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Dec. 6, 1913. Syphilis and the Abderhalden Reaction. — G. Sangiorgi and M. Trossarello find in contradiction to the results obtained by certain American observers that the Abderhalden reaction has no value in the diagnosis of syphilis. This is the case whether the antigen employed is obtained from the viagra coupon walgreens human being or whether it is de- rived from the rabbit. — Pathologica. 436 MEDICAL RECORD. [September 11, 1915 THE RELATION OF LANDRY'S PARALYSIS TO POLIOMYELITIS.* viagra after ejaculation By M. NEUSTAEDTER, M.D., Ph.D.. NEW YORK. LECTURER IN NERVOUS DISEASES AT THE N. T. UNIVERSITY AND EELLEVUE HOSPITAL MEDICAL COLLEGE. In 1859 Landry described the viagra coupon walgreens following character- istic symptom complex: Individuals who up to the time of their illness have been in perfect health develop a flaccid paralysis in the lower e.xtremities, preceded by a general malaise and paresthesias in the affected parts. Within a few days the muscles of the trunk and then those of the upper extremities become involved in the same manner. And finally the muscles of deglutition, articulation, and respira- tion become paralyzed, and the patient dies of respiratory failure within a few days or weeks. Exceptionally some cases present a mild degree of these phenomena and survive without leaving any residual paralysis. In these cases the muscles last aflFected are the ones first to recover their function. viagra coupon walgreens He points out that there is no atrophy of the muscles and viagra coupon walgreens no electrical changes in them, and that he found no pathological changes upon autopsy. A great many cases, however, have viagra coupon walgreens been reported that vary from the first description. Muscle atrophy with electrical changes is frequently observed, sen- sory disturbances are not uncommon, involvement of sphincters is at times reported, and a unilateral or bilateral facial palsy of Bell's type has been described. Owing to the more advanced methods of examina- tion the conception of the etiology and pathology of the disease has undergone marked changes. Although Landry was inclined to ascribe the affec- tion to a toxic process, Westphal first demonstrated this to be a fact. The fact that in the majority of cases there are an enlarged spleen, swelling of the lymph glands, hemorrhagic foci in the lungs and intestines, and a nephritis points to a toxic or in- fectious process. Chantemesse and Ramon observed a large number of cases of paralysis, clinically not dissimilar to Landry's, in an epidemic form at an institution for the insane, suggesting a possible in- fection. Baumgarten found in one case BaciUu.'i anthracis in the blood, and Curschmann cites a case in which typhoid bacilli were found in the spinal cord, of which pure cultures could be grown. Cen- tanni found in a case of interstitial neuritis bacilli in the 'endoneural lymph spaces. Eisenlohr reports a case of Landry's paralysis due to viagra after ejaculation a mixed infec- tion. He found Staphylococcus pyogenes and Staphylococcus cereus albus in the spleen and sciatic nerve. In another case he found several types of bacilli. Remmlinger found Streptococcus lor^gvs and Marinesco diplococci which were partially en- closed in leucocytes. In a case of Marie and Marinesco a bacillus similar to that of anthrax was found in the blood. A virulent pneumococcus was shown to be present in the cases of Roger and Jesue, and of Courment and Bonne. Macnamara and Bern- stein grew a tetracoccus from the blood and cerebro- spinal fluid of their case, and Sheppard-Hall a strep- tococcus from his case. F. Buzzard isolated a coccus from the dura which produced a flaccid paralysis in animals. Wochenius found Staphy- lococcus pyogenes albus in the spleen viagra coupon walgreens and peripheral nerves. In recent years, on the other hand, cases of *Read before the New York Neurological Society, June 1, 1915. Landry's paralysis have been reported in which no germs were found. Such cases are reported by Seifert, Schultz, Thomas, Kapper, Workman, Hunter, Burghart, Mosny and Moutier, Pfeiffer, and E. D. Fisher. No less uniform is the pathology of this disease. Not only in viagra coupon walgreens former days but also in recent years the microscopical findings were negative in some cases as reported by Ormerod and Prince, Seifert, Kapper, Hun, Girandeau-Levy and others. Goebel and Burghardt report cases with very slight changes. In some cases disseminated foci of an inflammatory character were found in the bulb only ; in others again exudates with capillary hemorrhages in the spinal cord only. Wappenschmidt has placed particular weight upon viagra after ejaculation hyaline thrombi in his case as viagra coupon walgreens tending to prove the theory of Recklinghausen and Klebs that they are due to the action of bacterial toxins. In a few instances a marked swelling of the axis cylinders in the anterior pyramids was noticed. Widal and Le Sourd mention a neuritis of the viagra after ejaculation roots as the only change. Since the peripheral nerves began to engage viagra after ejaculation the