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June 6, 1908


JAMA. 1908;L(23):1903-1904. doi:10.1001/jama.1908.25310490031003b

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Patient.  —Mr. D., aged 35, bookkeeper, came under my care Nov. 1, 1907.

History.  —Previous history was as follows: For some weeks he had been suffering from left earache. The tympanum had twice been incised and a little mucus drained for a short time. Headache had been severe and unrelenting. There was loss of weight, constipation, anorexia and difficulty in passing the urine. The temperature had been running from 98 F. in the morning to 99.5 F. in the evenings. Pulse was not accelerated.

Examination.  —Examination showed marked photophobia, mental dulness, a peevish restlessness, no anesthesias, no paralysis, pupils negative, tongue heavily coated, mastoid not tender except one-half inch above and behind the external auditory meatus. Catheterized urine showed no changes. The question of diagnosis lay between abscess of brain and tuberculous meningitis.

Blood Examination.  —Dr. Wylie Jones was called in to make a differential leucocyte count. November 2 he

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