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Acute serous meningitis and seropurulent meningitis due to streptococci
:358
C o n d e m ~ a t i o n of T u b e r c u l o u s M e a t
tPubnorreaml
Riding things were carried out on a much more satisfactory basis. If the meat inspector--he mentioned his name also, but I need not - - h a d occasion to examine the carcass of a beast suspected, he would give instructions to the dressers of the same to make it look as well as possible, and he would examine it later on. Now, I believe this speaker was relating the truth, and not so much in a boastful manner did he mention this, but to show that what was good enough for the big place he mentioned should surely be equally satisfactory for us. The regulations laid down by the Local Government Board with regard to meat seizure are, to my thinking, sufficiently explicit, but in order to have proper supervision of all meat supplied to the public, private slaughter-houses should be abolished in all districts, urban or rural, and competent managers of the public slaughterhouses should be appointed--men who would not be afraid of doing their duty. But with any amendment of the Acts, unless all medical officers of health are agreed to work together on the same basis as to what they will seize and what they will pass for food, the changes would only be futile.
ACUTE SEROUS MENINGITIS AND SEROPURULENT MENINGITIS DUE TO STREPTOCOCCI. An instructive contribution to the pathogenesis of meningeal inflammations occurring in the course of acute diseases is made by Nob~court and Deles~tre (Annales de Mddecine et Ch#urgie Infantiles, April 15, 1900, p. 261). During an epidemic of bronchopneumonia in the service of Hutinel at the Hospice des EnfantsAssist~s two eases were observed, both terminating fatally, one of which presented the lesions of an acute serous cerebral meningitis, the other of a seropurulent cerebro-spinal meningitis, in both of which the same organism--a streptococcus--was found. The first case was an infant, aged twenty months, admitted for bronchopneumonia. Five days after admission meningeal symptoms appeared: rigidity of the neck, vomiting, Kernig's sign, strabismus, irregularity of the pulse and respiration, cerebral t£che, and moderate elevation of temperature. Sevenclays later a measles eruption appeared coincident wi~h au amehoration of the cerebral symptoms, but the pulmonary condition became aggravated, and death occurred on the following day. At the autopsy, in addition to the lesions of bronchopneumonia, there was observed a diffuse, oedematous congestion of the meninges of the convexity of the hemispheres, more marked posteriorly. The cerebro-spinal fluid was abundant, but clear and limpid, as was also that of the lateral ventricles. There was no solid exudate and no tubercles. The spinal meninges were unaffected. Cultures of the cerebrospinal fluid, obtained by lumbar puncture during life and also at the autopsy, showed the presence of a streptococcus (pure). A second case observed in a child, aged four years, who had presented meningitic symptoms for two days before death, showed at the
Feb~y,~90~
Acute Serous Meningitis
359
~utopsy the lesions of a seropurulent cerebro-spinal meningitis. The cranial meninges were distended by a cloudy, whitish fluid rich in leucocytes. Upon the convexities the meninges were infiltrated wi~h an opalescen~ exudate, especially marked about the sulci and fissures. The fluid of the lateral ventricles was abundant and cloudy. The spinal meninges at the lumbar enlargement contained cloudy fluid, and the posterior aspect of the cord at this point presented an opaline appearance. Bacteriological examination of the cerebro-spinal fluid from the lateral ventricles and from the lumbar portibn of the cord showed the presence in pure culture of a streptococcus analogous to that observed in the first case. The same organism, therefore, determined in one case a serous inflammation, in the other a seropurulent one. In discussing the reason for this difference of effect the authors think that a difference in the virulence of the germ in the two cases can scarcely be invoked, since in the seropurulent ease the organism was innocuous for animals ; neither could the duration of the disease be considered important, since the serous inflammation evoluted more slowly than the other. The hypothesis of a special resistance or a peculiar predisposition of the meninges alone remains, but these are factors which are not clearly understood: The organism presented some interesting peculiarities. I t grew poorly at first upon gelose, giving very minute punctiform colonies, resembling those of .the pneumococeus. After several removes it acquired the t~spical characteristics of a streptococcus, giving in liquid media a deposit formed of large clumps. Morphologically it had at first the form of a diplococcus; later there were long chains when cultivated in the blood-serum of the rabbit. The organism possessed no capsule taking stain. It was virulent for neither rabbits nor mice.
