Cerebro-Spinal Fever and Meningococci Infection

THIS contribution consists in a review of work done during the severe epidemic of cerebro-spinal meningitis which occurred in Belfast during 1907 and 1908, together with some additional observations that have been made in France during the Great War and also during the present year in Belfast. During 1907 and 1908 we devised an application of Sir A. E. Wright's opsonic technique for the laboratory diagnosis of this infection. We found that this technique was not difficult and gave positive results in several hundreds of cases of the disease examined during the epidemic. By means of this test, a number of cases of meningitis not due to the meningococcus could be definitely excluded, and these negative findings were confirmed in a number of instances by post-mortem examination. Sera obtained from cases infected with other microorganisms or sera from normal individuals never gave this reaction. One of us, while in France during the Great War, further tested the accuracy of this method, and again during the present epidemic in Belfast has reapplied this test to the diagnosis of the disease and to determine the type of the infecting meningococcus. The points of interest in this serological test are-(1) Its great value in the diagnosis of meningococcal infection-the first place in diagnosis must of course be given to the isolation of the meningococcus from the cerebro-spinal fluid or the blood, but in a number of cases such examinations may fail to give positive results, and again in so-called meningococcal septica?mia without meningitis blood-culture may be negative. (2) The reaction to be described occurs in cases treated with Sulphapyridine, and as this reaction is no doubt a reaction of immunity, its presence in such treated cases seems to support the view of Fleming and others that the action of such drugs is bacteriostatic and that the defences of the tissues are also necessary for the cure of the disease. (3) This method has only differentiated two types of meningococcus, and has not confirmed Gordon's classification into four types.