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centrifugation deposit showed scanty lymphocytes and large endothelial cells.
No organisms were formed. Protein=.025 per cent. No globulin; dextrose, a
slight trace. Chemical analysis yielded urea .05 per cent., sodium chloride .7 per
cent. (i.e., normal amounts). Phosphates (as calcium phosphate *196 per cent,
or as (P206) .089 per cent.) were ten times the normal amount. Excess of phosphates
has also been recorded in cases of simple congenital hydrocephalus amounting
to three or four times the normal quantity .013-.02 per cent.
Neurosyphilis of the Brain and Spinal Cord.—1. General paralysis provided 11 cases
(8 males and 3 females, ages 36 to 49 years) in which examination of the cerebrospinal
fluid confirmed the diagnosis. All the specimens were clear and colourless
with the exception of two which exhibited slight turbidity. The cell content was in
each case above normal, but showed a range of from 10 to 138 cells per c.m.m. with
an average of 41. Lymphocytes were the greatly prevailing type of cell with occasionally
large endothelial cells.
Protein as measured by Aufrecht's albuminometer showed a range of from
.01—.1 per cent., or an average of .05 per cent., i.e., definitely in excess of the normal
.02. Globulin was in every case in excess. Dextrose was as a rule above the normal
.7 per cent. The Wassermann and colloidal benzoin reactions gave positive results
confirmatory of neurosyphilis.
2. Tabes dorsalis (locomotor ataxy).—In three cases the diagnosis was confirmed
by the fluid showing changes similar to those above recorded in the closely
allied condition of G.P.I. Three other cases, in which the fluid did not confirm
the suggested diagnosis of tabes, proved eventually to be peripheral neuritis, syphilitic
pachymeningitis of the cauda equina, and melancholia associated with arteriosclerosis.
In four additional cases, suggested as either G.P.I. or attributable to
neurosyphilis, the specific nature of the disease was not confirmed. The conditions
were subsequently diagnosed as dementia and obsessional insanity due to chronic
alcoholism in two, in which the fluids showed nothing abnormal.
Alzheimer's disease was suggested as a possible diagnosis of the third case.
This condition has been attributed to a presenile form of cerebral arteriosclerosis
characterised by slow dementia with focal symptoms, aphasia and apraxia, and in
addition to the changes in the blood vessels, is associated with a proliferation of
the neurofibrils (diffuse gliomatosis). The fluid showed no change in composition
and the negative special reaction tests contra-indicated neurosyphilis. Postencephalitis
was also put forward as an alternative diagnosis. This case, in a man
aged 47, supplied a history dating back to 1917, beginning with an attack of cerebral
thrombosis causing right hemiplegia, followed by recovery. In 1924 a further
lesion occurred resulting in paralysis of the right side of the face, with tremor and
fits and much mental confusion. From this condition there has been but little
improvement since, and gradual mental deterioration has become manifest, necessitating
removal to an asylum.
The fourth case attributed to syphilis of the mid-brain presented tremor, wasting
and weakness of the hands and forearms. The fluid, however, gave no confirmation
of neurosyphilis, the patient was subsequently discharged, with his condition
relieved, under the diagnosis of syphilitic mesencephalitis.
3. Syphilitic meningitis.—The fluid from a single case of this somewhat rare
condition afforded no clue to the diagnosis, which was only revealed by post-mortem
examination, when in addition to the meningitis, gummata were found involving
the right frontal lobe.
The patient, a girl aged 17, during her stay in hospital provided no suggestive
family history nor did her clinical condition yield any evidence pointing to congenital
or acquired syphilis. The temperature was up to 100°F. at first and later
normal. The blood Wassermann reaction was negative 10 days after admission.
Her symptoms were drowsiness, headache and vomiting. The cerebrospinal fluid