1480 



COSMOPOLITAN FEVERS 



certain amount has been written with regard to the so-called pleomorphism 

 of the meningococcus — e.g., the papers in 191 5 by Lundie, Thomas, and 

 Fleming, and by Donaldson in the same year, while in 191 5 and 191 6 Hort, 

 Lakin, and Benians have doubted the causal action of the meningococcus, 

 and in the last publication Hort has stated : — 



' In order to discover the true infective agent, whether biologically related 

 to the meningococcus or not, further research is imperative, attention being 

 particularly directed to hltrable organisms in the naso-pharnyx and cerebro- 

 spinal fluid of acute cases.' 



With regard to the question of filtrable organisms, Chalmers and O'Farrell 

 have performed an experiment of this nature with a fresh cerebro-spinal fluid, 

 but the result was negative. 



With regard to the meningococcus being the causative factor in epidemic 

 cerebro-spinal meningitis, the above observations make it sufficiently clear 

 that it has been regularly found in the cerebro-spinal fluid of persons sufiering 

 from the disease, and that it has been found in the blood and also in the urine 

 when looked for at the correct time or in suitable infections. It is also generally 

 present in the naso-pharynx of the cases, and was found by Sophian, Westen- 

 hoffer, and others in such complications as arthritis, pyelitis, pneumonia, endo- 

 carditis, and in purulent conjunctivitis from a virulent case of the disease. 



Epidemiological studies easily convince anyone associated with the disease 

 that some contagion can at times pass from the sick to the healthy, causing 

 an attack of the disease, and, moreover, as we have pointed out above, many 

 of the contacts show the meningococcus. It is true that, as a rule, but few 

 attendants on cases acquire the disease, though there are marked exceptions. 



It is also true that the accidental infection by Kief er of his own nose with a 

 culture from the laboratory produced a severe rhinitis, but he did not develop 

 meningitis, and one of us accidentally infected his thumb from some cultures, 

 with the result that haemorrhagic granulation tissue formed from which the 

 germ was recovered, cultivated, and tested biochemically, and agreed with the 

 meningococcus in these details. Although the lymphatic glands enlarged 

 and a mild chronic fever lasting for months ensued, with almost constant 

 and sometimes very severe headache, no meningitic symptoms developed, 

 although the opsonic index varied from o-8 to 1*3, until meningococcal vaccine 

 therapy cured the condition. 



In the first case it is possible that the coccus never got into the system, and 

 in the second that it never entered the blood-stream, and hence the lack of 

 meningeal infection. 



Turning now from man to experiments upon animals, von Lingelsheim and 

 Leuchs, followed by Flexner in 1906, reported successful inoculations of 

 monkeys subdurally. They were followed in 1908 by M'Donald, but neither 

 he nor Davis in 1905, nor any of the above experimenters, were able to infect 

 animals by injections into the blood-stream, although M'Donald produced 

 an acute toxaemia by this method, nor were Kolle and Wassermann or Davis 

 able to reproduce the disease in the same animals via the nose. Elser and 

 Huntoon consider that the value of these experiments is questionable when the 

 peculiar affinity of the meningococcus for the leptomeninges is taken into 

 account. They point out that other organisms injected subdurally will cause 

 a meningitis, but no other common pathogenic organism shows a similar 

 selective action for the meninges of man. 



Further, it is to be remarked that Bettencourt and Fran9a and Kolle and 

 Wassermann were unable to infect monkeys even by means of subdural 

 injections, and this has happened to us both with fresh cerebro-spinal fluid 

 from which growths were subsequently obtained and with cultures, although 

 we have also had successes. 



Only Councilman, Mallory, and Wright have succeeded in infecting a goat 

 when dealing with the true meningococcus, and Vansteenberghe and Grysez 

 produced meningitis in rabbits and guinea-pigs, but it seems to us to be doubt- 

 ful whether they worked with a true meningococcus. 



We have been unable to peruse Flexner's original papers, but according to 

 Batten the general circulation became infected in his monkeys. 



