The Cerebro-Spinal Fluid in The Insane

Morton, Hugh (1911) The Cerebro-Spinal Fluid in The Insane. MD thesis, University of Glasgow.

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1. The Wassermann Reaction was done in the intraventricular and the spinal fluid in four cases of general paralysis; in two the intraventricular fluid was negative and the spinal fluid positive. In the other two cases the fluid from both sources reacted positively; but in one the reaction of the interventricular fluid was weak compared with that obtained with the spinal fluid from the same case. In both cases in which the intraventricular fluid gave a positive reaction, the choroid plexus showed evidence of degeneration, whereas in the other two cases degenerative changes were not observed. 2. A positive Wassermann reaction was present (with the spinal fluid) in fifty-two out of sixty cases of general paralysis (by the original method); the spinal fluid of thirty cases of epilepsy and dementia praecox, examined by the same method, gave a negative reaction. Using the cerebro-spinal fluid alone as a diluent for the alcoholic extract a positive reaction was got in thirty out of thirty cases of general paralysis, including two which gave a negative reaction with the original method. Twenty cases of mental disease other than general paralysis were also examined by this method and a negative reaction got in each. Forty-five cases of general paralysis at various stages and twenty cases of mental disease other than general paralysis were examined by the Lecithin, Lecithin-cholesterin method, again using the cerebrospinal fluid as a diluent for the alcoholic extract. The general paralytics all reacted positively and the others negatively. This was found to be the most delicate method. 3. A qualitative examination of the intensity of the reaction, in terms of haemolytic doses of complement, showed that great variation exists from case to case; speaking generally the more advanced the case the greater the amount of complement absorbed, 4. Fresh cerebro-spinal fluid possesses no activating properties for cobra venom; certain fluids rich in cellular content were found to inhibit the activating power of alcoholic extract of liver; this inhibitory action disappeared when the cellular elements were centrifugalised. Alcoholic extract of cerebro-spinal fluid possesses to a slight extent and in a very varying degree the power of activating the lytic action of cobra venom for ox red blood corpuscles. This power of activation has no relation to the occurrence of substances which produce a Wassermann reaction, and is present in spinal fluids from various sources, such as epilepsy, dementia praecox and maniac depressive insanity as well as in the fluids from cases of general paralysis. (In filtering alcoholic or etherial extracts allowance must be made for the fact that certain lytic substances in the filter paper may be extracted, but this point does not invalidate the general conclusions stated here). 5. Mixtures of cerebro-spinal fluid and alcohol present varying degrees of turbidity; as a rule the greatest degree of turbidity is seen in cases of general paralysis, but equally turbid mixtures were observed with fluids from cases of epilepsy and dementia praecox in their acute phases. There is no relationship between the degree of turbidity and the amount of complement absorbed in the Wassermann reaction; a fluid which, with an equal volume of alcohol, gives rise to an opalescent mixture may deviate more haemolytic complement in the Wassermann test, than a fluid which, with alcohol, gives rise to a markedly cloudy precipitate. Examination of the protein content of the spinal fluid by precipitation with ammonium sulphate, and also by the Noguchi method, showed that there is a clear correspondence between these methods of precipitation and the precipitation by alcohol. A few cases of dementia praecox were found with a high protein content, just as they sometimes show a considerable precipitate with alcohol. These is, however, no relationship between the protein content of the spinal fluid and the intensity of the Wassermann reaction. Most cases of general paralysis show a high protein content in the spinal fluid, but a fluid with a high protein content may give a weak reaction. Cases of dementia praecox with a high protein content do not give a Wassermann reaction. 6. The Wassermann reaction is related to the presence of a substance associated with the globulin of the cerebro-spinal fluid, and to the interaction of this substance with lipoid bodies such as are present in an alcoholic extract of liver. The specific substances ("syphilitic antibody") in the cerebro-spinal fluid can be removed by precipitation on half saturation with ammonium sulphate, i. e. they are carried down with the globulin fraction; they are also precipitated by a suitable amount of a suitable alcoholic extract of ox liver. In the removal of the specific substances ("syphilitic antibodies") by precipitation with alcoholic extract of liver, the substances in the extract which possess the power of activating cobra venom (lecithin) also pass into the precipitate, and do not lose their power of activating cobra venom. 7. In general paralysis as a rule there is a high cellular content in the spinal fluid, but there are other diseases apart from general paralysis in which a high cellular content is also present. In a case of Catatonic Stupor about 350 cells of a mononuclear type were present in each cubic centimetre, and in two cases of Plumbism the cerebro-spinal fluid was found to contain 200 and 250 cells per cubic centimetre respectively. These cases had a high protein content in their cerebro-spinal fluid, but in each case the Wassermann reaction was negative.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Neurosciences, Medicine
Date of Award: 1911
Depositing User: Enlighten Team
Unique ID: glathesis:1911-81233
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 02 Apr 2020 13:17
Last Modified: 02 Apr 2020 13:17

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