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To the Editor:—
In The Journal February 19 is a paper by Freund, Anderson and Lilly entitled "Recovery from Gonorrheal Endocarditis After Artificial Hyperpyrexia." In the first paragraph of the second column on page 549 is the sentence "According to the criteria generally accepted, a patient proved to have gonorrheal endocarditis must have a positive blood culture in vivo or a positive culture or smear from the vegetations at necropsy." These criteria, however, as applied to a case in which recovery occurs are entirely inadequate as, in the authors' own words in the second paragraph in the first column on page 550, "A positive blood culture in itself is not definite evidence of endocarditis, for one frequently sees gonococcemia without endocardial involvement.... The diagnosis may be obscured by the presence of a chronic valvular disease and may not be detected until the signs of fresh valvular involvement or of embolic
Merrill D. "RECOVERY FROM GONORRHEAL ENDOCARDITIS AFTER ARTIFICIAL HYPERPYREXIA". JAMA. 1938;110(20):1689. doi:10.1001/jama.1938.02790200057024