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July 10, 1915


Author Affiliations

Fellow of the American College of Surgeons NEW YORK

JAMA. 1915;LXV(2):163-164. doi:10.1001/jama.1915.02580020029012

The following case is presented as a justification of my theory1 that the primary source (focus) of an infection or of anaphylaxis—whether general, metastatic, or local—is, as a rule, to be found in the nasopharynx, localized in Luschka's tonsil. The case described was one of acute poliarticular "rheumatic" sinovitis.

History.  —The patient, a man, aged 26, had been under treatment by the usual internal and external remedies in a large orthopedic hospital with little relief. No focus of infection had been located, in spite of well-directed effort.He had been subject to severe attacks of "lumbago" as long as he could remember. The present illness began in the right knee. Pain and a large effusion in the right knee and ankle had lasted for six weeks, while the right hip had been painful and useless a week. He came to the office on crutches, walking with difficulty. He said

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