The frequency of pneumococcal infection of the paranasal cavities in lobar pneumonia was noted by Darling1 in 1906, when he demonstrated acute inflammatory changes due to that organism in one or more nasal sinuses in more than 90 per cent of a series of pneumonia cases in which he performed necropsies. These findings have been confirmed in a much larger series of necropsies.2 Darling's belief was that "the portal of entry of the pneumococcus in most instances is an accessory nasal sinus, the mucous membrane of which is probably fitted for the reception of the pneumococcus by an antecedent influenza or rhinitis." Little investigation has been made of the nasal passages and sinuses during the course of lobar pneumonia. In a series of thirty-five cases, Stillman3 took cultures of the nose by introducing a swab into the nostrils, and in fifteen cases isolated the pneumococcus, though not
FELTY AR, HEATLEY CA. THE NASAL PASSAGES IN LOBAR PNEUMONIA: A CLINICAL AND BACTERIOLOGIC STUDY. JAMA. 1926;86(16):1195–1197. doi:10.1001/jama.1926.02670420019004
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