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CASE OF ACUTE ASEPTIC MENINGITIS.
903
CLINICAL AND LABORATORY NOTES CASE OF ACUTE ASEPTIC MENINGITIS. BY ISAAC GORDON, M.B., B.S. LOND., HOUSE PHYSICIAN TO THE HAMPSTEAD GENERAL HOSPITAL; AND
O.B.E., M.D. CAMB., F.R.C.P. LOND.,
ADOLPHE ABRAHAMS,
PHYSICIAN TO THE HOSPITAL.
THE recent publication by Dr. J. H. Gibbens of of acute aseptic meningitis in THE LANCET (July 4th, p. 12) encourages us to describe an example of this condition in an adult. Dr. Gibbens’s patients were all under the age of 12. A male, aged 34, in previous excellent health, was admitted to the Hampstead General Hospital on some cases
July 8th, 1931, complaining of headache and vomiting. His illness began suddenly on June 30th with malaise, severe headache, and pains in the limbs. His doctor had observed that pyrexia, ranging from 101° to 103° F., was present for the first three days of the illness, and that after two days of general improvement all his symptoms recurred with increased severity, when for the first time complaint was made of stiffness in the neck and vomiting. Lumbar puncture had been performed ; the cerebro-spinal fluid not under increased pressure was opalescent, containing an excess of protein and capable of a slight reduction of Fehling’s solution. The total
During the two days following admission, vomiting persisted but terminated abruptly, although headache apyrexia
(Continued from previous page.) relieve salivation. In these doses it is well tolerated. It does not produce anything like so complete a relief of all the symptoms as is effected by the alkaloids of the hyoscine group, but may be of some value as an adjuvant to these, in the treatment of
were
showed the presence of slight secondary anaemia.. The total leucocytes were 16,000 per c.mm., of which 78 per cent.
were polymorphs. Improvement began steadily continued, and within ten days all symptoms had disappeared. By this time the cerebrospinal fluid, still turbid, contained 250 white cells per c.mm., 90 per cent. of which were lymphocytes. The total protein was now 120 mg. per cent., chlorides
and
Cultures sterile. A week were 715 mg. per cent. later the fluid was clear, colourless, with eight cells per c.mm., all lymphocytes. Total protein 95 mg. per cent., globulin very slightly increased. Sugar within normal limits, chlorides 720 mg. per cent. Lange’s colloidal gold curve 0000000000. A final lumbar puncture was performed on August 12th. The cerebro-spinal fluid was clear and colourless without coagulum. Eight cells-all lymphocytesper c.mm. Total protein 0-035 mg. per cent. Globulin a faint trace. Sugar normal. Chlorides 690 mg. per cent. It should be added that the Wassermann reaction in the blood was negative, Mantoux’s test was negative, and that a skiagram of the skull exhibited no abnormality to suggest disease of the sinuses.
cell count
was 280 per c.mm., with a differential of 40 per cent. polymorphs, 30 per cent. proportion small mononuclears, and 30 per cent. endothelials. Some coliform bacilli-presumably a contaminationwere found on culture. On admission, although obviously very ill, he was fully conscious with unimpaired cerebration. The temperature was 98-8° F., cardiac-rate 56, respirations 20. Physical signs were inconspicuous ; all the cranial nerves were unaffected. Although the muscles at the back of the neck were rigid, Kernig’s sign was not elicited. The cerebro-spinal fluid was not under pressure and exhibited the following characters: Appearance, turbid with a fine clot; total cell count 280 per c.mm., polymorphs 17 per cent., lymphocytes 83 per cent.; total protein, 160 mg. per cent.; globulin increased; sugar within normal limits; chlorides, 700 mg. per cent.; Wassermann reaction negative; no organisms identified in smear or culture.
Bradycardia and maintained. Examination of the blood
and stiffness of the neck continued.
CARCINOMA OF THE CERVIX WITH TWIN
PREGNANCY AND
BY J. L.
NORMAL DELIVERY.
BLONSTEIN, M.R.C.S. ENG.
