300 THE MENINGOCOCCUS GONOCOCCUS GROUP 



Dissemination and Prophylaxis. The disease is usually more fre- 

 quent in children and young adults, usually in the winter and spring 

 months. Frequently a nasal inflammation is prevalent before the 

 disease begins to spread. The disease spreads by contact, as the organ- 

 isms die out rapidly away from the human body. Many cases do not 

 progress beyond the stage of nasal pharyngitis and sore throat, and 

 it is probable that these cases are potentially carriers. According 

 to Bruns and Hohn, 1 there may be from ten to twenty times as many 

 carriers as cases. The disease is very likely to occur in barracks and 

 boarding houses. Many people may be exposed to infection but 

 comparatively few acquire the disease, suggesting a rather high 

 natural resistance to the organism. The meningococcus may remain 

 for months in the nasal passages of carriers, although ordinarily 

 they remain less than a week. 



Ward attendants should be segregated and quarantined, and nasal 

 sprays used on the patients and attendants. It is quite probable that 

 infected handkerchiefs or inhalation of infectious droplets are impor- 

 tant in spreading the organism. It should be treated like any other 

 acute infectious disease of the respiratory tract. 



Parameningococcus. In a critical discussion of the treatment of 

 epidemic cerebrospinal meningitis with a specific antimeningococcus 

 serum, Flexner 2 had directed attention to a relatively small group of 

 cases which either failed to respond favorably to the serum, or reacted 

 for a short time and later failed to improve. The spinal fluid of these 

 cases contained organisms microscopically indistinguishable from 

 typical meningococci. It was assumed tentatively that there might 

 be two types of meningococcus, one of which was naturally "serum- 

 fast," the other acquired ''serum-fastness" during the coujrse of the 

 treatment with the serum. Dopter 3 has described an organism the 

 parameningococcus apparently identical with the typical meningo- 

 coccus in its morphological and cultural characteristics, but specifi- 

 cally different in its serological reactions. The parameningococcus, 

 like the meningococcus, has been isolated from the nasal and oral 

 cavities of man, and, in a few cases, from the blood stream and the 

 meninges as well. The clinical manifestations incited by the para- 

 meningococcus are indistinguishable from those of epidemic cerebro- 

 spinal meningitis, but they fail to respond favorably to the adminis- 

 tration of meningococcus serum. Dopter 4 has prepared a specific 



1 Loc. cit. 2 Jour. Exp. Med., 1913, xvii, 553. 



3 Compt. rend., Soc. de Biol., 1909, Ixvii, 74. 4 Semaine med., 1912, xxxii, 298. 



