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JAMA. 1918;71(26):2144-2146. doi:10.1001/jama.1918.26020520013010c.
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Although the portal of entry of the meningococcus has never been demonstrated, the evidence in favor of the nasopharyngeal route to the cerebromeninges has been so strong that it has been more or less generally accepted. Whether, however, it reaches the meninges by way of the blood stream or more directly by the olfactory nerves or ethmoid sinuses is still a much discussed detail. A growing list of cases of meningococcic septicemia (Baeslack and collaborators,1 Raffaelli2 and others) and a few acute meningococcic endocarditis (Worster-Drought and Kennedy,3 Cecil and Soper4) have now been reported.5 Furthermore, the type of initial fever and the finding of meningococci in the petechiae and elsewhere indicate that in many cases at least the infection is temporarily generalized (Netter6) and the occasional isolation of meningococci from the blood prior to their detection in the spinal fluid is added proof that


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