OBSERVATIONS ON THE TREATMENT OF CEREBRO-SPINAL FEVER
Authors: C. Worster-Drought
Journal: BMJ (1916)

r RDie J8;kNA 689.Iu twvo cases aRzte mortemz cardiac thrombi were found in tlle riaht lheart and hIaemnorrllagic infarcts were present in the lulngs.In one of tllese polyserositis was found, the pericarditis being especially well marked.PyopericardiuLm was seen in 8 cases (11 per cent.),utsuially being the greatest factor in the cauisationi of a toxaemic death.Pericardial and pleural adliesions were often seen but did not seem to have aniy importance.The serous memalbranes frequenitly (13 per cent.)showed petechial haemortrhages.Tie ependyina lining thle lateral ventricles was peteclhial in a few cases.The clhoroid plexus on sevveral occasions slhowed hyper- troplhy and vesiculation.This was more apparent in the more chronic cases.Pyclitis was marked in two cases, but many sliowed turbid uirine comiing away from the pelvis on cutting the ureter.'The spleen slhowed appreciable enlargemlient in 29 cases (41 per cent.).Most writers seem to form too low an estirmate of this feature.Milligan 9 reports enlargement of thie lymplatic glands in this condition at autopsy in at very great number.I found the mesenteric glan(ds enlarged andl reddened in tlle majoritv.Aortic atlheroiyia.vas present in 15 cases (22 &er cenit.).In 5 cases (aged 13, 15, 20, 21, 25) atlheroma was present, aind tiae organis were firtm.In one case, aged 13 years, thie aorta was clcar, anid tlhe organs dlid not slhow aniy ulndulle firmness.Tlrhoulgh these cases are verv few, they bear out the opinions of some autlhorities wlho state that in tlhe majority of adolescents dying fromu acute infectious diseases there is a syplhilitic basis.Thje positive evidence in these.five cases is at least very suagestive.PuLrulent bronichlitis wvas present in tlle miajority of cases comingm to autopsy, tlickI creamDy pUs often being ex- ,')ressed from tdie bronchli witlh ease..This seeniis to invite furtlher study.In view of its great frequency I weo.uld suaggest thje possibility of tlhis being the primary site of the itifection, witlh disseminiation taking place the jefronll.Haenzorrliages.I lave purposely left the consideration of the liaenmorrlaaic tenidency in this diseitso (as evidenced in tlle laboratory and post-mzortemz room) to the last.I lhave already remuarked oti the great frequency of red 'blood corpuscles in the cerebro-spitial fluid-a condition -which is unlikely to be always due to aceidlental cauises or fauLlty techlniquie, especially in view of the dexterity anld perfection wl ich those conistantly performingt, lutmiibar punctture attain.Thie occlurrenlce, in 3 cases, of cerebral haenmourrage (capsular), in one of multiple sl mall miieningeal (stubarachnoid) lhaemorrlrages, and in iiany cases the presence of a general lhaemorthlagic condition of the base of the brain, give fturtlher evidence of this tendency.I lhave referred above, also, to the frequency of pctcchiial hlaemiorrlhages under the ependyina and the serous mern- branes.Th'le purpuric skini cotnditioin is frequenitly seen pest mortenm, mlost often in fulminant and byperacute cases.OCn two occasions multiple leaemorr-liages into lung tissue were seen, witlhout apparent gross cause.In one case tlho initestinial canial was filled witlh blood clot.Tlhcrc was no lesion in the intestinal wall to account for this condition.Horder8 states that smnall hlaemiiorrliages into the intestinal canaLl m-lay be conispicuous, especially in acute eases.Thiis case, hiowever, demonstrates tlle pos- sibility of a large haemorrhage occurring.Recently, in two examinations conducted in fulninant cases, the presence of a liaemorrIjagic enlargement of the adrenals -was noted, this being very conspicuous.