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530 EISNER AyD HAWLEY: THE CLINICAL VALUE OF THE GENTRIFUOE. [N. Y. Mbd. Joob., fuge in the examination of sputum for tubercle bacilli, pneumococci, and otber bacterial and elastic tibevs. The first are ofttimes present in such small order topamax canada numbers before advanced pulmonary changes have taken place that it becomes important to precipitate as great a number as possible for staining. For. this class of cases Biedert (20) and von Sehlen (21) each recommended a method by which it was topamax generic price sought to dilute the sputum with alka- lies, setting the mixture aside for precipitation. The former diluted the sputum with water, then added caustic soda, and boiled the solution until a homogeneous fluid re suited, which he allowed to deposit, this process occupy- ing at least twenty-four hours. In the Sehlen method the sputum is thoroughly mixed with a hot solution of borax and boric acid (twelve 'and a half per cent, of each), and in four days the topamax generic weight loss sediment is gained for further treatment. If the tuberculous sputum is mixed with either of these fluids the centrifuge will precipitate the bacilli in from five to eight minutes, more completely than by the older methods alone and migraine prescription topamax with a great saving of time, an advan- tage which we often need prescription topamax appreciate. We have experimented with dried sputum, dilating with the von Sehlen solution, and centrifugalizing with very topamax generic brand pleasing and positive results. The practical advantage of topamax mg for weight loss this method was demonstrated in a recent case which we saw in consultation with Dr. Weidman at Marcellus, where the sputum, all that could be obtained while there, dried on the plate. The diagnosis depended largely on the result of bacteriological examina- tion which we made after the method above described. The attending physician received his report in less than eighteen topamax generic availability hours after the. consultation. It is not always necessary to dilute the sputum, but in many cases it is of decided advantage. The element of time plays an important role in the ex- amination of serous fluids and other exudates. With |)lcural effusion there is ofttimes such a rapid coagulation (the mi- cro-organisms being held in the coagulura) that no desira- ble precipitate can non prescription topamax be obtained. Such fluids have yielded characteristic and satisfactory results with the almost im- mediate use of the centrifuge. In all of our cases of pleu- ral effusion we found with the centrifuge the presence of pneumococci, either of Fraenkel or of Friedliinder, as well as blood-corpuKcles. In cancerous disease of the urinary tract, particularly the bladder and kidney, the centrifuge has precipitated epi- thelial elements topamax 50mg and weight loss and cliarncteristic stirc(ls wliicli wcri' not always found by ordinary sedimentation. The conohisions which are forced u])on us after a care- ful coHHideration buying topamax online of this subject from a practical point of view arc : 1. That buy topamax online without script the time gained by centrifugalizing iiriin! is of great Jid vantage in many cases where an get prescription topamax unaltered urine is topamax order online (ieHJred (fermentation not having taken ()lacc), such early pri'eipitaleH Hliowing the epithelial casts and other structures before changes in Hhiipe, size, and contour occur, without lini-t<;rinl contamination, 2. The rcMtrifngi' does n'lt yield a pri'cipilale in all iirinr'H, liiough in llie majority of tliiise urines in which no ■ lecifjed depimil lakes piiice there is a haze or clondini'ss near the bottom of the eprouvette which with care can be gained and ofttimes gives a valuable microscopic picture. In some urines absolutely 100 mg topamax no precipitation or haze can be found. 3. Centrifugalizing demonstrates, as no other method can, the insoluble and suspended elements present in topamax generic vs brand an abnormal urine. 4. The presence of lilood in the urine can often be demonstrated by the aid of the centrifuge when the older method fails to show it. 5. In cases of transitory, cyclic, or permanent albuminu- ria, without marked subjective or objective symptoms ac- companying, the centrifuge will ofttimes.aid in establishing the underlying pathologic condition ; hence, for the insur- ance examiner the instrument becomes invaluable. 6. No other inethod of urinary examination will be as likely to demonstrate primary genito-urinary tuberculosis. The repeated examination of suspected urine is necessary, as failures are topamax 100 mg weight loss frequent and tubercle bacilli are present in small numbers only. 7. The centrifuge precipitates albumin with picric acid in from five to ten minutes, the test being equal in value to Esbach's, having the decided advantage over the topamax order latter (which requires fully twenty-four hours) that only a short time is needed, and that the mucin and other insoluble elements can be measured or weighed. 8. The prompt bacteriological examination of serous exudates and other pathologic fluids can be made by the aid of the centrifuge more thoroughly and do i need a prescription for topamax with greater

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