404 



Gerebro-spinal Meningitis 



Metabolic Products. — ^The meningococcus breaks up dextrose and 

 maltose with the production of acids, but has no similar action upon 

 levulose, saccharose, or inulin. Acid production is unaccompanied 

 by gas evolution. To determine the acid the coccus may be grown 

 upon acetic-fluid agar containing the sugar under examination, and 

 a Uttle litmus or neutral red. 



No indol is produced, no gelatin-softening, coagulating or other 

 ferments are formed. 



Elser and Huntoon ("Jour. Med. Research," xv, 1909) give the 

 following table showing the fermentative peculiarities of the 

 Gram-negative diplococci. 



The meningococcus produces an endotoxin. Albrech and Ghon* 

 were able to kill white mice with dead cultures. Lepierref obtained 

 a toxin from bouillon cultures by precipitating them with alcohol. 



Pathogenesis. — ^Flexnerf found that in large doses the coccus 

 was always capable of killing small guinea-pigs and mice when in- 

 jected intraperitoneally. To achieve this, however, the organisms 

 should be suspended in sheep-serum water, not in salt solution, 

 which is an active poison to them. . 



Bettencourt and Franca§ tried to infect monkeys by trephining, 

 by injecting into the spinal canal, and by rubbing the cocci upon 

 the nasal mucous membranes, but without success. Von Lingel- 

 sheim and Leuchs|| and Flexner** were more successful. Flexner's 

 method was to introduce a hypodermic needle into the spinal canal, 

 wait until a few drops of cerebro-spinal fluid had escaped, and then 

 inject the culture. When thus introduced at a low level of the spinal 

 canal, the diplococci distribute themselves through the meninges in 

 a few hours and excite an acute meningitis, the exudate of which 

 accumulates chiefly in the lower spinal meninges and the meninges 



* "Wiener klin. Wochenschrift," 1901. 

 t "Jour, de phys. at de path, g^n.," v. No. 3. 

 JLoc. cit. 



§ "Zeitschr. f. Hyg. u. Infekt.," xlvi, p. 463. 

 II "Klin. Jahrbuch," 1906, xv, p. 489. 

 **Loc. cit. 



