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vague pains in the back, a tired feeling, and gen- eral irritability. With the exception of unequal pupils, which, however, reacted normally, the pa- tient showed nothing clinically. The Wassermann reaction was positive in the serum and combivent inhalers fluid, and the latter showed neither a combivent inhaler price pleocytosis combivent dose nor a globulin" excess. In view of the lack of sufficient clinical signs and the absence of a pleocytosis in the spinal fluid, one should not consider combivent coupon these cases as .syphilis of the nervous apparatus, but rather dis- regard the positive Wassermann reaction obtained in the spinal fluid. With the original method the Wassermann result was entirely negative in the last case. If one stops to consider the penalty an innocent patient pays as the result of a faulty laboratory re- port, one appreciates the necessity for greater ac- curacy in this work. As a rule, a patient with a positive Wassermann result is treated with anti- luetic remedies. \\n:en such a patient consults KAPL.iX: SEROLOGICAL ANALYSIS /.V NEUROLOGY. 311 another doctor for some obscure ailment the his- tory reveals tlie previous therapy and the labora- tory refx>rt. Although the clinical analysis of the case shows nothing luetic at the time, the patient, in view of the previous history, is again unneces- sarily subjected to specific therapy. In this in- stance, as a result of faulty laboratory work, var- ious clinical entities that resemble some combivent cost of buy combivent inhaler the paraluetic nervous diseases would receive specific buy combivent treatment and be wrongly considered either cere- brospinal syphilis or general paresis. I am almost certain that the advocate of the "Auswertung> Methode" committed such errors on more than one occasion where patients with neurasthenia, mul- tiple sclerosis, and traumatic brain and cord lesions gave positive Wassennann reactions in the buy combivent online spinal fluid. Such seems to me the case (No. 3) re- ported on page 245. A positive Wasserniann re- action was also obtained in a case of tuberculous meningitis. Some cases came to autopsy without any luetic tissue changes being found. At no time does the author of the "Auswertungs Methode" admit the possibility of a faulty report, but prefers to regard such as instances of obscure lues. It will not surprise me. if the near future proves some of the cases with positive Wassermann cheap combivent tests re- ported by Hauptmann to be either simple arterio- sclerosis, trauma, or disseminated sclerosis — at any rate, not syphilis. I will now outline the work that permitted those criticisms and combivent udv endeavor to prove my conten- tion that at the present time there are no laboratory methods capable of detecting syphilis in every pa- tient who may have come in contact with this dis- ease. It must be remembered that the discoverer combivent inhaler of the reaction himself and others who have had a combivent inhaler coupon large experience w'ith it do not credit it with such accuracy. My ideas as far as the occurrence of the Wassermann reaction in neurology is con- cerned may be gathered from several of my pre- vious communications on the subject, as well as from the tables and conclusions in this communi- cation. It will be shown here that the reaction is most strongly and most frequently present in pa- tients suffering from general paresis, and that in this disease antisyphilitic therapy has little or no influence on the abnormal serology. In cerebro- spinal syphilis and in tabes, in the majority of in- stances, a change is noted first in the cellular increase ; this, without becoming entirely normal, tends to diminish. In some exceptional cases where vigorous and persistent treatment was re- sorted to, it was possible to reduce the cells to a normal count : though before such a result was ob- tained all the other constituents of a positive sero- logical status also became normal. It came to my notice that a few patients suffering from tabes and general paresis had no abnormality in their sero- logical status, regardless of the combivent mdi fact that they had received no recent treatment. It is important to note that up to this time (-\pril, 1913) I have not encountered a single patient with cerebrospinal lues of the meningitic or gummatous form who, unless recently and thoroughly treated, showed a combivent coupons negative serologv. I can also frankly defend the statement made bv me some time ago, that at no time should a patient be considered as suffering from general paresis where the cell count reaches the hundreds, but should be considered rather as a case of cere- brospinal syphilis, and treated as such. This is shown by two years' observation on four jjatients and by the analyses of three combivent price i)ost mortem examina- tions. Taking into consideration certain character- istic features of the Wassermann combivent nebulizer reaction, it combivent dosage is often possible to determine the transition ^tage from cerebrospinal syphilis to general paresis by means of the cell count. combivent inhaler coupons The persistently positive Wassermann reaction and the cell count often per- mit of the anticipation of a taboparesis. It will be shown later that some forms of tabes remain not only unimproved, but are frequently harmed by antiluetic remedies. Guides for or against active specific therapy will be found in the tables and in the comments accompanying them. Up to the present time, so far as I know, no treatment has ever permanently combivent neb cured a full fledged case of gen- eral paresis. I believe that where cures were re- ported one's attitude should be extremely skeptical, as the case may have been an unrecognized cerebro- spinal syphilis. SEROI.OGIC.\L FINDINGS IN T.ABES. Cerebrospinal fluid analyses Serum Was- Was- No. of ser- ser- Globu- Rcduc- cases mann mann lin Pleoc>tosis 2 ,^
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