CASES of carcinoma of the cervix and pregnancy with delivery per vias naturales have been recorded. Usually these have been diagnosed before delivery, and if not terminated by Caesarean hysterectomy, there has been severe post-partum haemorrhage. In 1913 H. B. Mylvaganam1 reported a case of advanced carcinoma of the cervix uteri containing twins, treated by vaginal hysterectomy at the fifth month. In this case pregnancy was not diagnosed, the foetuses only being discovered at operation. The indication for operation was the severe haemorrhages. In 1918 B. P. Watsonreported a case of cancer of the cervix complicating triplet pregnancy, treated by Caesarean Wertheim hysterectomy at the fifth month. Pregnancy was diagnosed, but from the second month haemorrhages and foul vaginal discharge *
were
present.
The following case appears to be unique. I was called in by a midwife to Mrs. A., aged 38, a 2-para, on account of a prolonged first stage. The history of the pregnancy was uneventful except for a certain amount of low backache. There was no parkinsonism. of The last offensive or history bleeding. discharge REFERENCES. 1. Lewin, L.: Arch. f. Exp. Path. u. Pharm., 1928, cxxix., menstrual period had commenced on Sept. 23rd, 133. 1930, had lasted five days, and labour had begun on 2. Lewin and Schuster, P.: Deut. Med. Woch., 1929, April 27th, 1931. There had been a show, but the lv., 419. 3. Beringer, K. : Ibid., 1928, liv., 908. pains were slight and infrequent. On examination 4. Rustige, E.: Ibid., 1929, lv., 613. the abdomen was seen to be very pendulous. Twins 5. Beringer and Wilmanns, K. : Ibid., 1929, lv., 2081. 6. Halpern, L.: Ibid., 1930, lvi., 651 and 1252. On vaginal examination the were easily diagnosed. 7. Gunn, J. A.: Trans. Roy. Soc. Edin., 1911, xlviii., 83. It was noticed that of half a os the size crown. was 8. Marinesco, Kreindler, and Scheim: Arch. f. Exp. Path. u. Pharm., 1930, cliv., 301. the cervix was hard and irregular in outline. No 9. Hill, T. R., and Worster-Drought, C.: THE LANCET, 1929,
ii., 647. 10. Gunn and others :
Quart. Jour. Pharm. and Pharmacol., 1929, ii., 525 ; 1930, iii., 1 and 218 ; 1931, iv., 33.
1 THE LANCET, 1913, ii., 930. 2 Amer. Jour. Obst., 1918, lxxviii., 347.
CLINICAL AND LABORATORY NOTES CASE OF ACUTE ASEPTIC MENINGITIS. BY ISAAC GORDON, M.B., B.S. LOND., HOUSE PHYSICIAN TO THE HAMPSTEAD GENERAL HOSPITAL; AND
O.B.E., M.D. CAMB., F.R.C.P. LOND.,
ADOLPHE ABRAHAMS,
PHYSICIAN TO THE HOSPITAL.
THE recent publication by Dr. J. H. Gibbens of of acute aseptic meningitis in THE LANCET (July 4th, p. 12) encourages us to describe an example of this condition in an adult. Dr. Gibbens’s patients were all under the age of 12. A male, aged 34, in previous excellent health, was admitted to the Hampstead General Hospital on some cases
July 8th, 1931, complaining of headache and vomiting. His illness began suddenly on June 30th with malaise, severe headache, and pains in the limbs. His doctor had observed that pyrexia, ranging from 101° to 103° F., was present for the first three days of the illness, and that after two days of general improvement all his symptoms recurred with increased severity, when for the first time complaint was made of stiffness in the neck and vomiting. Lumbar puncture had been performed ; the cerebro-spinal fluid not under increased pressure was opalescent, containing an excess of protein and capable of a slight reduction of Fehling’s solution. The total
During the two days following admission, vomiting persisted but terminated abruptly, although headache apyrexia
(Continued from previous page.) relieve salivation. In these doses it is well tolerated. It does not produce anything like so complete a relief of all the symptoms as is effected by the alkaloids of the hyoscine group, but may be of some value as an adjuvant to these, in the treatment of
were
showed the presence of slight secondary anaemia.. The total leucocytes were 16,000 per c.mm., of which 78 per cent.
