MENINGITIS. 



559 



examination of the cerebrospinal fluid which is 

 removed by lumbar puncture. 



Acute encephalitis, acute bronchitis, lobar pneu- 

 monia and acute arthritis have been observed as 

 complications, in which organisms resembling the 

 meningococcus have been found in a number of 

 instances. An accompanying bronchitis, lobar or 

 lobular pneumonia may be caused by mixed infec- 

 tion with other organisms (pneumococcus, strepto- 

 coccus, staphylococcus). Since it would be diffi- 

 cult to explain some of these complications except 

 on the basis of metastasis, it seems very probable 

 that the organism reaches the blood stream. Micro- 

 cocci resembling the meningococcus have been 

 found in acute bronchitis, rhinitis, lobular pneu- 

 monia and conjunctivitis, in the absence of cere- 

 bral involvement, and it is possible that it may be 

 the cause of independent inflammations in these 

 tissues. Weichselbaum, however, is inclined to 

 doubt the identity of such organisms with the 

 meningococcus. Particularly in cases of bronchi- 

 tis and lobular pneumonia the coccus may be con- 

 fused with the Micrococcus catarrhalis of Pfeiffer, 

 with which it is identical morphologically. 



The extent to which the meningococcus is a 

 normal inhabitant of the nasal mucous membrane 

 is unknown. 



Since the organism seems to be excreted chiefly 

 or only with the nasal discharges, the latter prob- 

 ably are important for transmission of the infec- 

 tion. Because of the low resistance of the organ- 

 ism to desiccation and light, transmission prob- 

 ably is a fairly direct one. This is suggested also 

 by the occasional occurrence of epidemics in insti- 

 tutions. Contagiousness is of a rather low order; 



Complica- 

 tions and 

 Other 

 Infections. 



Transmission 

 and Coii- 

 tagiousness. 



