39 2 Cerebrospinal Meningitis 



Flexner* found that in large doses the coccus was always capable 

 of killing small guinea-pigs and mice when injected intraperitoneally. 

 To achieve this, however, the organisms should be suspended in 

 sheep-serum water, not in salt solution, which is an active poison to 

 them. 



Bettencourt and Francaf tried to infect monkeys by trephining, 

 by injecting into the spinal canal, and by rubbing the cocci upon 

 the nasal mucous membranes, but without success. Von Lingel- 

 sheim and LeuchsJ and Flexner were more successful. Flexner's 

 method was to introduce a hypodermic needle into the spinal canal, 

 wait until a few drops of cerebro-spinal fluid had escaped, and then 

 inject the culture. When thus introduced at a low level of the spinal 

 canal, the diplococci distribute themselves through the meninges in 

 a few hours and excite an acute meningitis, the exudate of which 

 accumulates chiefly in the lower spinal meninges and the meninges 

 of the base of the brain. The inflammation extends, in monkeys, 

 into the membranes covering the olfactory lobes and along the 

 dura mater into the ethmoid plate and nasal mucosa. 



The nasal mucous membrane is found in many instances to be 

 inflamed and beset with hemorrhages. Smear preparations from 

 the nasal mucosa show many polymorphonuclear leukocytes con- 

 taining the cocci in a degenerated form. The cocci were not culti- 

 vated from the nasal exudates. 



Mode of Infection. It is not known by what channels infection 

 with Diplococcus intracellularis meningitidis takes place. Weich- 

 selbaum supposed it might enter by the nasal, auditory, or other 

 passages, especially the nose, where he constantly found it, and the 

 more recent studies of Goodwin and Sholly|| have shown the organ- 

 isms to be of frequent occurrence in the nasal cavities of meningitis 

 patients as well as occasionally in those associated with them. It 

 thus becomes evident that association with the diseased may lead 

 to the infection of the well, and that the cases should be isolated. 

 The same conclusions were reached by Kolle and Wassermann,** 

 who studied the nasal secretions of 112 healthy individuals, not 

 exposed to the disease, without finding any cocci, but found them 

 in the nasopharynx of the father of a child suffering from the dis- 

 ease, and that of another child with suspicious symptoms. 



Steel 1 1 has found what may be a variety of the meningococcus 

 in the simple posterior basic meningitis of infants. The organism 

 differs from that of Weichselbaum in having a greater longevity upon 

 culture-media, where it often lives as long as thirty days. It is 



* Loc. cit. 



t "Zeitschr. f. Hyg. u. Infekt.," XLVI, p. 463. 



j "Klin. Jahrbuch," 1906, xv, p. 489. 



Loc. cit. 



|| "Journal of Infectious Diseases," 1906, Supplement No. 2, p. 21. 



** "Klinisches Jahrbuch," xv, 1906. 



ft "Pediatrics," Nov. 15, 1898. 



