M1CROCOCCUS INTRACELLULARIS MENINGITIDIS 545 



and found to be negative. A month later, he went to a military 

 hospital with the symptoms above enumerated, and the swab from 

 his nasopharynx revealed meningococcus, but curiously not of the 

 same type as that of the case with which he had been in contact. 

 He mentions other similar cases. 



An interesting point comes up in regard to whether or not the 

 presence of meningococcus in the nasopharynx leads, in itself, to a 

 catarrhal inflammation. Fliigge in the early days of meningococcus 

 carrier investigation believed that the carrier state was usually 

 associated with local inflammations. Gordon, however, finds that, 

 in general, there was no nasopharyngeal catarrh associated with the 

 carrier state. But he also finds that_ cases with tonsillar or pharyn- 

 geal inflammations were much more difficult to free from meningo- 

 coccus than others. The same he says is true of convalescents, a 

 point which indicates the importance of bringing the mucous mem- 

 branes to normal in connection with the cure of carriers. 



The question of how we are to deal with meningococcus carriers 

 in times of epidemic is a difficult one. Local treatment .of the nose 

 and throat has been tried with antimeningococcus serum, with 

 astringent solutions, and various disinfectants, without encouraging 

 result. Sprays of Dichloramine T and other chlorin preparations 

 have been tried, also, in our opinion, without marked success. Dur- 

 ing the war the British constructed rooms of about one thousand 

 cubic feet capacity, along the sides of which steam pipes were 

 placed at about the height of a man's waist, and jets were fitted 

 to them in such a way that a spray of steam could be ejected. These 

 sprays were connected with bottles containing 1 to 2 per cent 

 chloramine, or 0.5 per cent zinc sulphate. The carriers were put 

 into these inhaling rooms for from fifteen to twenty minutes a day, 

 during which they inhaled the medicated spray through their nos- 

 trils. By this method, they claimed to clear up all but the most 

 resistant cases of so-called pure meningococcus carriers. In general, 

 it may be said that cases in which only a few meningococcus colonies 

 form on the plates, clear up rather readily, and that the others 

 in which the cultures are almost pure are extremely resistant to any 

 kind of treatment. Our own impression from some experience with 

 the various methods would lead us to conclude that the best treat- 

 ment for a carrier would be careful attention to the nasopharynx, 

 with an attempt to bring it back to normal as far as the condition 

 of the mucous membrane is concerned, correction of tonsillar, adenoid, 



