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c.c. Contract Milk.—Lactose fermenters (including B. Coli) numbered 187,000
per c.c. As no non-lactose fermenting colonies were found in either specimen,
B. Typhosus could be considered absent.
V. Cerebro-Spinal fluid examinations.—During 1928 assistance in diagnosis
was afforded by examination of 81 specimens of cerebro-spinal fluid from a total
of 79 cases in the Poor Law Hospitals, viz., 38 at the Fulham Hospital, 26 at St.
James' Hospital, Balham, 9 at Highgate Hospital and 6 at St. Pancras Hospital.
Although such help was originally offered in connection with cases admitted to the
hospitals, to assist the diagnosis of notifiable infectious disease, particularly
cerebro-spinal fever, encephalitis lethargica and poliomyelitis, the scope has been
considerably widened and now includes many other conditions. Thus out of
the 81 specimens examined during the past year, six only were from cases of
encephalitis and five from cases finally diagnosed as meningococcal or cerebrospinal
meningitis. Taken in order numerically the specimens reported on may
be conveniently classified under the following headings according to the final
diagnosis:—
1. Meningismus.—The term applied to conditions clinically suggestive of
inflammation of the meninges, but showing normal cerebro-spinal fluid and proving
from the subsequent course of events to be due to pneumonia, bronchitis, gastroenteritis,
etc. Thus out of 14 cases which showed nothing abnormal in the cerebrospinal
fluid, but diagnosed on clinical grounds as tuberculous or other form of
meningitis, eleven eventually proved to have been suffering from pneumonia or
broncho-pneumonia, two from gastro-enteritis, and one from enteric fever.
2. Meningitis.—(25 specimens from 23 cases), (a) Tuberculous meningitis.—
11 cases aged 54, 26, 24 (two), 23, 15, 7 (three), 2 years and 1 5/12 years. Tubercle
bacilli were found in 6 specimens, and in the remainder, although no tubercle bacilli
were found, pathological changes, e.g., well marked excess of lymphocytes and
increase in protein, pointed to the probability of a tuberculous meningitis, confirmed
by post mortem examination.
(6) Other forms of meningitis—(14 specimens from 12 cases).
(1) Meningococcal (cerebro-spinal or post basic).—In 7 specimens of cerebrospinal
fluid from 5 cases the presence of a marked excess of leucocytes chiefly polymorphs,
in the acute stage, succeeded later by lymphocytes, together with gram
negative intra-cellular diplococci and a marked increase in protein, absence of or
merest traces of dextrose, pointed to a meningococcal infection.
(2) Pneumococcal.—In two cases, aged 23 and 37, abundant pneumococci and
heavy deposit of pus cells were found.
(3) Influenzal.—B influenzae and numerous polymorph cells confirmed the
clinical diagnosis in one case.
(4) Secondary to extension from the mastoid and middle ear, meningitis was
indicated by the presence in three cases of pus cells, marked excess of protein, together
with staphylococcus and B. proteus obtained in culture. In one case of uncomplicated
otitis media, the cerebro-spinal fluid proved to be normal and recover followed.
3. Cerebral Disorders.—I. Gross Lesions.—(a) Tumour (three cases). (1)
carcinoma of frontal lobe, secondary to carcinoma of the lung. (2) Glioma of the
temporosphenoidal lobe. (3) Cerebellar tuberculoma. The cerebro-spinal fluid
afforded little help in diagnosis beyond excluding meningitis and cerebral syphilis,
the only abnormality being the increase in the protein content. (6) Cerebral hœmorrhage
(two cases)—In which the fluid showed some increase in protein and colour
changes due to the presence of blood serum.
II. Cerebral degeneration associated with altered mental states (10 cases),
(a) Chronic Hydrocephalus (two cases, aged 47 and 3 years)—One showing some
increase in lymphocytes and protein content but no evidence of active meningitis,
and the other normal fluid. (b) Polioencephalitis, aged 12 years, and cerebral