1478 



COSMOPOLITAN FEVERS 



positive diplococci, and in the same year Castellani described Weichselbaum's 

 organism in cases in Ceylon, and Dunn and Gordon reported upon an epidemic 

 simulating influenza in Hertford in which they obtained Micrococcus catar- 

 rhalis and forms resembling the meningococcus. It was during this investi- 

 gation that Gordon brought forward the carbohydrate tests as differential 

 agents for the meningococcus, a point which he further elaborated in 1907, 

 in which year Buchanan introduced a modification of Loeffler's blood serum 

 by adding neutral red in a proportion of i in 10,000, 



The outbreaks of cerebro-spinal meningitis in 1905 in Prussia and New 

 York produced excellent work, in the former by von Lingelsheim and by 

 KoUe and Wassermann with reference to the organism, which, together with 

 the labours of other collaborators, was published in one volume in 1906. In 

 this epidemic von Lingelsheim found the meningococci to be present in 23' 12 

 per cent, of the cases, but, as many of the samples came from a long distance, 

 it is interesting to note that he obtained 70-6 per cent, positive results from 

 examinations in the hospital near the laboratory and taken during the first 

 day of illness, and 66*6 per cent, in those taken from first to fifth day of the 

 illness, while he obtained 24'5 per cent, from sixth to tenth day, 11 '29 per 

 cent, from eleventh to twentieth day, and only 4'39 per cent, after the twenty- 

 first day. Thus in three weeks 90 per cent, of the cases were free from meningo- 

 cocci, but he found that 15 per cent, of the contacts became carriers. He 

 also gave an account of D. crassus and, with Leuchs, of experiments on animals 

 with the meningococcus. 



The American epidemic was investigated by Elser, Durham, Goodwin, and 

 ShoUy, and produced results similar to those of von Lingelsheim, and in the 

 same year Robertson-Milne reported upon cerebro-spinal meningitis as seen 

 in India. 



In this year Kutscher described a coccus in the naso-pharynx of carriers 

 which agreed mprphologically and culturally with the meningococcus, but 

 which could be differentiated by Castellani's absorption test, and Westen- 

 hoeffer stated that the primary focus of the disease was in the pharyngeal 

 tonsils, post-nasal region, and the nasal sinuses, in which in the early days of 

 the disease he reported that it caused an inflammation. In 1907 Taylor 

 investigated the opsonic index with a view to diagnosis. In 1909 Elser and 

 Huntoon named Kutscher's organism the Pseudo-meningococcus. At first it 

 was thought that organism was rare and had nothing to do with the disease, 

 but, when Gordon and Murray's researches mentioned below are considered, 

 it is obvious that it would agree with such of their groups as do not agglutinate 

 with and absorb intracellularis serum ; at the present it is only differentiated 

 from the strains with which Kutscher and Elser and Huntoon were working, 

 and may or may not be the same as Dopter's parameningococcus, which is 

 mentioned below. 



In 1908 von Lingelsheim gave the following differentiation of the organisms 

 found by him in the naso-pharynx of the contacts : — 



(1) Micrococcus catarrhalis. — Frequent; colonies, dry crumbling; when seen 

 under microscope granulated, generally with irregular borders. Attacks 

 neither grape-sugar, nor maltose, nor levulose. 



(2) Diplococcus flavus I. — Colonies on ascitic agar very similar to those of 

 meningococcus. Twenty-four hours' culture exhibits clear yellow pigment in 

 thick layer. 



(3) Diplococcus flavus II. — Colonies polymorphic, sometimes moist and 

 glistening, sometimes dry and wrinkled. Twenty-four hours' culture exhibits 

 yellow pigment in thick layer. 



{4) Diplococcus flavus III. — At commencement difficult to cultivate, and 

 therefore rarely coming under observation. All three species of flavus form 

 acids in the presence of grape-sugar, maltose, and levulose; whilst the meningo- 

 coccus ferments only grape-sugar and maltose, the latter regularly. 



(5) Diplococcus mucosus. — Colonies more prolific and juicy than those of 

 meningococcus. Grows also on gelatine at room temperature. According to 

 many authors, markedly pathogenic for mice. 



(6) Micrococcus cinereus. — Coarse, uneven granular. Colonies and cultures 



