PARASITES AND DISEASE (VEGETABLE PARASITES) 163 



in cities. Infection must depend upon a particular 

 susceptibility, as it is rare to have more than one case 

 in a home, and carriers are frequently found who, 

 though perfectly healthy themselves, carry the germs in 

 their throats or noses. It seems not to be contagious. 

 Heat, overexertion, squalor, and want appear to be pre- 

 disposing causes. Sporadic cases occur at all times. 

 Flexner has demonstrated by animal inoculations that 

 the meningococcus is the cause of the disease, and has 

 perfected a curative serum. 



Morbid Anatomy. The brain and cord show intense 

 congestion, accompanied in cases that have lasted a week 

 by a fibropurulent exudate most marked at the base of 

 the brain. Sometimes the entire cortex may be covered 

 with exudate. The cerebrospinal fluid is turbid and 

 contains the meningococcus. In chronic cases there may 

 be general thickening of the meninges. Petechia of the 

 skin may occur, giving to the disease the name spotted 

 fever. Other organs of the body are but slightly affected, 

 though pericarditis, pleurisy, and parotitis may occur. 



Morbid Physiology. Because of the location of the 

 infectious process in the brain and spinal cord the per- 

 version of function is widespread. There are chills, 

 fever, vomiting, headache, convulsions, and paralysis. 

 Mental disturbances, delirium, mania, stupor, or coma 

 may be present. Increased leukocytosis is a constant 

 and persistent condition. Cases which recover are usu- 

 ally mentally defective or suffer from various paralyses, 



