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JAMA. 1937;108(9):696-700. doi:10.1001/jama.1937.02780090008003.
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In a recent article Ferris Smith1 called attention to the well organized exudate at the base of the brain as compared to the more recently appearing exudate over the cerebral hemispheres in patients dying of meningitis of otitic or nasal sinus origin. This suggests that there is a stage of localized basilar meningitis lasting from hours to days before the onset of generalized meningitis. The author advocated early incision and drainage of the dura beneath the pontile cistern by way of a burr opening in the sphenoid bone, made through the posterior wall of the sphenoid sinus or through the roof of the nasopharynx. Three cases of early meningitis treated by this method were reported, with one recovery. In two patients the meningitis was from the sphenoid sinus, the lumbar spinal fluid showing 1,800 cells per cubic millimeter in one, 190 cells in the other. Organisms were not present

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