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with heavy deposit of pus cells and gram-positive cocci, also heavy protein content,
varying from .05 to 1.44 per cent. (average .43 per cent.), marked excess of globulin,
and total absence of dextrose. Chlorides estimated in two cases amounted to .85
and -64 per cent. Cultures yielded streptococcus in four, pneumococcus in two cases
and a diphtheroid bacillus in one and staphylococcus in one. In both pneumococcal
and streptococcal types of infection there was evidence of a primary inflammatory
focus in the middle ear, either acute or chronic, extending to the mastoid bone or
sphenoidal sinus, with the additional complication, in three cases, of cerebral abscess.
In the case of staphylococcal meningitis, invasion of the meninges had followed an
intracranial haemorrhage, the result of fracture of the skull from a fall six days
previously.
Mention may here be made of two cases, one of chronic middle ear disease and
mastoid infection, the other of infection of the frontal sinuses, in which symptoms of
meningeal irritation were present. The cerebro-spinal fluid, however, which in both
cases proved to be normal, contra-indicated the existence of meningitis. Complete
recovery followed.
5. Gross Cerebral Lesions. (1) Cerebral hoemorrhage.—Six cases (four male,
two female, aged 51, 52, 60, 62, 65 and 69) in which the cerebro-spinal fluid was
normal in composition or contained the products of extravasated blood, and yielded
on centrifugation evidence of blood serum in the yellowish supernatant fluid with
very high protein content and excess globulin, but low leucocyte count, pointing to
absence of inflammatory reaction. In these cases the application of special tests for
the Wassermann and colloidal benzoin reactions afforded means of determining
whether the arterial degeneration responsible for the haemorrhage was due to a
syphilitic arteritis or not. Of five specimens so tested, the reactions were negative
in four and positive in one. Three of the six cases proved fatal and three were discharged
much improved.
Gross
cerebral
lesions.
(2) Cerebral arteno-sclerosis and thrombosis.— Vascular degeneration of tiie
cerebral blood supply, a condition showing itself usually in later middle life and
known as cerebral arteriopathy, may cause obstruction to the circulation in the
brain, which may be partial, intermittent, or complete, and result in altered mental
or physical states, according to the particular regions of the brain affected; to be
differentiated from a haemorrhagic lesion due to actual rupture of a blood vessel
with destruction of brain tissue by the extravasated blood, commonly occurring
in the path of the upper motor tract and causing sudden paralysis or hemiplegia.
In five cases of cerebral arteriopathy, specimens of cerebro-spinal fluid were
examined and showed no change from the normal, except for a high protein content
in two cases. Moreover, the negative Wassermann and colloidal benzoin reactions
obtained, contra-indicated the possibility of syphilitic arterial disease.
In two of the cases of cerebral thrombosis, there was interference with the
blood supply of the motor area and consequent hemiplegia, which proved fatal in one,
and was followed by partial recovery in the other. In the remaining three cases
altered mental states were prominent features, attended by some loss of power
of one side-terminating fatally in one case, and in the other two resulting
in partial recovery, or a state of dementia necessitating removal to a mental
hospital.
(3) Tumours of the brain, (i.) Glioma of the occipital lobe.-Girl, aged 7, with
symptoms suggestive of meningitis, developing a month after an attack of measles.
The cerebro-spinal fluid showed no abnormal change other than slight increase
in protein content and globulin, relatively few cells and those chiefly lymphocytes;
findings, which were equally consistent with cerebral tumour, abscess, or encephalitis,
but clearly contra-indicated meningitis. Death occurred a fortnight after
the first onset of cerebral symptoms and at post-mortem examination a gliomatous
tumour with central necrosis was found occupying the right occipital lobe.
14172 D