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November 19, 1898


JAMA. 1898;XXXI(21):1233. doi:10.1001/jama.1898.92450210034002k

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The differential diagnosis of the various forms of meningitis is, in my experience, often impossible. There are, however, two methods of certain diagnosis, when available. One is by lumbar puncture of the spinal cord, as recommended by Quincke and Ziemssen, and the bacteriologic examination of the withdrawn fluid to determine the micro-organisms which are present, and the other depends on the Skeer sign, described by me in a clinical lecture published in the Journal of the American Medical Association, Jan. 7, 1888, and by Dr. Skeer of Chicago twenty years before. The Skeer sign when present will enable a diagnosis of tubercular meningitis to be made very early. It is due to the deposition of tubercle around the pupillary margin of the iris. It shows itself first as a distant wreath of white clouds about a millimeter from the margin (see Fig. 1). This sign occurs before any change has taken

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