THE SERUM TREATMENT OF PNEUMOCOCCUS MENINGITIS 805 



shown, however, that mixtures of homologous antipneumococcus serum, 

 sodium oleate, and boric acid exert a marked and decided curative in- 

 fluence upon a virulent experimental meningitis, and while this method 

 has not thus far been generally applied in the treatment of the disease 

 in humans, it is deserving of trial and offers considerable encouragement 

 for an otherwise highly fatal infection. 



Pneumococcus Meningitis. This infection is usually secondary, 

 and follows on pneumonia or on inflammations of serous membranes by 

 indirect transmission by the blood or by direct infection from the naso- 

 pharynx, mastoid cells, frontal, sphenoid and ethmoid sinuses, and 

 internal ear. 



The diagnosis is usually made as the result of microscopic examination 

 of stained smears of cerebrospinal fluid removed by lumbar puncture. 

 Large numbers of polynuclear leukocytes with intracellular and extra- 

 cellular Gram-positive diplococci, occurring in pairs or in short chains, 

 usually indicate a pneumococcus infection. Whenever possible, the 

 diagnosis should be confirmed by making cultures of the fluid on dextrose 

 blood agar, and by injecting portions intraperitoneally and subcutane- 

 ously in mice. 



Pneumococcus infections of the cerebral meninges have been found 

 experimentally to be more refractory to treatment than infections of the 

 spinal meninges, hence human infections following injuries to the head, or 

 occurring as the result of direct extension from neighboring sinuses, are 

 likely to be more refractory than indirect infections by way of the blood. 



Serum Treatment. Numerous investigations by Conradi, 1 Korschun 

 and Morgenroth, 2 Levaditi, 3 and Noguchi 4 have shown that substances 

 may be obtained directly from tissue-cells and leukocytes or after auto- 

 lysis which are bactericidal and hemolytic, and, as shown by Noguchi, 

 are largely in the nature of higher saturated fatty acids or their alkaline 

 soaps. (For an account of their similarity to complements see Chapter 

 XVIII.) As shown by Klotz, 5 soaps occur in inflammatory foci, and the 

 origin of the fatty acids and soaps is readily accounted for since Achaline 6 

 has shown the presence of lipase in such foci. With the death of leuko- 

 cytes in an inflammatory focus, brought about by a bacterial poison, 

 leukocidins, or lack of nutriment, disintegration occurs, and by auto- 



1 Beit. z. chem. Phys. u. Path., 1902, i, 193. 



2 Berl. klin. Wochenschr., 1902, xxxix, 870. 



3 Ann. de 1'Inst. Pasteur, 1903, xvii, 187. 



4 Biochem. Zeitschr., 1907, vi, 327. 5 Jour. Exper. Med., 1905, vii, 633. 

 8 Compt. rend. Soc. de biol., 1899, li, 568. 



