Annual report of the Board of Control : 12th, 1925.

Date:
1925
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Licence: In copyright

Credit: Annual report of the Board of Control : 12th, 1925. Source: Wellcome Collection.

    144/482 (page 134)
    3. In suspected general paralysis neglect to examine the cerebro¬ spinal fluid is unpardonable. The mental and physical factors can be very deceptive, and serum examination alone may be more misleading than helpful. Thus, two cases in this series were actually certified as suffering from general paralysis—diagnoses that proved to be wrong on subsequent fluid examination. 4. Early diagnosis and treatment of syphilis of the supporting and nutritional tissues of the central nervous system will often prevent the case passing into disease of the parenchymatous tissues, and thus changing from a curable into an incurable disease. Two very marked instances of this were found in the present series. 5. Fluid examination must consist of several tests if accurate diagnosis is to be arrived at, as no single reaction is pathognomonic of any particular disease of the central nervous system, syphilitic or otherwise. Thus, not even in general paralysis is a positive Wassermann reaction or a typical paretic gold curve invariably got in the cerebro-spinal fluid. Proof of this was not wanting in the present investigation. 6. In all cases where the clinical findings suggest syphilis one negative Wassermann reaction in the serum must not be regarded as final, but the examination must be repeated, preferably after a provocative dose of a salvarsan preparation. In this series two paretics gave positive Wassermann reactions after previous negative ones. Nor must it be forgotten that in rare cases the serum in general paralysis may be persistently negative, as in one case in this series. 7. More frequent examination of the cerebro-spinal fluid in mental patients will lead to the detection of causal factors which might otherwise be missed, e.g., meningitis of various origins, cerebral tumours, trypano¬ somiasis, etc. 8. The diagnosis of syphilis of the central nervous system cannot be left to the pathologist alone. The clinical findings must also be taken into account. This is especially the case in tabetics, and for differential diagnosis between the various forms of syphilitic disease of the central nervous system. Although not emphasized in this paper, in which treatment has not been recorded, the last word often rests with the therapeutic test.—(Journal of Mental Science, April, 1925.) B.—■Blood Sugar Studies in Encephalitis Lethargica.—By Dr. P. K. McCowan, M.R.C.P., D.P.M., Dr. J. S. Harris, D.P.M., and Capt. S. A. Mann, B.Sc., F.I.C. The blood sugar curves after 50 grammes glucose were investigated in 15 patients suffering from the mental and physical sequelae of Encephalitis Lethargica. The lsevulose test for liver efficiency was also carried out in the same cases. Conclusions. 1. In post-encephalitis lethargica there is definite derangement of carbohydrate metabolism as shown by the blood sugar curves. 2. The lsevulose test does not support the contention that there is definite permanent hepatic insufficiency in post-encephalitis lethargica. 3. The majority of post-encephalitic lethargies show a hyperglycsemia following glucose injection, markedly sustained in 50 per cent, of cases. 4. The mental states of depression and stupor were associated with the most profound abnormalities of carbohydrate metabolism. 5. No correlation could be fomid between the clinical pictures and the types of blood sugar curves obtained.