THE GONOCOCCUS GROUP 341 
valescent cases of cerebrospinal meningitis occasionally exhibit specific 
agglutinins for the meningococcus. Of 593 tests, von Lingelsheim 
found 24.1 per cent positive during the first five days fo the disease, 
56.7 per cent positive from the sixth to the tenth day. Normal sera 
did not agglutinate with the organism in dilutions greater than 1 to 
25; the sera of patients agglutinated in dilutions as high as 1 to 200. 
Elser and Huntoon have obtained agglutination in dilutions as high 
as 1 to 400. The diagnosis of meningitis by agglutination with the 
patient's serum is not satisfactory, even when an homologous strain 
of the organism is used in the test. 
The method of complement-fixation has not been entirely satisfactory 
in the diagnosis of cerebrospinal meningitis.^ 
Dissemination and Prophylaxis.— Epidemic cerebrospinal meningitis 
is exclusively a disease of the human species. In civil populations it 
is usually more freciuent in children and young adults, usually in the 
winter and spring months. Frequently a nasal inflammation is 
prevalent before the disease begins to spread. This may be caused 
by the meningococcus, although definite proof is as yet unavailable. 
The disease spreads by contact, and particularly by droplet infection, 
as the organisms die out rapidly away from the human body. Many 
cases do not progress beyond the stage of nasal pharyngitis and sore 
throat, and it is probable that these cases are potentially carriers. 
According to Bruns and Hohn,- there may be from ten to twenty 
times as many carriers as cases. The disease is very likely to occur 
in barracks and boarding houses. Many people may be exposed to 
infection but comparatively few acquire the disease, suggesting a rather 
high natural resistance to the organism. The meningococcus may 
remain for months in the nasal passages of carriers, although ordinarily 
they remain less than a week. 
Ward attendants in hospitals where cases of meningitis are being 
treated should be segregated and quarantined, and nasal sprays used 
on the patients and attendants. It is quite probable that kissing, the 
use of infected handkerchiefs or inhalation of infectious droplets are 
important in spreading the organism. It should be treated like any 
other acute infectious disease of the respiratory tract.^ 
THE GONOCOCCUS GROUP. 
Micrococcus Gonorrheas.— Synonyms.— Diplococcus gonorrhea^, gon- 
ococcus. 
Historical.— The gonococcus was first observed by Neisser^ in puru- 
lent urethral and vaginal discharges. Some years later Bumm^ grew 
' Von Lingelsheim: XIV Cong, for Demog. and Hyg., Berlin, September, 1907. 
2 Klin. Jahrb., 1908, 18, 285. 
' For a discussion of statistics and the control of epidemic cerebrospinal meningitis, 
see Frost (Public Health Reports, 1912, 27, 97). 
* Centralbl. f. d. med. Wlssensch., 1879, 17, 497. 
^ Die Mikroorganismen des gonorrhoischen Schleimhauterkrankungen, Gonococcus, 
Neisser, Wiesbaden, 1885. 
