DEAR DR. DONOHUE: Does meningitis always kill? A woman in our neighborhood had it and died. She was quite young. What are the signs of meningitis? It has me terrified. – A.A.

ANSWER: The meninges cover and protect the brain and spinal cord. Meningitis is an inflammation of those coverings, and it is usually caused by bacteria or viruses. Viral meningitis is most often less serious than is bacterial infection. I’ll confine these remarks to bacterial meningitis.

Many different bacteria are responsible for meningitis, but the two most common are pneumococcus (NEW-moe-KOK-us) and meningococcus (men-IN-go-KOK-us). Quite often, the meningococcus germ is spread from a healthy person who happens to carry it in the throat or nose to a person who has never had previous exposure to the germ. This is the way epidemics of meningitis in college dorms and among Army recruits start off. The pneumococcus germ is transmitted by droplets coughed into the air by a person harboring the germ.

Once either germ gets into the throat of susceptible people, it can spread to the meninges by way of the blood.

The signs and symptoms of meningitis can become full-blown in a matter of hours, or they can progress more slowly over several days. Headache, fever and stiff neck are three salient features of the illness. Nausea and vomiting are also common. In untreated meningitis, lethargy develops, as can seizures and coma.

A spinal tap for spinal fluid provides evidence of infection and gives the doctor important information for choosing the appropriate antibiotic.

You need not live in dread of meningitis. Most infections are successfully treated. The meningococcal vaccine has all but eliminated meningococcal meningitis from the armed forces. Incoming college freshmen should check with their schools as to the advisability of obtaining that vaccine.

DEAR DR. DONOHUE: For many years I had a cocaine habit, of which I am not proud. I have been clean for a good while now. In the past few months I have noticed a whistling sound when I breathe in. I looked in my nose with a mirror and light and found I have a hole in the partition between the two sides of my nose. What can I do about this? Is it from the cocaine? – K.J.

ANSWER: The partition between the two nostrils is the nasal septum, and a hole in it is a perforation. Snorting cocaine can lead to a nasal perforation.

Small septal perforations can be left alone if they aren’t causing any symptoms. Larger perforations can cause nosebleeds, and they usually require attention. Very large perforations can cause the nose to collapse, and they must be treated.

If you’re not having any trouble, you don’t have to run to the doctor. The next time you see the family doctor, ask him or her to look in your nose and give you definite advice about the need for correction of the hole.

DEAR DR. DONOHUE: I have enclosed for your inspection the list of medicines my mother takes. She is quite groggy all the time, and I suspect her medicines have something to do with this. What do you think? – Anon.

ANSWER: I had to make you “Anon” because I misplaced your letter. I haven’t forgotten it, and I haven’t forgotten the medicines your mother takes. There were 17 medicines on the list. Five of them can cause drowsiness. Seventeen medicines for an elderly woman are far too many. For that matter, 17 medicines for a person of any age are far too many. I agree with you. It is quite reasonable to suspect that your mother’s grogginess comes from all the medicines she takes. You should have a conference with her two doctors. Perhaps they do not know what the other has prescribed. If you can’t make any headway with the current doctors, get another opinion.

You should not stop medicines on your own, even though the temptation is there. You and I don’t know which of those medicines is essential to your mother’s health.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.