430 Cerebrospinal Meningitis 



Mode of Infection. It is not known by what channels 

 infection with Diplococcus intracellularis meningitidis takes 

 place. Weichselbaum 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 organisms 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,f 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 disease, and that of 

 another child with suspicious symptoms. 



Steel J has found what may be a variety of the meningo- 

 coccus 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 easily stained by methylene- 

 blue, but not by Gram's method. Another similar organism 

 has been described by Elser and Huntoon. 



Specific Therapy. Kolle and Wassermann|| carefully 

 studied antimeningococcus sera for specific opsonins, for 

 bacteriotropic substances, and for other evidences of favor- 

 able therapeutic action, but came to no definite conclusions. 

 Flexner and Jobling ** had better success both in developing 

 the experimental and practical knowledge of the serum. 

 The serum was prepared first with goats and then with 

 horses, the animals being injected with suspensions of the 

 meningococci. The serum is used by injecting it into the 

 spinal canal through a lumbar puncture. The precaution 

 must be taken to permit some of the fluid to escape first, and 

 then replace it by the antiserum, of which not more than 

 30 c.c. must be injected. Tabulations of the results follow- 

 ing the employment of Flexner 's serum show a large per- 

 centage of recoveries. 



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

 f "Klinisches Jahrbuch," xv, 1906. 

 t " Pediatrics, " Nov. 15, 1898. 

 "Journal of Medical Research," 1909, xx, 377. 

 || Loc. cit. 

 ** "Jour. Experimental Medicine," 1907, ix, p. 168, and 1908, x, p. 141. 



