400 Cerebro-spinai Meningitis 



stain badly and do not grow when the pus is transferred to culture- 

 media. It has recently been claimed by Hort* that we are mistaken 

 in regarding the meningococcus as an organism belonging to the 

 coccaceas. His observations lead him to believe that it is not a 

 bacterium at all, but one of the ascomycetes. Certain large organ- 

 isms in the cultures, to which he applies the term "giant meningo- 

 cocci" are the fully developed organisms, the meningococci as usu- 

 ally observed, being regarded by him ascospores of the higher 

 organism. 



Identification. — ^There should be no difficulty in identifying the 

 organism under what may be spoken of as normal conditions. Thus, 

 a Gram-negative diplococcus inclosed in the polymorphonuclear leu- 

 kocytes of a cloudy fluid drawn from the spinal canal of a case of 

 suspected cerebrospinal fever, can scarcely be anything else, and is 

 sufficient not only to make certain that the organism is the menin- 

 gococcus, but also that the patient is suffering from the disease. 



The difficulty arises when the micro-organisms are to be iden- 

 tified under abnormal conditions, as, for example, when a search 

 is being made for "meningococcus carriers" by an examination of 

 the nasal secretions. Should nasal or pharyngeal mucus from an 

 apparently normal man be found to contain Gram-negative diplococci, 

 the question at once arises whether these may not be Micrococcus 

 catarrhalis. Micrococcus flavus, Diplococcus pharyngis siccus 

 or some other similar but comparatively harmless organism. This 

 question cannot be settled by microscopic examination alone, but 

 must be achieved through cultivation and specific serum agglutination 

 of the organisms. 



Staining. — The organism is stained with the usual aqueous 

 solutions of the anilin dyes. The effect of 'staining is not, however, 

 always uniform. Some may stain uniformly and intensely, others 

 unequally and palely, some may not stain at all. Large cocci 

 usually show the greatest irregularity. It is supposed that the young 

 actively growing cocci stain well, the old dying cocci, irregularly 

 or not at all. It does not stain by Gram's method. 



For staining the meningococcus the method of Pick and Jacob- 

 sohnf was highly praised by Carl Frankel, who modified it by adding 

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

 original instructions, which were 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. Car- 

 bol-thionin also stains meningococci well. 



Isolation. — The organism can be secured for cultivation either 

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

 the fluid obtained during life by lumbar puncture. To obtain this 



* "Brit. Med. Jour.," 1917, 11, p. 377. 



t "Berliner klin. Wochenschrift," 1896, 811. 