were polymorphs. Improvement began steadily continued, and within ten days all symptoms had disappeared. By this time the cerebrospinal fluid, still turbid, contained 250 white cells per c.mm., 90 per cent. of which were lymphocytes. The total protein was now 120 mg. per cent., chlorides
and
Cultures sterile. A week were 715 mg. per cent. later the fluid was clear, colourless, with eight cells per c.mm., all lymphocytes. Total protein 95 mg. per cent., globulin very slightly increased. Sugar within normal limits, chlorides 720 mg. per cent. Lange’s colloidal gold curve 0000000000. A final lumbar puncture was performed on August 12th. The cerebro-spinal fluid was clear and colourless without coagulum. Eight cells-all lymphocytesper c.mm. Total protein 0-035 mg. per cent. Globulin a faint trace. Sugar normal. Chlorides 690 mg. per cent. It should be added that the Wassermann reaction in the blood was negative, Mantoux’s test was negative, and that a skiagram of the skull exhibited no abnormality to suggest disease of the sinuses.
cell count
was 280 per c.mm., with a differential of 40 per cent. polymorphs, 30 per cent. proportion small mononuclears, and 30 per cent. endothelials. Some coliform bacilli-presumably a contaminationwere found on culture. On admission, although obviously very ill, he was fully conscious with unimpaired cerebration. The temperature was 98-8° F., cardiac-rate 56, respirations 20. Physical signs were inconspicuous ; all the cranial nerves were unaffected. Although the muscles at the back of the neck were rigid, Kernig’s sign was not elicited. The cerebro-spinal fluid was not under pressure and exhibited the following characters: Appearance, turbid with a fine clot; total cell count 280 per c.mm., polymorphs 17 per cent., lymphocytes 83 per cent.; total protein, 160 mg. per cent.; globulin increased; sugar within normal limits; chlorides, 700 mg. per cent.; Wassermann reaction negative; no organisms identified in smear or culture.
Bradycardia and maintained. Examination of the blood
and stiffness of the neck continued.
CARCINOMA OF THE CERVIX WITH TWIN
PREGNANCY AND
BY J. L.
NORMAL DELIVERY.
BLONSTEIN, M.R.C.S. ENG.
CASES of carcinoma of the cervix and pregnancy with delivery per vias naturales have been recorded. Usually these have been diagnosed before delivery, and if not terminated by Caesarean hysterectomy, there has been severe post-partum haemorrhage. In 1913 H. B. Mylvaganam1 reported a case of advanced carcinoma of the cervix uteri containing twins, treated by vaginal hysterectomy at the fifth month. In this case pregnancy was not diagnosed, the foetuses only being discovered at operation. The indication for operation was the severe haemorrhages. In 1918 B. P. Watsonreported a case of cancer of the cervix complicating triplet pregnancy, treated by Caesarean Wertheim hysterectomy at the fifth month. Pregnancy was diagnosed, but from the second month haemorrhages and foul vaginal discharge *
were
present.
The following case appears to be unique. I was called in by a midwife to Mrs. A., aged 38, a 2-para, on account of a prolonged first stage. The history of the pregnancy was uneventful except for a certain amount of low backache. There was no parkinsonism. of The last offensive or history bleeding. discharge REFERENCES. 1. Lewin, L.: Arch. f. Exp. Path. u. Pharm., 1928, cxxix., menstrual period had commenced on Sept. 23rd, 133. 1930, had lasted five days, and labour had begun on 2. Lewin and Schuster, P.: Deut. Med. Woch., 1929, April 27th, 1931. There had been a show, but the lv., 419. 3. Beringer, K. : Ibid., 1928, liv., 908. pains were slight and infrequent. On examination 4. Rustige, E.: Ibid., 1929, lv., 613. the abdomen was seen to be very pendulous. Twins 5. Beringer and Wilmanns, K. : Ibid., 1929, lv., 2081. 6. Halpern, L.: Ibid., 1930, lvi., 651 and 1252. On vaginal examination the were easily diagnosed. 7. Gunn, J. A.: Trans. Roy. Soc. Edin., 1911, xlviii., 83. It was noticed that of half a os the size crown. was 8. Marinesco, Kreindler, and Scheim: Arch. f. Exp. Path. u. Pharm., 1930, cliv., 301. the cervix was hard and irregular in outline. No 9. Hill, T. R., and Worster-Drought, C.: THE LANCET, 1929,
ii., 647. 10. Gunn and others :
Quart. Jour. Pharm. and Pharmacol., 1929, ii., 525 ; 1930, iii., 1 and 218 ; 1931, iv., 33.
1 THE LANCET, 1913, ii., 930. 2 Amer. Jour. Obst., 1918, lxxviii., 347.