Merrill Moore

The need for psychiatry in a municipal general hospital.

AT THE Boston City Hospital, psychiatry labeled as such does not officially exist. Actually, about 1000 obviously psychotic patients are admitted to its wards each year. Most of these patients are ...

TUMOURS OF THE BRAIN ASSOCIATED WITH MARKED PLEOCYTOSIS IN THE CEREBROSPINAL FLUID.

A SLIGHT or moderate pleocytosis in the cerebrospinal fluid is not rare in cases of tumour of the brain. Greenfield and Carmichael state that a slight pleocytosis (5-10 cells) frequently occurs in cases of cerebral tumour. Alpers2 examined the ventricular fluid in 102 cases and found a pleocytosis in nine instances; from 7 to 20 cells in sevenl fluids, 73 cells in one fluid, and 375 in another. Spurling and Maddox3 studied the cerebrospinal fluid from 108 patients and reported that the cell count was low, usually under 3. Moersch4 examined the cerebrospinal fluid obtained by lumbar puncture from 252 cases of cerebral tumours; he found more than 100 cells in two cases only. The finding of a large number of cells in the cerebrospinal fluid is rare, and for this reason we are reporting two such cases that have come under our observation. PERSONAL CASES. CASE I.-E. C. The patient was a white Syrian merchant, aged 62; admitted to the Neurological Service of the Boston City Hospital, February 7, 1929, in a semicomatose condition. The following history was obtained from his daughter. Until three weeks prior to entry the patient was perfectly well. At this time he developed a headache, just before or after sustaining a slight injury to his head. Ten days before entry he had a chill and was confined to bed for one day. He appeared to be confused, as he was playing with his fingers and had washed his face with an orange. For one week the daughter had noticed that the patient seemed sleepy, talked very slowly, complained of severe pain in both temples, and was incontinent of urine. Six days before entry he vomited, became very drowsy and slept continuously. On the day of admission the patient put his right hand to the right side of his head frequently. There was no record of fever while at home. Physical examination showed a well developed but poorly nourished elderly male in a deep stupor. The skin was moist Lnd the lips were slightly cyanotic. There was a mucopurulent discharge in the posterior nasopharynx. The ear drums appeared normal. There was moderate opisthotonus, slight stiffness of the neck, and bilateral Kernigs sign. The brachial and radial arteries showed a moderate degree of arteriosclerosis. The right pupil was larger than the left; both reacted sluggishly to light. There was a mild choking (1-2 diopters) of the optic discs. Otherwise the cranial nerves