CHAPTER VII 

 CEREBRO-SPINAL MENINGITIS 



DiPLOCoccus Intracellularis Meningitidis (Weichselbaum) 



General Characteristics. — A minute non-motile, non-flagellate, non-sporog- 

 enous, non-chromogenic, non-liquefying, aerobic, pathogenic coccus, staining 

 by ordinary methods, but not by Gram's method. 



Acute cerebro-spinal meningitis may be secondary to various 

 more or less well-localized infections when it depends upon such 

 micro-organisms as may be carried by accident to the meninges. 

 Among these may be mentioned pneumococci, staphylococci, strep- 

 tococci, Bacillus influenzae, B. typhosus, B. coli, B. mallei, B. pestis 

 and others. 



In addition to these cases, however, there are numerous cases of 

 primary infection of the membranes, either sporadic or epidemic in 

 occurrence. Such constitute the disease known as cerebrospinal 

 fever, epidemic cerebro-spinal meningitis, or " spotted fever." It is a 

 very dangerous febrile malady, characterized by high temperature, 

 an irregular exanthem, early meningitis, a moderate degree of con- 

 tagion, and a high mortality. The cause of this infection is a 

 specific organism known as the meningococcus, or Diplococcus intra- 

 cellularis meningitidis. 



As early as 1887 Weichselbaum* carefully described a diplococcus 

 found in 6 cases of cerebro-spinal meningitis that may have been 

 identical with one found by Leichtensternf in 1885 in the purulent 

 exudate of a case of meningitis, and with a coccus observed as 

 early as 1884 by Celli and Marchiafava.J Weichselbaum's studies 

 and description of this coccus seem to have attracted but little 

 attention at first, and references to them are but brief in most of 

 the text-books. The prevailing opinion was that its occurrence in 

 cerebro-spinal meningitis was accidental, as inoculations into ani- 

 mals showed its pathogenic power to be very limited. The careful 

 studies of Jager,§ Scherer,|| Councilman, and Mallory and Wright** 

 (embracing 55 cases, in which the cocci were found by culture or 

 by microscopic examination in 38), and of Flatten, ff Schneider,tt 

 Rieger,tt Schmidt,tt G6ppert,ft Fliigge,tt von Lingelsheim,tt 



* " Fortschritte der Med.," x, 18 and 19. 



t "Deutsche med. Wochenschrift," 1885. 



% "Gazette degli Ospedali," 1884, viii. 



§ "Zeitschrift fiir Hygiene," xix, 2, 351. 



II "Centralbl. f. Bakt. u. Parasitenk.," 1895, xvii, 13 and 14. 

 ** "Amer. Jour. Med. Sci.," March, 1898, vol. cxv, No. s- 

 tt "Klinisches Jahrbuch," 1906. 

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