The outbreak of meningitis, at Amherst College, on March 13, 1995, was abrupt and frightening. Twelve hours after the illness was first identified on campus, one student was dying and another was deathly ill in intensive care at the local hospital. The latter would ultimately live and return to school to function normally.

Intensive questioning of the two students and their contacts led to the conclusion that the germ, meningoccus, had been spread at a drinking party two nights before, where the two students probably shared drinking cups with someone who was a carrier. The disease can be spread through activities such as kissing and sharing drinks or eating utensils. There has been some data to suggest that alcohol consumption makes transmission more likely.

The first student who developed meningitis came to Health Services in the morning complaining of discomfort. Later, the student's condition worsened, with deep breathing, vomiting, severe headaches, muscle aches and loose bowel movements. On initial examination, all I noticed were symptoms that might have been the result of a hangover or flu-like illness, but due to the combination of disabling symptoms and ill appearance, the student was admitted to the hospital for observation and given intravenous fluids. In the University of Massachusetts Health Service hospital, the student's symptoms became more typical of meningitis; the headache was not relieved with analgesics. Six hours later, the fever became high and the neck became stiff. Family members were notified of the severity of the illness, and the student was immediately transferred to Cooley Dickinson Hospital for more intensive care. Intravenous antibiotic treatment began in the Emergency Department and a diagnosis of meningococcal meningitis was confirmed. Treatment continued in the Intensive Care Unit, and following relatively quick improvement, the student was discharged from the hospital in less than a week.

Meanwhile, less than six hours after the first student had been admitted, a second student was brought to Cooley Dickinson Hospital. Despite intensive care, within hours that night, the student succumbed. The rapid spread of germs through the bloodstream had caused several vital body organs to become infected, making the disease overwhelming and causing rapid death.

News of the fatality and severe illness spread rapidly, and by the next morning, students and staff of Amherst College were generally disabled with grief and worry over further contagion. Because the two students lived in different housing areas, and had contacts in the campus day-care and on an athletic team, a large population felt it was at risk for exposure and possible infection.

The Health Services department on campus mobilized extra staff from the University Heath Center to assist in the collection and dispensing of information and prophylactic medicine. Various possible means of infection were evaluated, and all reasonably close contacts of the students were advised to come in for prophylactic medicine within two or three days. There was a sense of urgency and fear, especially among the students who were known to have had contact with the infected students.

Since students would soon be leaving for spring break, and the incubation period for meningitis is up to 10 days, authorities recommended that all students who had even slight exposure to the infected students be administered medicine, rather than spread the germ more widely or develop sickness far away. Potentially exposed students were encouraged to participate in discussion groups led by a medical practitioner so they could decide whether or not to take the medicine offered. The entire campus was grieving the loss of a classmate and friend, and worrying that they might also become infected and succumb to the disease. Stress levels were high amongst the student body, the involved staff and others in the Five College community. Perhaps more medicine was dispensed than necessary (1,297 doses), but Health Center staff members decided to err on the side of caution rather than on the side of economy.

I do not know how many classes were canceled or how many spring break plans were changed that week, but the Health Center had never experienced such a time of business and concern. It was the only time in memory that the campus Health Center was staffed all night to provide medical, mental health and health education services. The campus community, students and staff, were brought together in a special way, but the price was terribly high. Everyone was relieved, after spring break, that no futher cases of the disease had developed. Soon classes - and life - returned to normal.

Daniel E. Clapp, M.D. is currently the Director of Health Services at the Amherst College Student Health Center.