.)
Cerebral thrombosis.—Hemiplegia and aphasia associated with pregnancy.
Alternative diagnosis of encephalitis not supported by cerebro-spinal fluid examina-
11908 d