This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1910 edition. Excerpt: .stylet should be withdrawn. If the fluid does not escape through the needle, it should be withdrawn slightly and the stylet reintroduced to dislodge any obstruction in the lumen of the needle.

The puncture should be made as simply as possible to avoid lacerating the tissue around the vertebral column and causing bleeding by lateral movements of the needle. Amount of Fluid to Be Withdrawn.--For diagnostic purposes we require from 5 to 10 c.e, (about 2 fluidrachms). Cerebrospinal fluid may appear clear macroscopically and still contain pathogenic bacteria, though few in number may be found. Either a centri-fuged specimen or the sediment on standing at least twenty-four hours will reveal the true bacterial content. It may contain, though clear, the Diplococcus intracellularis, hence with meningeal symptoms present a careful microscopical examination should be made. If the spinal fluid is turbid then the more we can withdraw the better.

I have withdrawn as much as 50 or 60 c.c. (2 fluidounces). If the Diplococcus intracellularis is found in the spinal fluid it is especially important to withdraw as much as possible. The site of puncture should be closed with a strip of adhesive plaster or with a drop of collodion. Local Anaesthesia.--Ethyl chloride in the form of a spray is useful in very sensitive children. It is not necessary to have general anaesthesia during this procedure.

General rules of asepsis must be strictly applied in respect to the childs skin, the operators hands, and the needle used. A dry tap may result, first, if the calibre of the needle is small and the spinal fluid very thick; second, if adhesions are present at the base of the brain, preventing the passage of fluid from the ventricles to the subarachnoid space; third, .