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What the study says is that it deals with "clinical data of 189 cases with 4 cases confirmed with definite TBM, 65 cases of probable (diagnostic score, ≥12 with imaging or ≥10 without imaging) and 120 cases of possible (diagnostic score, 6–11 with imaging or 6–9 without imaging) TBM admitted to Xiangya Hospital of Central South University between January 2009 and January 2015."
... not meaning that they found out that only 2.3 per cent of the 189 cases was actually TBM, but instead that 2.3 per cent of the (173) cases responded to a specific smearing method test. The study nevertheless described the 189 cases as per the above.
But the overall interesting question is not whther or not the cases in the study were all TBM cases! It is instead to which degree we should expect TBM patients to develop hypotermia with temperature levels that are extremely low. As I understand things, it is instead very much likelier that a TBM patient will have a fever, not hypothermia.
Can you confirm that this is correct?Comment
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I googled "symptoms of tuberculosis meningitis" and these are the first three hits on the net:
Number one:
Symptoms of Meningeal Tuberculosis
At first, symptoms of TB meningitis generally appear slowly. They get more severe over a span of weeks. Throughout the early stages of the infection, symptoms can involve:- low-grade fever
- malaise
- fatigue
As the disease advances, the symptoms will grow more serious. Typical symptoms of meningitis, such as headache, light sensitivity, and stiff neck, are not always exhibited in meningeal tuberculosis. Rather, you may experience the symptoms such as:- fever
- nausea and vomiting
- irritability
- unconsciousness
- confusion
- lethargy
Number two:
What Are the Symptoms of Tuberculosis Meningitis?
In the case of immunocompromised individuals, dissemination of the bacteria to the brain can result in a Rich focus, a granuloma in the cortex or meninges, that can rupture into the subarachnoid space leading to tuberculous meningitis. The HIV-associated tuberculous meningitis accounts for 27% of meningitis cases in HIV-positive patients.7 While most individuals with the disease typically have CD4+ cell counts <200 cells/μL, there have been numerous cases where dissemination to the CNS has occurred in individuals with normal CD4+ cell counts. Clinical manifestations of the disease are nonspecific and include fever, headaches, lethargy, and both focal and diffuse motor and sensory deficits.
Number three (which was the same as number two):
What Are the Symptoms of Tuberculosis Meningitis? In the case of immunocompromised individuals, dissemination of the bacteria to the brain can result in a Rich focus, a granuloma in the cortex or meninges, that can rupture into the subarachnoid space leading to tuberculous meningitis. The HIV-associated tuberculous meningitis accounts for 27%of meningitis cases in HIV-positive patients.
While most individuals with the disease typically have CD4þcell counts <200 cells/mL, there have been numerous cases where dissemination to the CNS has occurred in individuals with normal CD4þ cell counts. Clinical manifestations of the disease are nonspecific and include fever, headaches, lethargy, and both focal and diffuse motor and sensory deficits.
It seems to a layman like me as if fever, first low fever, then rising fever, is an expected symptom of tuberculosis meningitis. Nowhere does it say that hypotermia is an expected symptom of the disease, which makes me think that it is something that is more or less rare, but MAY occur in some cases. Would that be fair to say?Comment
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Yes - there is a narrow sliding scale of likelihoods which is of more utility in trying to guage what happened that the wider sliding scale of theoretical possibilities.
And then juxtaposed with this we have the declaration that Long's evidence is compelling...
she walked down Hanbury Street on her way to work. The time is probably the least controversial aspect as presumably she knew when she had to be at work and she had seen or heard a clock.
She later discovered that a murder had taken place at a location she will have passed.
She then claimed to remember the conversation she fleetingly heard, recognised the woman and remembered the exact location on Hanbury Street of that very brief and at the time totally unremarkable encounter. She did not see the body to confirm the identification until I think four or five days later.
Unsurprisingly the police were less convinced by her evidence. That sort of evidence is amongst the weakest in a case like this. Later eye witness testimony to what at the time was unremarkable is notoriously unreliable.Comment
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I also found this study from 2002 (https://nsj.org.sa/content/nsj/7/4/301.full.pdf), where the conlusion says that "In conclusion, fever is a common clinical feature of tuberculous meningitis".
