COCCACE.E AND THEIR PARASITIC RELATIONSHIPS 255 



on ordinary media, but its cells disintegrate rapidly in the colony, 

 which is viscid. In nearly every respect it resembles very closely 

 the gonococcus. 



Intraperitoneal inoculation of white mice and of guinea-pigs 

 usually results in fatal peritonitis and the organism can be recov- 

 ered from the heart's blood. Intraspinal inoculation of monkeys 

 with large doses causes typical meningitis with symptoms similar 

 to those of the disease in man. In man the disease is undoubtedly 

 transmitted very largely by coccus-carriers, healthy people or 

 people with slight pharyngitis or rhinitis, who carry the virus 

 on their mucous membranes and distribute it. 



Antimeningococcus serum is prepared by immunizing horses 

 with a mixture of many typical and atypical meningococcus 

 cultures injected subcutaneously. At first the cultures are 

 killed by heat before injection, and only one or two loopfuls are 

 given. The dose is increased and repeated every 8 to 10 days 

 until the growth on two Petri dishes is being injected. Living 

 cultures are then given, and finally old cultures which have 

 disintegrated are also used. The serum is used after the horse 

 has been treated for 8 to 10 months. Jochmann showed that 

 the subcutaneous injection of the serum is without effect upon 

 meningitis in monkeys but that when introduced into the spinal 

 canal is specifically curative. Flexner 1 and his co-workers 

 have studied this very fully and there can no longer be any ques- 

 tion of the value of the serum in the treatment of meningococcus 

 meningitis. 



Cerebrospinal fluid is obtained by Quincke's puncture. For 

 children a needle 4 cm. long and with a lumen of i mm. is intro- 

 duced near the median line upward and forward so as to enter 

 the spinal canal between the second and third or the third and 

 fourth lumbar vertebrae. From 20 to 50 c.c. of fluid may be with- 

 drawn if it comes away under pressure, and then the curative serum 

 is injected through the same needle. The fluid withdrawn should 

 be examined to establish the presence of meningitis and its 



Flexner: Harbin lectures. Journ. State Medicine, 1912, Vol. XX, pp. 257-270. 



