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.

    5/7 (page 17)
    gests that one cannot draw the conclusion that because the cerebrospinal fluid is negative, there is no meningitis present. The cerebrospinal fluid in the four cases of influenza meningitis all showed great turbidity, the cells were practically all of the polymorpho- nuclear variety, and the influenza organism was readily cultivated. An examination of a smear from the fresh fluid shows at once that the organism is not the meningococcus, and a culture on blood agar should therefore immediately be made. Cultures on ordinary media would show no growth and one would easily be misled if one relied on them. The organisms are not numerous in the smears, in marked contrast to the great numbers of organisms in cases of pneumococcus meningitis. In a series of twenty-four meningococcus cases, the fluid from twenty- two showed the usual turbidity, great numbers of polymorphonuclear cells and the presence of the meningococcus in the smears and by culture. In two cases the findings were unusual. One was that of a six months old child admitted in the second week of illness with a history strongly suggesting meningitis. By lumbar puncture 15 c.c. of clear fluid was obtained, which was negative by smear and culture. A very few poly- morphonuclear cells were found. The fever and nervous symptoms increased with such severity that a second puncture was made seven days later, and 20 c.c. of slightly turbid fluid obtained, in which the meningo- coccus was easily demonstrated. From this time the course of the dis- ease was that of a rather mild cerebrospinal meningitis. An almost identical history was that of a nine months old child, admitted after an illness of four weeks. The symptoms were rather indefinite. The first puncture in this case also showed clear fluid and no organisms of any kind could be found. Two week# later the fluid was that of a typical cerebrospinal meningitis and the meningococcus was grown from fluids obtained at four subsequent punctures. From a study of these histories the question arises whether there may not be a definite meningeal inflammatory lesion present with, at the same time, a clear cerebrospinal fluid from which no organisms can be cultivated. In the ten cases of streptococcus meningitis the fluid from each showed great turbidity. There were many polymorphonuclear cells present. The streptococci were present in large numbers and grew read- ily on ordinary media. There were three cases in which more than one type of organism was found. In one case tuberculous meningitis occurred six weeks after recovery from a meningococcus meningitis. In another, tubercle bacilli and streptococci were both present during the acute stage. In the third, pneumococci and meningococci were both isolated from the thick, puru- lent fluid.