MICROCOCCUS INTRACELLULARIS MENINGITIDIS 527 



from a slightly turbid serous fluid to that of a thick fibrinous exudate. 

 In chronic cases encephalitis and dilatation of the ventricles may take 

 place. Apart from their presence in the meninges and in the naso- 

 pharynx, meningococci have not been satisfactorily demonstrated in 

 any of the complicating lesions of the disease. Reports of their pres- 

 ence in the conjunctivas, in the bronchial secretions from broncho- or 

 lobar pneumonia, and in otitis media, have been reported but are 

 not very common. 



The occurrence of this microorganism in the circulating blood of 

 meningitis cases has been definitely proved by Elser, 36 who found it 

 in ten cases. 



In the discussions on epidemiology, below, we will see that Her- 

 rick and others claim that the meningococcus is probably, in the 

 majority of cases, in the blood before it reaches the meninges, making 

 its way to the central nervous system by way of the blood stream 

 rather than directly along the lymphatics at the base of the skull. 

 It seems fair to assume from blood culture evidence that this cer- 

 tainly happens in many cases even though it may not be the rule. 

 During epidemics, also, there are occasional cases in which a general 

 septicemia due to meningococci occurs, without ever giving rise to 

 symptoms pointing to meningeal involvement. These cases are 

 always violent in course, usually fatal and accompanied by a profuse 

 petechial rash. 



BACTERIOLOGICAL MANAGEMENT OF THE MENINGITIS 

 CASE AND SERUM TREATMENT 



In the light of our present knowledge of the bacteriology and 

 serum treatment of epidemic meningitis, a considerable responsibil- 

 ity rests with the bacteriologist. The difference between recovery 

 and death may depend directly upon the speed with which a bac- 

 teriological diagnosis is made and a proper management of the serum 

 treatment. When a case of suspicious fever in which slight stiffness 

 of the neck, and a developing Kernig sign is associated with the 

 other indications of an acute infection, the first step must consist of 

 lumbar puncture. 



A sterile lumbar puncture needle is thrust into the spinal canal, 

 a little to one side of the third or fourth lumbar space, and the fluid 



36 E Iscr, Jour. Med. Ees., xiv, 1906. 



