MENINGOCOCCUS. 51 



reported where with a high leukocytosis the cocci have been found in 

 the polymorphonuclears of blood smears and in cultures from the 

 blood. 



By the use of alternate injections into horses of living diplococci, 

 then seven days later of an autolysate made from different strains; 

 seven days later again injecting living diplococci; thus alternating 

 material every week, an antiserum of value has been obtained by 

 Flexner. The immunization requires about one year. In using, 

 withdraw about 20 c.c. of cerebrospinal fluid with a syringe, and then 

 inject, through the same needle, an equal quantity of the serum. 

 The injection is repeated every day for three or four days. 



For diagnosis, make smears and cultures from cerebrospinal fluid. 

 The sediment from the centrifuged material gives better results. In 

 tuberculosis the lymphocytes preponderate ; in cerebrospinal meningitis 

 the polymorphonuclears. 



It has been stated that a point of difference between the phagocyto- 

 sis with the gonococci and the meningococci is that the meningococci 

 invade and at times destroy the nucleus of the polymorphonuclear, 

 which is not true of gonococci. The appearance of large phagocytic 

 endothelial cells, often containing polymorphonuclears, in the centri- 

 fuged cerebrospinal fluid is a favorable prognostic sign. At times 

 there does not appear to be any relation between the number of pha- 

 gocytic polymorphonuclears and the severity of the case. 



Micrococcus Catarrhalis (Seifert, 1890). This organism has 

 been specially studied by Lord. It resembles the meningococcus 

 strikingly and can only be differentiated by cultural procedure. It 

 grows on plain agar and at room temperature, and does not produce 

 acid in glucose media. It not only occurs in the nasal secretions of 

 healthy people, but appears to be responsible for certain coryzas 

 resembling influenza. It also is responsible for certain epidemics of 

 conjunctivitis. The colonies are larger, more opaque and have a 

 more irregular wavy border than the round colonies of the meningo- 

 coccus. 



Micrococcus Melitensis (Bruce, 1887). This is the organism 

 of Malta or Mediterranean fever, sometimes called undulating fever, 

 on account of successive waves of pyrexia running over several months. 



