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IT has been established for many years that in meningitis and especially in tuberculous meningitis the concentration of chloride in the cerebrospinal fluid falls, and this fact has become of considerable value in diagnosis. Mestrezat [1912] was one of the first to note that the chloride concentration of the cerebrospinal fluid was higher than that of the serum, and he further reported its decrease in meningitis. In health the concentration of chloride in serum is 0-58 % (100 millemoles per litre) and in the cerebrospinal fluid 0-73 % (125 mM.). Attempts have been made to explain this difference on physical grounds, by the difference in water content and protein concentration of the two fluids leading to an unequal distribution of ions in accordance with the Donnan law [Hamilton, 1925]. Mestrezat and Lebebt [1921] produced by dialysis in vitro and in vivo fluids very closely resembling cerebrospinal fluid, and showing a higher chloride content than the serum from which they were formed. Duke-Elder [1927] found a higher chloride content in the aqueous humour than in the corresponding serum; he attributed this to the Donnan effect and found no evidence that the aqueous humour is a secretion. The aqueous humour is very closely related to the cerebrospinal fluid. Fremont-Smith [1927] reviews the evidence for and against the secretion of the cerebrospinal fluid by an essentially vital activity of the choroid, and accepts it as proven that its composition can be explained by the laws of filtration and dialysis. Against accepting this conclusion too hurriedly it may be observed that the value of the ratio Clserum/Cl0CS F is always much smaller than the value of R predicted from the formulae of Van Slyke, Wu and McLean [1923], and much less than the ratio for Cl actually found by Hastings, Salvesen, Sendroy and Van Slyke [1927] in a study of the relation of oedema fluid to serum. And further according to Donnan's law

The chlorides and inorganic constituents of the serum and cerebrospinal fluid in meningitis