The constant presence of the tubercle bacillus in the cerebrospinal fluid of tuberculous meningitis : with a study of the cerebrospinal fluid in other forms of acute meningitis / Josephine Hemenway.

  • Holt, L. Emmett (Luther Emmett), 1855-1924.
Date:
1911
Catalogue details

Licence: In copyright

Credit: The constant presence of the tubercle bacillus in the cerebrospinal fluid of tuberculous meningitis : with a study of the cerebrospinal fluid in other forms of acute meningitis / Josephine Hemenway. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Bacilli were therefore missed but once when a satisfactory amount of fluid could be obtained for examination, and that was from a puncture made very early in the disease. There is little doubt that the bacilli are more numerous late in the dis- ease, yet they were found in the first puncture in 117 cases; in the second in thirteen; and in the third puncture in four cases. Most hospital patients are not admitted until symptoms are tolerably well marked. It is therefore somewhat difficult to say how early in the disease bacilli may regularly be found. On the average, the first puncture was made about ten days before death. The larger amount of fibrin found in the fluid late in the disease, as evidenced by the constant formation of a film, renders the discovery of the bacilli easier at that time. The four cases in which a third puncture was necessary were admitted with symptoms suggesting meningitis. The early puncture showed only an excess of clear fluid, under slightly increased tension, and a few mononuclear cells. FINDINGS IN OTHER FORMS OF MENINGITIS Examination of the cerebrospinal fluid was made in twenty-two cases of pneumococcus meningitis. The fluid in twenty of the cases could not have been distinguished macroscopically from turbid fluids in other forms of meningitis. It varied from a slight cloudiness to such a turbid- ity as to cause a thick deposit of pus in each tube. The cells were chiefly polymorphonuclear; the organisms were plentiful in the smears, and grew readily in cultures. In contrast to these typical cases, it may be of interest to mention the findings in some other cases, which were quite exceptional. A child with lobar pneumonia showed definite meningeal symptoms. An excess of clear fluid under increased tension was obtained twice by lumbar punc- ture, and from both fluids the pneumococcus was grown in pure culture. The disease terminated by crisis, the nervous symptoms disappearing with the fall in temperature, the child making a prompt recovery. The case was certainly not one of meningitis. In twelve other cases of pneumonia with very pronounced nervous symptoms, punctures were made, but in none was the pneumococcus found. In cases of pneumonia with a high temperature, if a puncture was made, the cerebrospinal fluid was usually found to be under increased tension and in excess of the usual amount. This has later been observed to be true in many other diseases in which lumbar puncture has been done on children with nervous symptoms suggesting meningitis, the true diagnosis being made later. In one case, which was proved by autopsy to be one of pneumococcus meningitis, three punctures showed normal fluid in the acute stage. This finding, which was a very remarkable one, sug-