388 Cerebro-spinal Meningitis 



differentiation between the meningococcus and Micrococcus catar- 

 rhali§ (q.v.), especially when such investigations are directed toward 

 discovering the former organism in the nasal discharges. This can- 

 not be done by microscopic examination, but must be achieved 

 through cultivation of the organisms and observation of the cultures. 

 Micrococcus catarrhalis grows well upon nearly all culture-media; 

 meningococci, very sparsely except upon special media. The 

 former organism grows fairly well at room -temperatures (2o°C. or 

 less); the latter, only at 25°C. and above. The colonies of the 

 former are coarsely granular; those of the latter, finely granular. 



Staining. — The organism is easily stained with the usual aqueous 

 solutions of the anilin dyes. It does not stain by Gram's method. 



For staining the meningococcus the method of Pick and Jacob- 

 sohn* is highly praised by Carl Frankel, who modifies it by adding 

 three times as much carbol-fuchsin as is recommended in the 

 original instructions, which are as follows: Mix 20 cc. of water 

 with 8 drops of saturated methylene-blue solution; then add 45 to 

 50 drops of carbol-fuchsin. Allow the fluid to act upon the cover- 

 glass for five minutes. The cocci alone are blue, all else red. 



Isolation. — The organism can be secured for cultivation either 

 from the purulent matter of the exudate found at autopsy, or from 

 the fluid obtained by lumbar puncture. To obtain this fluid 

 Parkf gives the following directions: "The patient should lie on 

 the right side with the knees drawn up and the left shoulder de- 

 pressed. The skin of the patient's back, the hands of the operator, 

 and the large antitoxin syringe should be sterile. The needle 

 should be 4 cm. in length, with a diameter of i mm. for children, 

 and larger for adults. The puncture is generally made between 

 the third and fourth lumbar vertebrae. The thumb of the left hand 

 is pressed between the spinous processes, and the point of the 

 needle is entered about i cm. to the right of the median line and 

 on a level with the thumb-nail, and directed slightly upward and 

 inward toward the median line. At a depth of 3 or 4 cm. in children 

 and 7 or 8 cm. in adults the needle enters the subarachnoid space, 

 and the fluids flow out in drops or in a stream. If the needle meets 

 a bony obstruction, withdraw and thrust again rather than make 

 lateral movements. Any blood obscures microscopic examination. 

 Adults, not too ill, may sit upon a chair or upon the edge of the bed 

 while the spinal puncture is made, as shown in Kolmer's illustration. 

 The fluid is allowed to drop into sterile test-tubes or vials with sterile 

 stoppers. From 5 to 15 cc. should be withdrawn. No ill effects 

 have been observed from the operation." 



In making a culture from this fluid Park points out that, as 

 many of its contained cocci are dead, a considerable quantity of the 

 fluid (say about i cc.) must be used. 



* "Berliner klin. Wochenschrift," 1896, 811. __ 



t "Bacteriology in Medicine and Surgery," Philadelphia, 1899, p. 364. 



