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43
the immediate return to school of the children concerned. Reference is
made in my report as the School Medical Officer to the arrangements with the
authorities of Guy's Hospital for treatment of the chronic virulent carrier, a problem
which has for so long defied solution.
II. Ringworm.—out of selected samples of hair from 1,954 children, examined for
ringworm fungus in 1926 (as compared with 2,642 examinations in 1925), a total of
1,253 were negative, 10 unidentified fungus, and 691 positive (35 per cent.), as
against 40 per cent, positive in 1925. The varieties of fungus identified in the
691 positives were :—Small spore (Microsporon Audouini) 84 per cent., large spore
(Megalosporon Endothrix) 13-4 per cent, and 2.6 per cent. Favus (Achorion
Schoenleini).
III. Cerebrospinal fluid.—As an important aid to the clinical diagnosis of notifiable
and other diseases of the central nervous system, the routine examination
during 1926 was undertaken of 103 specimens of cerebro-spinal fluid from 93 cases,
68 of these were sent from the Fulham Hospital, 25 from St. James' Hospital, Balham,
4 from Highgate Hospital and 6 from private patients.
A detailed account of the significance of the cytological, chemical and bacteriological
changes affecting the cerebro-spinal fluid, and the value attaching to
them in the differential diagnosis of encephalitis, the different forms of meningitis,
including cerebro-spinal and tuberculous, and of various cerebral lesions, has appeared
in previous Annual Reports, and therefore the points already discussed need not be
repeated.
The specimens examined may be grouped under the following headings
based on the ultimate diagnosis of the several cases :—
1. Encephalitis Lethargica.—Five specimens from five cases (ages 4, 6, 8, 24
and 63 years) in which, by the absence of any marked departure from the normal,
the laboratory examination confirmed the original diagnosis in three, and contraindicated
the suggested diagnosis of meningitis in two—subsequently supported by
post-mortem examination in three fatal cases, and by the further course in two cases,
which made apparent recovery.
Encephalitis
lethargica.
2. lubercutous Meningitis.—18 specimens of cerebro-spinal fluid were examined
from 18 patients, whose ages ranged from 9 months to 59 years—five being
under 5 years, three aged 5-10 years, seven aged 10-20 years and three aged 26,
53 and 59 years. Sex incidence was evenly distributed. The duration of illness
from onset of symptoms to death was stated in 16 cases, to be three weeks in seven;
two to three weeks in three ; and one to two weeks in six. The provisional diagnosis
suggested in hospital was tuberculous meningitis in nine cases, meningitis (?) in
three. Encephalitis, uraemia, meningeal haemorrhage and meningismus were
diagnosed respectively in four cases. No diagnosis was stated in two cases.
Characters and composition of the eighteen specimens of fluid were as
follows :—
Tuberculous
meningitis.
Naked eye appearance.—Slight turbidity in 11, clear in 5, blood-tinged in 2,
fine clot formation in 14.
Cytology.—Marked lymphocytosis in all, cell counts in three specimens
showed 104, 150 and 370 cells per c.mm.
Tubercle bacilli.—Were identified in film preparation from the clot or cell
deposit in fifteen specimens or over 83 per cent.
Chemical composition.—The protein content was in excess of the normal
(•01 to -02 per cent.) in all, ranging from -04 to 1-8 per cent, with an average
of 42, and excess of globulin was also invariable. Dextrose was not quantitatively
estimated, but was roughly determined to be below the normal (•7 per
cent.) by the amount of reduction of Fehling's fluid, as absent in five, very
faint trace in six, faint trace in five, and definite trace in one specimen.
Chlorides in three specimens amounted to -64, -64 and -58 per cent.