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The Role of the Phagocyte in Cerebrospinal Meningitis. 

 By Ceesswell Sheaeeb, M.D., D.Sc., F.R.S., and H. Waebest Crowe, M.D., 

 Military Hospital, Devonport. 



(Received June 29, — Received in revised form October 11, 1916.) 



(For the Medical Research Committee.) 



[Plates 13 and 14.] 



The more or less constant presence of the meningococcus in the spinal 

 fluid of cases of cerebro-spinal fever, has led to many suggestions as to how 

 this microbe gains admission to the spinal canal. It has been assumed that 

 either there is a direct passage of the organism from the naso-pharynx to the 

 cerebral meninges, or that transmission takes place through the blood or 

 lymph channels. 



The membranes which enclose the spinal fluid, however, present a serious 

 obstacle to the passage of the microbe, and in fact it is doubtful if, in the 

 living tissues, such a passage could take place.* 



If passage by means of the blood stream or the lymph were easy, on the 

 other hand, we might expect to find meningitis a frequent complication of 

 streptococcal septicaemia — which is not the case.f 



Though the spinal meninges are probably impervious to the passage of free 

 meningococci, they certainly do not prevent the passage of leucocytes. 



Normal healthy spinal fluid contains a few wandering cells, mostly of the 

 lymphocyte variety. In cerebro-spinal fever the fluid is invariably crowded 

 with large numbers of polymorph leucocytes, which then frequently contain 

 many meningococci. In such cases we have often noticed that the microbes 

 within the leucocytes have undergone little change, and show no obvious 

 signs of degeneration or digestion. In staining reaction, moreover, they 

 show no appreciable difference from those lying without the phagocytes. 



* To obviate this difficulty it has been suggested that the meningococcus starts life as 

 a filterable virus, and that in this form it successfully enters the canal. In none of our 

 cases (with a Doulton filter) have we been able to obtain a filtrate that would give any 

 growth when planted out on chocolate medium. 



t No attempt has been made in the present paper to consider the question of the 

 infection of the meninges by way of the lymph channels. If this is brought about by 

 the flow of lymph from the nasal spaces through those surrounding the olfactory nerves 

 to the subdural and subarachnoid spaces of the cranium, then we have to assume a 

 peculiar susceptibility to infection on the part of the membranes surrounding these 

 spaces, by the meningococcus, or otherwise we should find meningitis a frequent com- 

 plication of the usual infections of the nose. 



