92 LOCALIZED INFECTIONS OF PUS NATURE 



whence it passes through the sieve-like bones through which 

 the olfactory nerves emerge from the skull. By this route 

 it penetrates to the under surface of the brain and extends 

 along the meninges. It can, however, invade the blood 

 stream first and later cause lesions of meningitis. 



The other agents of meningitis, the pneumococcus for 

 instance, usually gain entrance by way of the blood or lymph, 

 directly through the skull-base or by an extension from the 

 middle ear, where suppuration may burrow through the 

 bone. 



The meningitis coccus is found in the nose and throat of 

 patients, in the nose and throat of about 10 per cent, of their 

 attendants, and in a varying percentage of persons with 

 whom the cases come in contact. The last are called carriers 

 and are of considerable importance in epidemics because, 

 not being ill with the disease, they move about exposing 

 others when they cough or sneeze. It is the practice in epi- 

 demic times or in camps to make cultures from the nose and 

 throat of persons exposed to meningitis for the detection of 

 carriers, who are then segregated and treated by some anti- 

 septic like Dakin's solution; only when upon reculture they 

 are found free of the meningitis coccus are they allowed to 

 go about their usual business. 



The affection produces a thick, stringy, purulent exudate 

 in the spaces between the nervous system and their coverings, 

 the meninges, called the arachnoid space. This exudate 

 covers the brain and cord and fluid accompanying it dis- 

 tends the various cavities of the spinal column and interior 

 of the brain. The disease has a high mortality. It is much 

 more common among children and young people than in 

 those over thirty years of age. Its results or sequels consist 

 in blindness, deafness, and paralyses of various kinds. Men- 

 tality may be affected. 



In taking care of meningitis patients the chief concern is 

 with discharges from the nose and mouth. These cavities 

 should be cleansed with a mild antiseptic, say boric acid, 