The study also speaks of hypothermia: "Abnormalities of temperature regulation due to hypothalamic dysfunction, in patients with tuberculous meningitis, have been observed. Dick et al described a patient who developed chronic hypothermia following tuberculous meningitis due to a central defect of thermoregulation. Joshi et al reported 2 patients with tuberculous meningitis and hydrocephalus who developed hypothermia, which was thought to be secondary to pressure on the thermoregulatory center in the posterior hypothalamus."
It seems to me that hypothermia is not something that is common, but I have failed to find just how common it is (or is not). In the study, it is mentioned as a fringe possibility, or so it seems to me.
Do you have any numbers to supply me with?
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Having gone through newspaper articles from the inquest, I can only find Phillips saying that the lungs of Chapman were in a state of long-gone disease and that the membranes of her brain were also diseased. Does Phillips say more than so in any other source? It is reasoned that what we have is a case of tuberculosis that has spread to the brain, but is this confirmed? There are many diseases of the lungs just as there are many brain diseases that can affect the membranes (such as syphilis, for example).
How much do we know and how much can we conclude from it? Anybody?Comment
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With TB infecting 25% of "Whitechapel" at that time,I know where my money would go.
Not been able to find the TBM hypothermia figures you requested.
Just sent a pathology sample off.Been battling Fibromyalgia for 39 years.Same disease Sutton treated D'Onston for.Similar to Rheumatic Fever.Streptococcus.
Cost Aus$541 plus ~ $500 to have someone pick it up and deliver to Melbourne.
If people knew how many lies and BS we are fed about diseases ...... AARGH!Comment
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Thanks for making the effort to find the figures. Since you were unable to find them, being a medico (as I believe you are, correct me if I am wrong), could you say whether or not hypothermia is a rare or common feature in Tuberculosis meningitis?
Two more questions, if you don´t mind:
1. Would somebody who had developed tuberculosis meningitis to a degree where the brain was deteriorating and hypothermia set in be functioning the way Chapman did; being able to going out for business, conversating in a manner that seems unaffected by the brain disease and participating in a physical fight about a piece of soap days before she was killed?
2. I note that it is said on the net that Chapman was so far gone that she had days only to live. Is there confirmation for this in the Ripper-related sources or is it a fact that once the brain is infected to a visible degree, only days are left to live?
Thanks for your help!Comment
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I'm not a medico,however have held positions where knowledge has been essential.
jnnpsyc00059-0075.pdf
Really worth reading properly.
Patient presented with a low fever of 38.5C.
Two years later 32 to 34.5C.
Questions 1 and 2.
OK,you reckon that's normal behavior.
Doubt she had long to live.
Really interesting that an attempt at taking Chapman's head was commenced.
Do you think that was a co incidence!Comment
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Sarcoidosis is one possible alternative.Lungs,brain.Not aware of low temperatures though.Comment
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Isn´t there also the possibility that the lung disease and the brain ditto were unrelated? Lung tuberculosis and syphilitic meningitis, for example. As far as I understand, Phillips does not say that it was one disease only, he says the lungs were diseased and the brain was also diseased.
Or is there comments from Phillips saying that it was tuberculosis? Or that Chapman would die from it in a short time perspective? Or is that something that has been assumed? Is there a general time table for the ailment, telling us that once the brain is diseased, there is only little time left?
These are questions that need answers, I feel.
As for the killer attempting to cut Chapmans head off, no, I don´t think it was a coincidence at all. I think we deal with one killer only in the Ripper and Thames Torso cases, and from Hebberts writings, we know that the Torso killer was not able to decapitate by way of knife only until in September of 1889, when he did so succesfully in the Pinchin Street case. In September of 1888, however, he had not aquired the ability yet, and so Chapmans head stayed on her spine.Comment
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Not SM.
Most people would assume TB at that time.
Really not interested in a circular argument.
Bye.Comment
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But even if people "would assume TB at that time", I don´t see how that rules out that it was something else? If syfilitic meningitis affects the membranes of the brain, then it corresponds equally well to Phillips´ description. And I assume that other diseases can also affect the membranes of the brain.
If Phillips did not say that it was tuberculosis that had moved on to the brain, then I do not see why we should assume it must have been, unless there is a definitive reason to do so.
If you find that circular, I must say that I find the claim "It was tuberculosis because it must have been tuberculosis" a lot more circular.
It seems to me that we must assume that Chapman was afflicted by a number of rare conditions if we want to try and overrule what Thiblin says: it is likelier that she died 3-4 hours before she was found than just the one hour.Comment
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Ironically some expensive pathology has found I have a very high Streptococcus anginosus infection.Comment
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