244 CLINICAL BACTERIOLOGY AND HiEMATOLOGY 



(similar cells to those shown on Plate X., Fig. 3) may appear in 

 the fluid after a cerebral haemorrhage. They do not make their 

 appearance until three or four days after the blood has been 

 poured out. 



Htemorrhage into the meningeal cavities or into the ventricles is, of 

 course, accompanied by blood in the cerebro-spinal fluid. This 

 may be found in cases of fracture of the skull, especially of the 

 base, or of the spinal column, or in contusion of the brain, and it 

 is worth noting that in some cases there has been great relief of 

 the symptoms after the fluid has been drawn off. Lumbar 

 puncture should always be remembered as a means of diagnosis 

 in patients found unconscious. 



" Septic " Meningitis — i.e., that due to the meningococcus, 

 pneumococcus, streptococcus, typhoid bacillus, etc. — is character- 

 ized by the presence of large numbers of polynuclear cells in the 

 fluid (see p. 133). In all cases the numbers tend to be more 

 numerous than in tuberculous meningitis, and may run into 

 hundreds of thousands per cubic millimetre, in which case the 

 fluid resembles watery pus. 



The importance of this fact is very great, and the discovery of 

 polynuclear leucocytoses has led to the discovery that mild cases 

 of this affection occur which are hardly diagnosable clinically, and 

 which may be completely cured. According to several French 

 authorities, the first indication of commencing cure is the appear- 

 ance of lymphocytes, which must therefore be looked on as a 

 good sign ; after a time the polynuclears become less and less 

 numerous, and' finally the lymphocytes alone remain, and may 

 persist for some time after cure has taken place. I have watched 

 several septic cases recover, and have seen this occur two or 

 three times. The appearance of lymphocytes in an acute septic 

 meningitis may therefore justify a good prognosis. 



