EPIDEMIC CEREBROSPINAL MENINGITIS. 123 



is placed on the left side, very much in the same position as is 

 used for intraspinal cocainization, the skin of the patient and 

 hands of the operator are thoroughly sterilized, and an ordi- 

 nary antitoxin-serum needle is introduced into the spinal 

 canal, between the second and third lumbar vertebrae, the skin 

 being pierced a little to the right of the spinous process. The 

 needle is driven in for 4 cm. in a child, and 7 to 8 cm. in an 

 adult, until the spinal canal is reached, when the spinal fluid 

 is allowed to drop into a clean sterilized test-tube. From 5 

 to 15 c.c. of fluid are generally taken for examination. Cover- 

 glasses are prepared and a number of cultures are made. 

 This puncture seems to be followed by no ill effect. In a few 

 isolated cases the organism has been found in the blood of 

 meningitic cases. 



Biologic Characters. This coccus is aerobic and is a faculta- 

 tive saprophyte, non-motile, has no flagella, and grows on all 

 culture-media, but rather irregularly, thriving best on ordi- 

 nary or Loeffler's blood-serum. The organism has a low vital- 

 ity ; exposure in the dry state for twenty-four hours to direct 

 sunlight at the body temperature, 37 C., is sufficient to kill 

 it. At the room temperature it is killed in seventy-two hours 

 when dried. In inoculating cultures from the exudate of 

 patients, a large quantity of exudate must be used and a num- 

 ber of tubes inoculated, as otherwise no growth may be ob- 

 tained. It seems to grow best when the exudate taken comes 

 from a recent acute case. It does not cloud bouillon, but causes 

 a scanty deposit on the side and at the bottom of the fluid. 



On glycerin-agar and blood-serum it grows as transparent, 

 shiny colonies. It does not liquefy gelatin nor does it grow 

 on potato. It grows only at the temperature of the body, 

 37 C., in two or three days. Cultures of this bacillus live 

 only for five or six days, so that it is necessary to transplant 

 them every third or fourth day. 



Pathogenesis. It can not be inoculated into animals by the 

 ordinary methods used, but intrameningeal injections, either 

 spinal or under the cerebral dura, produce a characteristic 

 meningitis and fibrinous exudatr, the bacteria invading at 

 times the lungs, but never being found in the blood. 



