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tion. In two cases diagnosed as meningeal haemorrhage and cerebral concussion,
conclusions after examining the cerebro-spinal fluid were confirmatory. Eventual
recovery followed.
Lesions of
the spinal
cord and
peripheral
nerves.
Examinations of the cerebro-spinal fluid were made in 8 cases, which included
tabes dorsalis, tabo-paresis (juvenile type), disseminated sclerosis (2), transverse
myelitis, cerebral diplegia in a congenital syphilitic imbecile, spinal concussion with
traumatic lesion of the cord, peripheral neuritis.
It was possible from the evidence obtained from the examination of the cerebrospinal
fluid to exclude the likelihood of a syphilitic lesion in the cases of disseminated
sclerosis, myelitis, traumatism of the cord and neuritis, by the negative W.R. and
C.B.R., low cell count and absence of globulin.
In the cases of tabo-paresis and cerebral diplegia, the syphilitic origin was
indicated by positive W.R. and C.B.R., and the presence of globulin and lymphocytes
in excess. In contradistinction (as is found in some 40 per cent, of cases of tabes
dorsalis) the remaining case of tabes, however, yielded negative W.R. and C.B.R.
with no excess of globulin or cells.
Meningismus;
In five cases which presented symptoms of meningitis, the cerebro-spinal fluid
was found normal, and therefore contra-indicated the clinical diagnosis. Two of
these cases proved to be due to pneumonia, verified by post-mortem examination,
which also showed no evidence of meningitis. The other three, originally diagnosed
as tuberculous meningitis, but subsequently regarded as enteritis, broncho-pneumonia,
and doubtful encephalitis, recovered.
To this group of cases, occurring usually in children, and presenting the clinical
picture of meningitis, but showing no change in the composition of the cerebrospinal
fluid, the name meningismus has been given and is recognised as a clinical
entity not easily explained.
Consultation visits.—Visits were paid by either Dr. J. A. H. Brincker or Dr.
J. G. Forbes to 18 private patients at the request of general practitioners or medical
officers of health for the purpose of help in diagnosis of doubtful cases of encephalitis
lethargica or meningitis ; 7 being in Kensington, 5 in Islington, 1 in each of the
boroughs of Bermondsey, Camberwell, Hornsey, Lewisham, Westminster and
Woolwich.