The Value of Routine Examination of the Cerebrospinal Fluid: Report on the Examination of 3,200 Fluids.

THE examination of the cerebrospinal fluid is such a valuable aid to the diagnosis of nervous and mental diseases that it naturally forms a prominent feature of the work done in the laboratory of any mental hospital. A complete examination of the fluid is made in practically, every case admitted to this hospital, and I have in this article analysed the results of examination of 3,200 fluids carried out in our laboratory during the last ten years. In 2,400 normal specimens the fluid was clear and colourless, and there was no coagulum. The reaction was alkaline. The protein content ranged between *02 and -035 per cent. that of the chlorides between *72 and *75 per cent., the average being *74 per cent. Fremont-Smith and Dailey' also regard the normal chloride content as fronm *72 to *75 per cent. The average cell-count was *4 cells per c.mm., and ranged between 0 and 2-6 cells per c.mm., the cells consisting of large and small lymphocytes. The sugar content ranged between *062 and *089 per cent., the average being -077 per cent. Lange's gold sol test was constantly negative, as were also the colloidal gamboge test, the Wassermann reaction, and the Meinicke reaction. I found no polymorphonuclear leucocytes in normal fluids, and this coincides with the results obtained by most recent workers. Fontecilla and Sepulveda 2, however, consider that normally cerebrospinal fluid contains 5 per cent. of polymorphonuclear leucocytes. Leredde, Rubinstein and Dronet3 consider the number of cells in the normal fluid to range between *5 and 1 per c.mm., and Levinson's4 figures are 4 to 6 per c.mm., all the cells being small lymphocytes. Greenfield5 gives *3 cells per c.mm. as the normal finding. Stowe , in an analysis of 556 normal fluids, found the average sugar content to be about *075 per cent. Greenfield5 gives the normal range as 050 to -075 per cent., while Levinson's4 figures are *064 to -09 per cent. Alpers, Campbell and Prentiss7 give the normal range as 0053 to *084 per cent. In 'dementia pr2ecox, mania, melancholia, secondary dementia, acute confusional insanity, senile dementia and epilepsy, the fluid was found to be normal. Lochelongue8 reported the fluid to be normal in epilepsy.