4o8 Cerebro-spinal Meningitis 



marked colonies are transplanted to tubes containing i cc. each of 

 a medium made as follows: 



To I per cent, glucose broth (made from veal infusion and having an acidity 

 of from 0.5-0.7+ phenolphthalein) is added s per cent, of unheated, sterile, 

 clean, normal horse-serum. The medium is then distributed in small tubes 

 (from 8-10 mm. in diameter, and 9 cm. in length), one cc. being placed in each 

 tube.' 



The tubes are then incubated for twelve hours at 37°C. Owing to 

 the presence of the normal horse-serum in the medium, Micrococcus 

 flavus, TVEicrococcus crassus, Micrococcus pharyngis siccus, and an 

 unclassified Gram-positive bacillus will show firm agglutinations. 

 As hemoglobin is absent, Bacillus influenzae fails to grow. Micro- 

 coccus catarrhalis grows with a derise turbidity and often shows a 

 pellicle on the surface. The meningococci on the other hand 

 grows in a characteristic manner. The fluid becomes slightly 

 turbid and a slight sediment forms which emulsifies uniformly 

 when the tube is shaken. The final test, however, must be made by 

 the agglutinating serum which is added as o.i cc. of a i : 10 dilution 

 of a high titre serum. The tubes are then stood in a water-bath 

 at 37-38°C. for two hours when the characteristic agglutinations 

 will appear. 



II. The treatment of the carriers is an equally important matter 

 sometimes fraught with difficulty as they are well and therefore 

 capable of performing the daily duties and anxious to do so. They 

 should, however, be carefully segregated, and their naso-pharynges 

 sprayed with some appropriate disinfecting solution several times 

 dailyjfor several days. Then, after an interval of a day when no 

 spraying is done, the nasal passages should be swabbed and meningo- 

 cocci sought for. Three negative examinations should suffice to 

 release them, but an occasional swabbing should be done to see that 

 they do not relapse into carriers again. 



Specific Therapy. — Kolle and Wassermann* carefully studied 

 antimeningococcus sera for specific opsonins, for bacterio tropic 

 substances, and for other evidences of favorable therapeutic action, 

 but came to no definite conclusions. Flexnerf and Jobling had 

 better success both in developing the experimental and practical 

 knowledge of the serum. The serum was prepared first with goats 

 and then with horses, the animals being injected with suspensions 

 of the meningococci. The serum is used by injecting it into the 

 spinal canal through a lumbar puncture. The precaution must 

 be taken to permit some of the fluid to escape first, and then re- 

 place it by the antiserum, of which not more than 30 cc. must be 

 injected. Several such injections should be made. Tabulations 

 of the results following the employment of Flexner's seruiii show a 

 large percentage of recoveries. 



* Loc. cit. 



t "Jour. Experimental Medicine," 1907^ rx, p. 168, and 1908, x, p. 141. 



