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(ii.) Multiple tuberculous tumours of the brain and general miliary tuberculosis.—
Girl, aged 15, with symptoms of meningeal irritation of six weeks' duration, the
diagnosis of which rested between tuberculous meningitis, cerebral syphilis and
cerebral tumour. From examination of the cerebro-spinal fluid on two occasions it
was possible to exclude both meningitis and cerebral syphilis. The slight increase
in the protein cell content, lymphocytes and endothelial cells, were consistent with
cerebral tumour. Diagnosis, however, remained in doubt until death occurred four
months after the first onset of symptoms, and it was only at post-mortem examination
that the precise nature of the lesions was discovered, as above recorded.
(4) Cerebral abscess was found post-mortem in four cases as a secondary complication
to middle ear disease and associated with meningitis in three cases, and
chronic empyema in one case. The cerebro-spinal fluid in each case gave evidence
of an acute infection by the presence of pus cells in large number, high protein content,
globulin excess, and absence of dextrose. Culture yielded streptococcus in
two cases, a. diphtheroid bacillus in one, and staphylococcus in one case.
(5) General paralysis of the insane.—Examination of the cerebro-spinal fluid
established or confirmed the diagnosis in twelve cases of this type of cerebral degeneration.
In all the fluid was clear and colourless, and yielded a lymphocyte cell count
almost invariably in excess of the normal (15 per cm), ranging between 10 and
40 per cm, but in one case reached as high as 144—the average of eight cases being
24 per c.mm. The protein content was increased, ranging from .03 to .12 per cent,
averaging .062 per cent.; there was marked excess of globulin, and dextrose was invariably
present in amount slightly above normal. In confirmation of the neurosyphilitic
nature of the disease were the consistently positive Wassermann and
colloidal benzoin reactions, in close agreement with each other in each case. The
former, carried out and reported on by the courtesy of the Pathological Department
of St. Thomas' Hospital; the latter tests being performed as a routine measure in the
Council's laboratory. The twelve patients, with one exception, were all males,
whose ages ranged between 36 and 61 years, and averaged 48 years. Owing to
their mental condition, nine of the twelve were transferred from the Poor Law
hospital to various Mental Hospitals. The remaining three, however, improved
sufficiently under treatment to be discharged to their homes. In two of these cases
the symptoms pointed to advanced renal disease, and uraemia was suggested as a
possible diagnosis, but was contra-indicated by the fact that the chloride and
urea contents of the cerebro-spinal fluid proved to be within normal limits in each
case. (Chlorides .58 and .64 per cent, and urea .11 per cent.)—subsequent improvement
followed.
(6) Other conditions of cerebral degeneration (non-syphilitic).-In 7 other
cases of mental disorder the cerebro-spinal fluid was found to be normal-the
absence of excess in protein and globulin and the low cell content (3 to 10 per c.mm.)
together with negative Wassermann and colloidal benzoin reactions contra-indicated
neurosyphilis. The patients, with one exception, were males, six of whom were
aged thirty to fifty-five years, and were suffering respectively from epilepsy, mania,
or paralysis agitans; in two cases the mental states were diagnosed as due to
Alzheimer's disease, a condition in which diffuse overgrowth of the neuroglial connective
tissue of the brain (gliomatosis) is described. One patient, a boy of 11
suffered from epileptic mania. In none of the seven cases was it possible to associate
an attack of encephalitis lethargica in the past with the development of the various
mental states concerned.
(7) Diseases of the spinal cord.—The cerebro-spinal fluid of six adults (three
male and three female) aged 34 to 69 years, suffering from inflammatory and
degenerative lesions, showed the following changes :—
(i.) Disseminated sclerosis (3 cases). One fatal, two showed some improvement.