426 Cerebrospinal Meningitis 



Isolation. The organism can be secured for cultivation 

 either from the purulent matter of the exudate found at 

 autopsy, or from the fluid obtained by lumbar puncture. To 

 obtain this fluid Park * gives the following directions: " The 

 patient should lie on the right side with the knees drawn up 

 and the left shoulder depressed. The skin of the patient's 

 back, the hands of the operator, and the large antitoxin 

 syringe should be sterile. The needle should be 4 cm. in 

 length, with a diameter of i mm. for children, and larger for 

 adults. The puncture is generally made between the third 

 and fourth lumbar vertebrae. The thumb of the left hand 

 is pressed between the spinous processes, and the point of 

 the needle is entered about i cm. to the right of the median 

 line and on a level with the thumb-nail, and directed slightly 

 upward and inward toward the median line. At a depth of 

 3 or 4 cm. in children and 7 or 8 cm. in adults the needle 

 enters the subarachnoid space, and the fluids flow out in 

 drops or in a stream. If the needle meets a bony obstruc- 

 tion, withdraw and thrust again rather than make lateral 

 movements. Any blood obscures microscopic examination. 

 The fluid is allowed to drop into sterile test-tubes or vials 

 with sterile stoppers. From 5 to 15 c.c. should be with- 

 drawn. No ill effects have been observed from the opera- 

 tion." 



In making a culture from this fluid Park points out that, 

 as many of its contained cocci are dead, a considerable 

 quantity of the fluid (say about i c.c.) must be used. 



The cocci have also been cultivated from the nasal dis- 

 charges in the 6 cases studied by Weichselbaum and in 

 1 8 studied by Scherer. Elserf has isolated the organism 

 from the circulating blood of patients suffering from epi- 

 demic cerebrospinal fever. To determine the presence of 

 the coccus in the nasal discharges where other similar cocci 

 may be present, Gram's stain may be used and followed by 

 an aqueous solution of Bismarck-brown. The meningococci 

 will be brown. 



Cultivation. The organism was successfully cultivated 

 by Weichselbaum, but does not readily adapt itself to 

 artificial media. It develops upon agar-agar and glycerin 

 agar-agar, upon Loffler's blood-serum mixture, and, accord- 



* "Bacteriology in Medicine and Surgery," Philadelphia, 1899, 

 p. 364. 



t "Jour. Medical Research," 1906, xiv, 89. 



