THE OPTICAL ACTIVITY OF CEREBROSPINAL FLUID IN SUPPURATIVE MENINGITIS, AND ITS LACTIC ACID, SUGAR, AND CHLORIDE CONTENT

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Abstract
In 15 control studies on apparently normal fluids the sugar concentration in the fluid varied from 43 to 95 and averaged 66 mgm. %, and the lactic acid varied from 12 to 31 and averaged 19 mgm. %. The main study deals with 49 specimens of cerebrospinal fluid from 9 cases of meningitis (1 pneumococcic, 1 tuberculous, 3 streptococcic, 4 meningococcic). The sugar content in this series of cases was generally lowered, 1/2 the specimens showing a sugar content of 20 mgm. % or less. The lactic acid concentration increased in some cases 8-10 fold, 4 times becoming greater than 150 mgm. % in the last specimen prior to death. Only 7 observations showed less than 30 mgm. of lactic acid %. The authors conclude that lactic acid determinations on the cerebrospinal fluid give striking evidence of abnormality in cases of suppurative meningitis and the lactic acid concentrations are more or less related to the severity of the clinical symptoms. Chloride determinations (30) were made and the results range from 77 to 126 m. Eq. per liter being under 121 in 83% of the observations and under 110 in 50%. The authors agree with others that the chloride concentration is lowered, sometimes very considerably, in suppurative meningitis. The ratio of the concentration of chloride in the blood to that in the cerebrospinal fluid in suppurative meningitis was not found altered from the normal in 6 determinations on 4 cases. The cerebrospinal fluid was found to be actually levorotatory in 13 of 19 cases of suppurative meningitis. This fact, together with the high lactate content of the fluids and the absence of proteins, suggests that the lactates are present in the form of salts of d-lactic acid, all of which are levorotatory. The authors have found this to be the case in ultrafiltrates of glycolysed blood.