////: M I:\I.\GOCOCCUS 



PRESENCE IN THE NASAL CAVITY OF THE SICK AND TIIK \Vi I.L. In 

 1 of his 6 cases Weichselbaum succeeded in obtaining in pure culture 

 diplococci from the nasal secretion. Scheurer, in his 18 cases, found 

 the diplococci in the nasal secretions of all of them during life. In 50 

 healthy individuals examined they were found in the nasal secretions 

 of only two, one being a man suffering at the time from a severe cold. 

 This man, it is interesting to note, had been engaged in disinfecting a 

 room which had previously been occupied by a patient with cerebro- 

 spinal meningitis. Lately, there has been a tendency to throw doubt 

 on these findings, but from our experience in the recent epidemic in 

 New York, one can state that the meningococci are usually present in 

 great numbers in the nose and nasopharynx in most cases of menin- 

 gitis dur'ng the first twelve days of illness. After the fourteenth day 

 they cannot usually be found. In one case Goodwin of our laboratory 

 obtained them on the sixty-seventh day. She also found them in five 

 persons out of sixty tested who had been in close contact with the sick, 

 and in two of fifty medical students. 



COMPLICATING INFECTIONS. Occasionally we find secondary to the 

 cerebrospinal meningitis, and due to the micrococcus, inflammations of 

 nasal cavities and their accessory sinuses, also catarrhal inflammations 

 of the middle ear, acute bronchitis, and pneumonia. The absolute 

 determination of the identity of the micrococcus found in these con- 

 ditions has not been established, so that the above complications can 

 only be considered as probably due to this organism. 



Except in cases of meningitis the micrococcus has been absolutely 

 identified only in cases of rhinitis. Several observers believe they have 

 found it in the diseases mentioned above as occasionally complicating 

 meningitis. 



MENINGOCOCCI IN THE BLOOD. Elser in forty cases examined 

 during the early days of the disease found them in ten. 



AGGLUTINATION CHARACTERISTICS. Meningococci are agglutinated 

 in dilutions of the blood serum of animals immunized to any true 

 culture. As a rule dilutions higher than 1 : 40 do not give reactions. 

 In the second and third weeks of disease, agglutination in 1 : 10 or 

 higher dilutions of serum may be obtained. 



SERUM TREATMENT. The use of specific or other sera has not 

 proven of value. 



Bacteriological Diagnosis. By means of lumbar puncture, fluid can 

 readily be obtained from the spinal canal without danger. The skin 

 must be thoroughly cleansed and the needle aseptic. The fluid should 

 be placed in a sterile conical glass to settle. The sediment should be 

 used to make smears to examine (1) for pus cells, (2) for tubercle 

 bacilli, and (3) for other organisms. By Gram's stain we are able to 

 separate the three Gram-positive organisms met with in meningitis 

 (pneumococcus, streptococcus, and staphylococcus) from the others. 

 Of importance also is the point that the micrococcus intracellularis 

 is usually inside the leukocytes in the form of diplococci of varying 

 size, of coffee-bean shape, or of tetracocci, while the pneumococcus is 



