Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 9 (7).djvu/16

 The resulting growth is washed off and emulsions prepared with saline, and, in order to inactivate the antolysin, are heated for half an hour at a temperature of (55° C. They are then standardised to a strength of 2,000 million [)er c.c. and 5 per cent, of phenol added; with the predominate types of meningococci of last year's epidemic, high titre agglutinating sera have been prepared. The emulsions are tested against these, and, if necessary, the result can be confirmed by the absorption of agglutinin.

Case 1. — Pte. X., Y Regt., came in from parade on Friday, December 13th, 1915, complaining that he felt queer and went to bed early. During the night he became delirious, was very violent, and vomited occasionally. He was transferred from his billet to Richmond Military Hospital at about 1 a.m., December 18th. Just before death, lumbar puncture was performed, and a turbid purulent fluid was drawn off.

Microscopically the fluid shewed masses of polymorphonuclear leucocvtes and numerous gram-negative cocci, both extra-cellular and a few intra-celinlar. Culturally the finid yielded an abundant growth of gram-negative cocci. An enuilsion was prepared and the coccus sub- mitted to the agglutination test. The organism proved to be a Type I. meningococcus, which result was subsequently confirmed by absorption.

Four contacts from the billet, three intimate friends of deceased and two R.A.M.C. orderlies from Richmond Military Hospital were swabbed. These were all found to be negative. From four swabs suspicious gram- negative cocci were obtained, which the agglutination shewed to be negative.

Case 2.— Driv. X., Y Regt., was sent to the Richmond Military Hospital on February 19th, 191(5, suffering from what was suspected to be acute rheumatism. He complained of severe pains in head and bottou) of back, accompanied by vomiting. On P'ebruary 22nd, cerebro- spinal fever was suspected and he was isolated. Lumbar puncture was performed and turbid cerebro-spinal fluid was removed. Microscopically the fluid shewed many polymorphonuclear leucocytes and both extra- and intra-cellular gram-negative cocci. On blood plates a growth of meningococcus was obtained, which was shewn by agglutination to be of Type II. See Table I. A coccus of the same type was isolated from his naso-pharynx.

After diagnosis the man was removed to Fulham Military Hospital,