298 THE MENINGOCOCCUSGONOCOCCUS GROUP 



Similar results have been obtained in Germany with Wassermann's 

 serum. 1 Later observations by Flexner 2 confirm these results. The 

 mortality has been reduced from about 70 per cent, to about 20 to 

 25 per cent. 



Bacteriological Diagnosis. (a) Morphological. The demonstration of 

 Gram-negative, biscuit-shaped diplococci in purulent spinal fluid from 

 patients exhibiting the characteristic clinical symptoms is sufficient 

 to establish a diagnosis of the meningococcus. It is to be remem- 

 bered that the spinal fluid is clear for the first twenty-four hours of 

 the disease, and usually clear after the tenth day to the fourteenth 

 day even in untreated cases. Centrifugalization in sterile tubes must 

 be resorted to in such cases; the sediment is examined as above. 

 Smears from the nasopharynx, from middle-ear infections, and from 

 suspected carriers can not be definitely diagnosed upon morphological 

 characters alone. Cultural characteristics must be studied as well. 



Cultural Characters. Spinal fluid removed aseptically (and cen- 

 trifugalized if the fluid is clear) and material from the nasopharynx, 

 nasal cavity, or accessory nasal sinuses 3 is spread upon Loffler's 

 blood serum and incubated at 37 C. After twenty-four to forty-eight 

 hours' incubation, small, clear, round colonies develop in the majority 

 of cases in which meningococci are present. These should be trans- 

 ferred to ascitic broth (preferably containing 1 per cent, of dextrose 

 and a small piece of calcium carbonate) and examined after twenty- 

 four hours' incubation at body temperature. If growth occurs, inocu- 

 lation should be made in ascitic fluid dextrose and ascitic fluid maltose 

 broths to determine if acid is produced. Several diplococci have been 

 found which resemble the meningococcus microscopically but which 

 differ from it in their fermentation reactions. A negative result does 

 not exclude the possibility of an infection with the meningococcus; 

 negative cultures occur quite frequently. Von Lingelsheim 4 and Elser 

 and Huntoon 5 have studied these organisms carefully and give the 

 following differential table : 



1 Wassermann, Deut. med. Wchnschr., 1907, 1585; Wassermann and Leuchs, Klin. 

 Jahrb., 1908, xix, Heft 3. 



2 Jour. Am. Med. Assn., 1909, liii, 1443. 



3 Material for examination from the nasopharynx is best obtained upon sterile swabs; 

 the infected swab should be immediately rubbed over the surface of a series of blood 

 serum tubes or ascitic agar plates. This method is particularly adapted for the exami- 

 nation of suspected carriers. 



4 Klin. Jahrb., 1906, xv, Heft 2. 



6 Jour. Med. Research, 1909, xx, 377. 



