302 BACTERIOLOGY. 



tiou of the vessels of the cerebral meninges, accompanied 

 by an exudation composed principally of pus-cells. 

 There was very little fibrin and only small numbers of 

 diplococci in the pus-cells. The purulent infiltration 

 extended along the vessels into the cerebral cortex. 

 The morbid condition was less marked in the cord than 

 in the brain. The diplococci were recovered in pure 

 culture from both cord and brain. 



While the portal of entry for this organism to the 

 system is not known, it is still of importance to note 

 that it often makes its exit from the body by way of the 

 organs that are secondarily involved, and that open to 

 without, as the ear, nose, eye, and lungs. 



It is of equal importance to note that the organism is 

 of very low power of resistance, being destroyed in 

 twenty-four hours by direct sunlight and by dr3'ing at 

 body-temperature, and in seventy-two hours by drying 

 in the dark at ordinary room-temperature. 



For the diagnosis during life of epidemic cerebrospinal 

 meningitis by bacteriological methods it is desirable that 

 the meningeal fluid be obtained during the most acute 

 stage of the disease. This is best done by the operation 

 of lumbar puncture, a description of which, as given by 

 Mallory and Wright, is as follows : 



" The operation and the subsequent examination of 

 the fluid should be as carefully performed as any other 

 bacteriological investigation, in order to obtain accurate 

 results. The back of the patient and the operator's 

 hands should be made sterile. The needle shotild be 

 boiled for ten minutes. The patient should lie on the 

 right side, with the knees drawn up, and with the 

 uppermost shoulder so depressed as to present the 

 spinal columu to the operator. This position permits 



