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diplegia, aged 11 months—In each condition the fluid was normal. (c) Dementia
(two cases, aged 49 and 54 years)—Normal fluid was found with no evidence of
meningitis or cerebral syphilis, (d) Cerebral syphilis (one case, aged 33 years)—
The fluid showed slight lymphocytosis, excess of globulin and positive Wassermann
and colloidal benzoin reactions. (e) Epilepsy (three cases, aged 51 and 43 years
and 4 months)—In one case the fluid showed increased protein content only, and
in the others was normal—syphilis was contra-indicated by negative Wassermann
reactions and absence of cells.
III. Encephalitis lethargica (six cases)—In three cases, during the acute phase
of the disease, and in two during the later stages (one and three years respectively
since onset) the fluid was examined and, as is generally found, showed no changes—
thus excluding meningitis.
The sixth case, a man aged 35, was clinically suggestive of the acute phase of
encephalitis and the cerebro-spinal fluid showed a marked lymphocytosis (120 cells
per c.m.m.), and increase of protein content. Positive Wassermann and colloidal
benzoin reactions pointed to a syphilitic infection, which may have complicated the
acute cerebral condition. Recovery followed.
4. Diseases of the spinal cord and peripheral nerves (nine cases). (a) Pressure
Paraplegia from spinal caries (two cases) from lymphosarcoma—(one case). The
fluid in each case showed no excess of cells, but marked increase in the protein
content; the negative Wassermann and colloidal benzoin reactions contra-indicated
neurosyphilis. (6) Chronic spastic paraplegia (one case)—Normal fluid was found
together with negative Wassermann reaction. (c) Tabes dorsalis (one case)—Normal
fluid with negative Wassermann and colloidal benzoin reactions (as occurs in about
40 per cent. of cases of this form of neurosyphilis). (d) Anterior poliomyelitis (two
cases)—One in the acute stage (aged 7 years) showed normal fluid. In the other,
whose duration was several months, the fluid showed marked lymphocytosis (63 per
c.m.m.) and slight increase of protein. (c) Peripheral neuritis—affecting the lower
extremities (two cases). The fluid showed nothing abnormal.
5. Functional disorders (five cases).—In three cases the cerebro-spinal fluid
was normal. The clinical symptoms indicated gross cerebral or spinal lesions, but
eventually complete recovery resulted and in consequence the conditions were
regarded as temporary functional neuroses. In one case, however, the fluid showed
a marked increase both in the cell content (to 200 lymphocytes per c.m.m.) and in
the amount of protein. A negative Wassermann reaction and the absence of tubercle
bacilli contra-indicated both neurosyphilis and tuberculous meningitis. Eventually
the symptoms of headache and vomiting, which had pointed to possible cerebral
tumour, cleared up and the patient recovered. In the fifth case with paraplegic
symptoms, weakness in both legs, the fluid was normal and although there was no
improvement in the condition, in the absence of evidence of organic disease, the
patient, a woman of 34, was discharged as a case of hysterical paraplegia.
6. Acute blood infections—(a) Infective endocarditis.—In three cases in which
the cerebro-spinal fluid was examined, the subsequent course showed the condition
to be due to infective endocarditis, confirmed in the two cases by post mortem
examination. The fluid during life was blood stained and the films from the blood
cell deposit showed a well marked polymorphocytosis, and on culture, in one case
staphylococcus, and in the other streptococcus, was obtained—indicating a possible
blood infection rather than meningitis, as was borne out by the later examination
post mortem. In the third case, the fluid contained no blood and was normal in
character and the patient was subsequently discharged suffering from infective
endocarditis. (b) General toxaemia (two cases) in which the cerebro-spinal fluid
was examined and found to be normal. One proved to be suffering from purulent
synovitis of the knee joint and the other from osteomyelitis of the femur. Post
mortem examinations showed no evidence of meningitis.