4o6 Cerebro-spinal Meningitis 



appearing in the sediment are lymphocytes, tuberculous meningitis 

 should be thought of and smears stained for tubercle bacilli, and 

 guinea-pigs inoculated. 



Considerable difficulty may be experienced in the identification 

 of the meningococcus when it is encountered in other locations, 

 especially the naso-pharynx, because of the presence of other Gram- 

 negative diplococci with which it may be confused. It is, however, 

 precisely under these conditions that its identification becomes of 

 the greatest importance when it becomes necessary to stamp out 

 an epidemic of the disease. 



Sanitation. Discovery and Treatment of Carriers. — Epidemics of 

 cerebro-spinal meningitis occur not infrequently in civil life, but 

 are much more common and more destructive in military life where 

 large numbers of young and susceptible individuals from many 

 different centers of population are suddenly brought together. 

 Under such circumstances a certain numiber of sporadic cases may 

 always be expected, and epidemic outbreaks feared. Although it is 

 the common experience of those that treat the disease that direct 

 transmission is rare, and some mystery still surrounds the exact . 

 mode of infection, the undoubted infectivity of the patients and the 

 probably infectivity of the "carriers" makes it incumbent upon the 

 sanitarian to isolate the former at once, and to discover and segre- 

 gate the latter. 



The first consideration in regard to the carriers must be bestowed 

 upon those that have been in contact with the patients. As, how- 

 ever, there seem to be sporadic carriers just as there are sporadic 

 cases, it may be necessary to go farther than merely to consider 

 the contacts, and even become necessary to examine entire military 

 organizations that the sporadic carriers may be found and segregated. 



I. The detection of carriers is accomplished by swabbing the 

 naso-pharynx, cultivating the secretions upon appropriate media 

 and identifying the meningococci. 



I. Swabbing. — West* has invented a simple apparatus for swabbing the naso- 

 pharynx that has met with favor at many hands. It consists of a glass tube 

 about 1 .5 cm. in diameter and 15 or 16 cm. long, bent at the end so as to have its 

 opening at right angles. Enclosed in this is a cotton swab attached to a wire. 

 The whole is sterilized by dry heat. When used, the tube is passed over the 

 tongue and into the pharynx and by pushing on the wire the swab is thrust out 

 into contact with the mucous membrane, twisted about and then drawn into the 

 tube again. For this purpose we prefer a slender stick six inches long, with a 

 pledget of cotton fastened to one slightly roughened end. Bundles of these, 

 tied up in paper are steriUzed by dry heat, ready for use at any time. Petri 

 dishes are prepared and into each is poured about 10 cc. of dextrose-blood-agar- 

 agar, which is permitted to congeal and then kept at the body temperature. 



The swab is passed into the nasal passage through the anterior nares, care 

 being taken not to touch the skin, and thrust back until it touches the posterior 

 pharyngeal wall, when it is withdrawn with a rapid rotary motion, gathering 

 up the naso-pharyngeal secretions upon the cotton. The Petri dish is cautiously 

 opened and the swab applied so as to draw a number of horizontal lines from side 

 to side, not too close together. The dish is then stood in an incubating oven for 

 12-18 hours when the colonies will have developed. 



*"Jour. Amer. Med. Asso.," Aug. 25, 1917, vol. Lxrx, p. 640. 