---American Jou~ma2 of Medicai Science. THREE
MICrO-ORGANISMS
OTHER
THAN
KLEBS-~OFFLER
WHICH
PRO-
oucE MEM~RANOVS ANGI~A.--Bissell (Buffalo Medical Journal, December, 1900 ) says ?~he Bureau of Bacteriology in the city of Buffalo has observed that Stre2tococcus 2yogenes and the mierocoecus of sputum septicmmia, which belong to the bacteria, and Oidium albieans, which belongs to the group of fungi, are each capable of producing a pseudomembranous inflammation, which microscopically cannot be differentiated from that produced by the Klebs-L6ffler bacillus. So far as observed in that city, the Oidium albicans has never caused a fatal angina; but at least one death has been caused by each of the other germs named, in both of which cases the antitoxin of diphtheria was used without appreciable effect. Several deaths from the Stre~toc~cus pyogenes have been reported in New York City, in which nothing but a bacteriologic examination could distinguish the infection from a true diphtheria. The author draws the following conclusions : 1. Streptococcus 2yogenes and the mierococeus of sputum septicmmia can produce membranous anginas, accompanied by physical disturbances sufficient to result in death. 2, Oidium atbicans produces pseudo-membranous exudates easily mistaken for the Klebs-LSi~er inflammation. 3. The only positive means of determining a Klebs-LSffler infection is by microscopic methods. 4. From the s a n i t a r y standpoint, as regards quarantine, anginas due to St.re2tococcus 2yoyenes, mierococcus of sputum septicmmia, and Oidium atbicc~ns require little consideration.-Phitadel2hic~ Medical Jou.rnal.
C o n d e m ~ a t i o n of T u b e r c u l o u s M e a t
tPubnorreaml
Riding things were carried out on a much more satisfactory basis. If the meat inspector--he mentioned his name also, but I need not - - h a d occasion to examine the carcass of a beast suspected, he would give instructions to the dressers of the same to make it look as well as possible, and he would examine it later on. Now, I believe this speaker was relating the truth, and not so much in a boastful manner did he mention this, but to show that what was good enough for the big place he mentioned should surely be equally satisfactory for us. The regulations laid down by the Local Government Board with regard to meat seizure are, to my thinking, sufficiently explicit, but in order to have proper supervision of all meat supplied to the public, private slaughter-houses should be abolished in all districts, urban or rural, and competent managers of the public slaughterhouses should be appointed--men who would not be afraid of doing their duty. But with any amendment of the Acts, unless all medical officers of health are agreed to work together on the same basis as to what they will seize and what they will pass for food, the changes would only be futile.
