The meningeal picture resulting from meningococcus infection has so fixed the attention of clinicians and pathologists that the possibilities of extrameningeal infection by the organism have had scant notice. This has resulted in a general failure to recognize the fundamental nature of the disease as a meningococcus septicemia, which has in turn had important consequences in the fields of diagnosis and treatment.
The reason for this is not obscure. The premeningitic stage of the disease, which, up to the present, has been called epidemic cerebrospinal meningitis, is ordinarily not impressive enough to be of serious concern to the family physician, and is rarely, if ever, seen by the hospital physician or the consultant. Meningococcus infections apart from meningitis are practically unrecognized in civil life. The local meningeal involvement and the symptoms arising therefrom have been the criteria of diagnosis. To this the skill and care required to cause the organism
HERRICK WW. EXTRAMENINGEAL MENINGOCOCCUS INFECTIONS. Arch Intern Med (Chic). 1919;23(4):409–418. doi:10.1001/archinte.1919.00090210003001
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