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Menincococcus Meningitis

coccus, disease, purulent, epidemic, cerebrospinal, view and intracellularis

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MENINCOCOCCUS MENINGITIS (So-called epidemic cerebrospinal meningitis) The propriety of describing this disease as a special form of purulent or seropurulent meningitis, a distinction which we have not made with regard to coli, influenza or any other purulent meningitis is primarily based upon clinical observation. If the typical cases, in which a careful bacteriological examination has been made, are selected, and all atypical cases, whose relation to this class is doubtful, are for the time being, excluded, it appears that we have to deal with a specific disease, of which the meningoeoccus intracellularis is the definite cause. Knowing this, we are then in a position to sift the atypical eases and to gather them into the confines of this disease.

This view, however, has not yet been generally accepted and is opposed to another, according to which etiologically different cases of primary meningitis, with a protracted and at times favorable course and with a tendency to appear epidemically-, are considered together under the designation "sporadic and epidemic" cerebrospinal menin gitis. The latter view is supported especially by A. Frankel, von Leyden and Goldscheider and others: we, however, think it proper to follow the former, which is defended especially by Jager, Heubner and others.

Etiology.—The disease germ to which we ascribe this important role, was discovered by Weichselbaum (ISS1') at six autopsies on cases of cerebrospinal meningitiffis. To distinguish it from Frankel's diplo coccus pneumonim, he named it diplococcus intracellularis meningitis. The special diagnostic features were the following:— 1. The cocci occurred free in the purulent fluid of the diseased meninges, but preponderated within the pus eells. Here they were often found in considerable number and in a form strikingly resembling the gonococcus.

2. The cocci are always arranged in pairs, but in such a manner that the sides are juxtaposed (not the ends as is the case with diplo coccus pneumonite). Often four lie together. Among the approxi mately even sized pairs, some decidedly larger ones appear.

3. The coccus grows only at body heat, best on agar, not well on blood serum, not on potato. The cultures form rather luxuriant, gray,

viscid eolonies.

These important observations of Weiehselbaum attracted little attention (as in the case of Bordone-Uffreduzzi) and their validity was denied until in 1895, Jager reported the same bacteriologic discovery in ten fatal cases in an epidemic which occurred in a barrack; and unreservedly affirmed Weichselbaum's diplococcus as the specific virus of epidemic cerebrospinal meningitis.

Heubner's researches caused a further important advance in this direction, since he first discovered intra vitam by lumbar puncture (in five children) the Weichselbaum meningococeus, which he designated intracellularis; and he succeeded by injections into the spinal canal of a goat in demonstrating its ability to cause a purulent meningitis.

Since then the Weichselbaum-Jager-Heubner meningococcus has been the subject of numerous special investigations, partly concerning its clinical, partly- its bacteriologic aspect, which we have no occasion to follow here. It should only be noted that exact study shows eertain differences between the diplococeus described by Weiehselbaum and the diplocoeeus which Hcubner isolated and employed in his experiment on the goat. The chief of these is that the coccus of Weiehselbauin is said always to be decolorized by, while Heubner's coccus retains, the Gram stain. Recently, however, lleubner demonstrated that the meningococci obtained from the same patient may behave differently toward the. Gram stain at different stages of the disease, and that all other differences relating to the manner and luxuriance of growth, etc., which Albrecht and Ghon have emphasized, are inconstant or unimpor tant. In opposition to the effort to divide the meningococcus into two distinct types, viz.: Weichselbaum's and Jager-Heubner's the view of Bordone-I'ffreduzzi, until recently supported also by Concetti, Sor gente and others, may be briefly referred to, according to which the meningococeus only represents one variety out of the group of the pneumococci.

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