ACUTE SEROUS MENINGITIS AND SEROPURULENT MENINGITIS DUE TO STREPTOCOCCI. An instructive contribution to the pathogenesis of meningeal inflammations occurring in the course of acute diseases is made by Nob~court and Deles~tre (Annales de Mddecine et Ch#urgie Infantiles, April 15, 1900, p. 261). During an epidemic of bronchopneumonia in the service of Hutinel at the Hospice des EnfantsAssist~s two eases were observed, both terminating fatally, one of which presented the lesions of an acute serous cerebral meningitis, the other of a seropurulent cerebro-spinal meningitis, in both of which the same organism--a streptococcus--was found. The first case was an infant, aged twenty months, admitted for bronchopneumonia. Five days after admission meningeal symptoms appeared: rigidity of the neck, vomiting, Kernig's sign, strabismus, irregularity of the pulse and respiration, cerebral t£che, and moderate elevation of temperature. Sevenclays later a measles eruption appeared coincident wi~h au amehoration of the cerebral symptoms, but the pulmonary condition became aggravated, and death occurred on the following day. At the autopsy, in addition to the lesions of bronchopneumonia, there was observed a diffuse, oedematous congestion of the meninges of the convexity of the hemispheres, more marked posteriorly. The cerebro-spinal fluid was abundant, but clear and limpid, as was also that of the lateral ventricles. There was no solid exudate and no tubercles. The spinal meninges were unaffected. Cultures of the cerebrospinal fluid, obtained by lumbar puncture during life and also at the autopsy, showed the presence of a streptococcus (pure). A second case observed in a child, aged four years, who had presented meningitic symptoms for two days before death, showed at the
Feb~y,~90~
Acute Serous Meningitis
359
~utopsy the lesions of a seropurulent cerebro-spinal meningitis. The cranial meninges were distended by a cloudy, whitish fluid rich in leucocytes. Upon the convexities the meninges were infiltrated wi~h an opalescen~ exudate, especially marked about the sulci and fissures. The fluid of the lateral ventricles was abundant and cloudy. The spinal meninges at the lumbar enlargement contained cloudy fluid, and the posterior aspect of the cord at this point presented an opaline appearance. Bacteriological examination of the cerebro-spinal fluid from the lateral ventricles and from the lumbar portibn of the cord showed the presence in pure culture of a streptococcus analogous to that observed in the first case. The same organism, therefore, determined in one case a serous inflammation, in the other a seropurulent one. In discussing the reason for this difference of effect the authors think that a difference in the virulence of the germ in the two cases can scarcely be invoked, since in the seropurulent ease the organism was innocuous for animals ; neither could the duration of the disease be considered important, since the serous inflammation evoluted more slowly than the other. The hypothesis of a special resistance or a peculiar predisposition of the meninges alone remains, but these are factors which are not clearly understood: The organism presented some interesting peculiarities. I t grew poorly at first upon gelose, giving very minute punctiform colonies, resembling those of .the pneumococeus. After several removes it acquired the t~spical characteristics of a streptococcus, giving in liquid media a deposit formed of large clumps. Morphologically it had at first the form of a diplococcus; later there were long chains when cultivated in the blood-serum of the rabbit. The organism possessed no capsule taking stain. It was virulent for neither rabbits nor mice.
---American Jou~ma2 of Medicai Science. THREE
MICrO-ORGANISMS
OTHER
THAN
KLEBS-~OFFLER
WHICH
PRO-
oucE MEM~RANOVS ANGI~A.--Bissell (Buffalo Medical Journal, December, 1900 ) says ?~he Bureau of Bacteriology in the city of Buffalo has observed that Stre2tococcus 2yogenes and the mierocoecus of sputum septicmmia, which belong to the bacteria, and Oidium albieans, which belongs to the group of fungi, are each capable of producing a pseudomembranous inflammation, which microscopically cannot be differentiated from that produced by the Klebs-L6ffler bacillus. So far as observed in that city, the Oidium albicans has never caused a fatal angina; but at least one death has been caused by each of the other germs named, in both of which cases the antitoxin of diphtheria was used without appreciable effect. Several deaths from the Stre~toc~cus pyogenes have been reported in New York City, in which nothing but a bacteriologic examination could distinguish the infection from a true diphtheria. The author draws the following conclusions : 1. Streptococcus 2yogenes and the mierococeus of sputum septicmmia can produce membranous anginas, accompanied by physical disturbances sufficient to result in death. 2, Oidium atbicans produces pseudo-membranous exudates easily mistaken for the Klebs-LSi~er inflammation. 3. The only positive means of determining a Klebs-LSffler infection is by microscopic methods. 4. From the s a n i t a r y standpoint, as regards quarantine, anginas due to St.re2tococcus 2yoyenes, mierococcus of sputum septicmmia, and Oidium atbicc~ns require little consideration.-Phitadel2hic~ Medical Jou.rnal.