The diagnosis of meningitis in recent times, thanks to lumbar puncture has been greatly facilitated. That the cerebrospinal fluid is the mirror of the exudative and transudative phenomena occurring in the vascular apparatus of the pia and arachnoid is generally believed. The positive diagnosis of any form of cerebrospinal meningitis is never justified unless the specific micro-organism is found in the cerebrospinal fluid.
The dictum of Dunn1 of Boston that "without lumbar puncture a diagnosis of cerebrospinal meningitis is absolutely without value for scientific, statistical or therapeutic purposes" deserves repetition. It is believed almost generally that negative findings also, if extending over the late stages of the disease, will uniformly enable the absolute exclusion of meningitis. It must now be admitted that positive findings alone in this regard are conclusive, and that an encephalitis and meningitis may be present with a normal fluid. This does not apply to the tuberculous
BRADY JM. REPORT OF A CASE OF PNEUMOCOCCUS MENINGITIS WITH NORMAL CEREBROSPINAL FLUID. JAMA. 1913;60(13):972–973. doi:10.1001/jama.1913.04340130020007
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