THE MENINGOCOCCUS 69 



with the inoculating loop, they do not grow on plain agar. They will grow at times 

 on glycerine agar. The organism is very sensitive to light, cold and drying. It 

 ferments glucose and maltose but not lactose or saccharose and only grows at blood 

 temperature, thus distinguishing it from the M. catarrhalis which will not ferment 

 any of these sugars. It is scarcely pathogenic for laboratory animals, with the 

 exception of the mouse and guinea-pig, when intraperitoneal injections but not 

 subcutaneous ones give results. Intradural injections give results. The cultures 

 die out very rapidly, so that it is necessary to make transfers every one or two 

 days. The Meningococcus has been isolated from the nasal secretions of patients. 

 The possibility of these organisms being the M. catarrhalis must be considered. 

 Of the greatest importance is the examination of the naso-pharyngeal material 

 of those who have been in contact with a patient. These healthy carriers are im- 

 portant. To examine such people introduce a bent wire applicator with sterile 

 cotton tip past the soft palate so as to get material from the naso-pharynx. The 

 material should be immediately inoculated on blood or serum agar and quickly put 

 in the 37C. incubator. 



Flexner has shown that in monkeys, which are susceptible to the disease, in-^ 

 jections of cultures of M. intracellularis into the spinal canal is followed by migra- 

 tion of the cocci to the nasal cavity both free and in phagocytic leukocytes. 



The Meningococcus has a very slight resistance to sun or drying so 

 that its aerial transmission seems doubtful. It is supposed to effect an 

 entrance by the nares, thence reaching the cerebral meninges. Infec- 

 tion is probably by direct contagion. Several cases have been reported 

 where with a high leukocytosis the cocci have been found in the poly- 

 morphonuclears of blood smears and in cultures from the blood. (In 

 about 25% of blood cultures where from 5 to 10 c.c. are employed.) 



By the use of initial injections into horses of killed cultures followed by 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 

 patient's 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. 



As the result of extensive study of the relation of the Meningococcus to cerebro- 

 spinal fever in connection with epidemics in the European war zone many authorities 

 consider the causal relation of the organism to the disease as unproven. It is stated 

 that intraperitoneal injection of huge numbers of meningococci, cultivated in the 

 cerebrospinal fluid, failed to cause symptoms in monkeys while intraperitoneal 

 injection of a filtrate of fluid just removed from a patient caused symptoms in the 

 monkey similar to cerebrospinal fever. 



The history of hog cholera is cited by Hort and others to show that our long-stand- 

 ing views as to the~relstibnship of the hog cholera organism (B. aertryk] had to be 

 abandoned in favor of a filterable virus etiology, The possibility of a filterable 

 virus being the cause of cerebrospinal fever is suggested but the point is emphasized 



