Cerebro-Spinal Fluid Findings in a Case of Meningococcal Meningitis

smears made from the centrifuged deposit of the fluid, other findings such as the number and the type of cells, presence or absence of sugar, and the quantitative estimation of chlorides help to determine the diagnosis in a case of meningitis. Thus we say that meningococcal meningitis gives rise to increased polymorphonuclear cells and tuberculous meningitis to increased lymphocytes. This, however, seems to depend entirely on the intensity of the stimulus given by the infecting micro-organism and the stage of the disease at which the fluid is obtained. Thus if a case of meningococcal meningitis is seen early enough, before the infecting organism has multiplied sufficiently to cause a polymorphonuclear response, one may, as in the present case, find a predominance of lymphocytes. (The fluid in the present case was obtained on the very first day when the patient complained of fever and headache). Alternatively, I have seen a pure poly* morphonuclear exudate in a case of tuberculous meningitis following acute miliary tuberculosis. Similarly the character of the coagulum also will depend upon the number of cells and the amount of fibrin present in the fluid. In this case the quantitative estimation of chlorides alone helped diagnosis, and treatment for meningococcal meningitis was instituted on the strength of the chloride finding alone, without waiting for further bacteriological examination. An examination of the patient's blood film revealed a polymorphonuclear leucocytosisSubsequently, on incubation and further cul" ture, meningococcus was obtained from the fluidThe patient also made a remarkable recovery