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To the Editor:—
Dr. Flexner's admirable paper on the important work of himself and co-workers on poliomyelitis, in The Journal, Sept. 24, 1910, p. 1105, interested me greatly. I disagree with him, however, in his advocacy of the routine and early use of lumbar puncture by physicians in suspected cases, and I cannot refrain from commenting on this question.1. Until we have a definite serum to use, I see no value in determining by examination of the cerebrospinal fluid the presence of a slight lymphocytosis, especially since if done before paralysis has occurred, the puncture may be blamed by the relatives for the succeeding paralysis. As this lymphocytosis occurs early at a period when patients are rarely observed closely, lumbar puncture might be done later than the operator thinks he is doing it.2. Is this slight lymphocytosis with subsequent clearing of fluid and constant increase of polymorphonuclear leukocytes
Mayer EE. Lumbar Puncture in Poliomyelitis. JAMA. 1910;55(16):1396–1397. doi:10.1001/jama.1910.04330160064027
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