At first the fluid came from the needle under pressure, often flowing in a steady stream which rather rapidly decreased to a normal flow. We did not limit ourselves to a definite amount, but allowed the fluid to escape until the rate reached normal.In one case the delirium apparently began to return, leading us to repeat the puncture ; here there was no excessive pressure to the flow, and only a small amount was withdrawn. The symptoms increased no further, and the patient went on toward recovery.It is interesting to note that in the seven cases of delirium, four patients died, two developed empyema, one of these showing also myocardial weakness, and the remaining one had unresolved pneumonia with a greatly prolonged convalescence. In the cases which terminated fatally, death seemed to be the result of an overwhelming toxemia rather than a cardiac failure. The cases in which the patients recovered were extremely severe in type, and during the course of the disease the prognosis was so unfavorable that a successful termination was not expected.
REPORT OF CASESCase 1. (H-64017).-The patient was admitted to the ward, Dec. 19, 1916, with lohar pneumonia of the left lower lohe of four days' duration. He was delirious on admission to a wild and maniacal degree. Two days after admission, lumhar puncture was performed. The fluid was under considerahle pressure ; 30 c.c. were removed. No laboratory report was made, as the test tube was broken. The delirium greatly diminished, changing from a wild, active type to a low muttering. • The patient died, Dec. 23, 1916. Case 2 (F-64061).-The patient was admitted, Dec. 22, 1916, with lohar pneumonia of the right middle and lower lobe of two days' duration. He developed a marked delirium four days later and a severe headache. Lumbar puncture was performed on the eighth day of the disease ; 65 c.c. of clear fluid were removed under great pressure. The laboratory reported that it was sterile, with negative Noguchi and Rivolta tests. The delirium was almost immediately relieved, and improvement in the general condition was marked. The patient developed empyema, was operated on, and was cured.Case 3 (C-64074).-The patient was admitted, Dec. 25, 1916, with no obtainable history. There was lohar pneumonia of the left upper lobe. He was widly delirious on admission. Lumbar puncture was performed three days later ; 35 c.c. of clear fluid under marked pressure were removed. The laboratory reported that it was sterile, with negative Noguchi and Constitutional Signs
