MENINGEAL EFFUSIONS 361 



other base" may be found in the spinal fluid. (See "Choline, " Chap. 

 iv.) ^ 



Under pathological conditions the amount of protein varies greatly 

 and to some extent characteristically. Thus, in syphilis the euglobulin 

 is so greatly increased that it is readily identified by various precip- 

 tation methods,-^ while in more acute inflammations fibrinogen ap- 

 pears.-* According to Mott^'' the fluid is especially rich in nuclein 

 in progressive paral^'sis, and lipoids are increased in the fluid in do- 

 generations of the central nervous system. Pathological fluids show 

 also specific alterations in their colloidal property of preventing pre- 

 cipitation of colloidal suspensions b}' electrolytes (the "Goldzahl" 

 of Zsigmondy).'^ The surface tension is higher than that of the 

 serum and is not characteristically altered in disease. ''^ The increased 

 organic matter of pathological fluids raises the permanganate reduction 

 index." In epidemic meningitis there is more positively charged 

 protein while in tuberculous meningitis there is more negatively 

 charged protein, which can be distinguished by suitable precipitants 

 (Tashiro and Levinson).^^ 



Cholesterol can be found in all cases of mental disease, the amount 

 not bearing any relation to the type of ps3'chosis (Weston) ;^' ordinar- 

 ily' 0.2 to 0.7 mg. per 100 c.c. is found. The changes in PoOs content 

 in disease are doubtful,^^ while the amount of reducing substances is 

 said to be increased in disease. ^'^ In general the inflammatory fluids 

 in the spinal canal resemble exudates elsewhere, but usually the con- 

 centration of the different components is relatively low, except the 

 chlorides. ^^ Normal cerebrospinal fluid contains no antiprotease (for 

 leucoprotease), as does the fluid in many cases of chronic inflamma- 

 tions; in acute inflammation proteases ma}- appear (Dochez^*). Pep- 

 tid-splitting enzymes are especially abundant in meningitis. ■*" Anti- 

 bodies pass from the serum into the cerebrospinal fluid only in minimal 

 amounts or not at all, except when inflammatory exudation occurs, 

 and even then the antibody concentration is usually low,'*^ and even 



2" Kaufmann, Zeit. physiol. Chem., 1910 (66), 3-13; Laignel-Lavastine and 

 Lasusse, Compt. Rend. Soc. Biol, 1910 (68), 803. 



28 See Xoguchi, Jour. Exp. Med., 1909 (11), 604. 



=' See Mestrezat, Rev. d. Med., 1910, p. 189; Kaflfka, Deut. med. Woch., 1913 

 (39), 1874. 



3° Lancet. July 9, 1910. 



" Lange, Zeit. Chemother., 1912 (1), 44; Spat, Zeit. Immunitat., 1915 (23),'426; 

 Vogel, Arch. Int. Med., 1918 (22), 496. 



32 Ivisch and Remertz, Miinch. med. Woch., 1914 (20), 1097. 



" See Hoffman and Schwartz, Arch. Int. Med., 1916 (17), 293. 



3* Jour. Infect. Di.s., 1917 (21), 571. 



35 Jour. Med. Res., 1915 (33), 119. 



3® Apelt and Schumm, Arch. Psj-chiat. u. Xervenkr., ISOS (44), 845. 



" Jacob, Brit. Med. Jour., Oct. 26, 1912. 



3s Javal, Jour. phv.s. et path, gen., 1911 (15), 508. 



39 Jour. Exp. Med., 1909 (11), 718. 



"> Major and Xobel, Arch. Int. Med., 1914 (14), 383. 



*iLemaire and Debre, Jour, physiol. et path, g^n., 1911 (13), 233. 



