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In one case of serious meningitis (set 18), the possible consequences of postbasic
meningitis in early life, and in one case diagnosed as chronic pachymeningitis
following head injury, the fluid showed little change other than some increase in
protein content.
5. Mastoid diseases and otitis media.—14 specimens of fluid from 10 cases were
examined. Of 8 cases which eventually recovered, the fluid was normal in five;
but in three there was marked meningeal reaction, as shown by the increase in
protein and presence of polymorphocytosis, but cultures were sterile. One of these
was complicated by tetanus (B. tetani was cultivated from the ear discharge sent
to the Clinical Research laboratory), and another by cerebellar abscess relieved by
operation. Recovery followed in both cases.
In two cases which proved fatal from acute meningitis and cerebellar abscess,
streptococcus was cultivated from the cerebrospinal fluid.
6. Cerebral lesions.—19 cases—(1) General paralysis of the insane (G.P.I.),
and other syphilitic manifestations affecting the brain, e.g., arteritis and hydrocephalus.
In five cases, aged 27 to 48 years, the cerebro-spinal fluid yielded positive
Wassermann reaction (by tests carried out at St. Thomas's Hospital), excess of
protein and globulin, and increase of lymphocytes.
(2) Cerebral arteriosclerosis (non-syphilitic)—Showing but little change in the
fluid, except occasional increase in protein. Seven cases of altered mental states
arterial thrombosis, haemorrhage, or embolism.
(3) Cerebral tumour—3 cases.
(4) Concussion with right hemiparesis—one case.
(5) Epilepsy—two cases.
(6) Psychosis—cerebral degeneration.
Normal cerebro-spinal
fluid.
7. Diseases affecting the spinal cord and nerves.—Five cases in which the fluid
was found normal, viz.:—Disseminated sclerosis (2), Tabes dorsalis (1), Peripheral
neuritis (1), Hysterical paraplegia (1).
8. Meningismus.—Twelve cases with symptoms of meningeal irritation suggesting
meningitis, in which the fluid proved normal and recovery followed. These
included six cases of pneumonia or broncho-pneumonia, two cases of acidosis and
cases of pericarditis, malnutrition and diarrhoea.
9. Conditions not associated with disease of the central nervous system in
which the fluid was found normal—two cases of influenza, two cases of nephritis,
one case of miliary tuberculosis, and tuberculous disease of the knee joint, but no
meningitis.
(1) Sputum—Eight specimens; tubercle bacilli found in five.
(2) Conjunctival discharge from infants under observation for ophthalmia
neonatorum—five cases. Gonococcus not identified.
(3) Urine.—10 specimens examined.
(4) Vaginal discharge.—Gonococcus not found—one case.
(5) Fceces from a case of dysentery—B. dysenteriae (Flexner) and Morgan's
bacillus (No. 1) isolated in pure culture.
(6) Bacteriological examination of skin and wound of a midwife and two cases
of Pemphigus—Yielded staphylococcus only.
(7) Blood examination—Complete counts and haemoglobin estimation of four
cases showed nothing abnormal in two and anaemia in two.
(8) Histological examinations of post-mortem material (sent from hospitals) of
cerebral and cerebellar tissue; included one case of tuberculous meningitis and one
of cerebellar abscess.
Miscellaneous
examinations.
Special investigations of swimming bath water were carried out during the course
of the summer and early autumn months. In all, a total of over 100 samples were
examined bacteriologically from (1) five open air baths and one covered bath of the
fill and draw supply, (2) seven natural or artificial swimming ponds, (3) two open
Swimming
baths