Mt Sinai Hospital Reports . e hydrostatic pressureof the cerebrospinal fluid by sitting the patient up. It has beenclaimed that in the sitting posture there occurs in pathological con-ditions sedimentation of the cerebrospinal fluid, facilitating success-ful microscopical examination; this advantage seems to us largelya theoretical one, and is offset by the disadvantages of insufficientspinal flexion and the danger in cases of greatly increased tensionof untoward symptoms resulting from too rapid withdrawal of fluid. L16 MOI NT SIWI HOSPITAL KKIORTS. The child is placed on its left side close
Mt Sinai Hospital Reports . e hydrostatic pressureof the cerebrospinal fluid by sitting the patient up. It has beenclaimed that in the sitting posture there occurs in pathological con-ditions sedimentation of the cerebrospinal fluid, facilitating success-ful microscopical examination; this advantage seems to us largelya theoretical one, and is offset by the disadvantages of insufficientspinal flexion and the danger in cases of greatly increased tensionof untoward symptoms resulting from too rapid withdrawal of fluid. L16 MOI NT SIWI HOSPITAL KKIORTS. The child is placed on its left side close to the edge of the bed oroperating-table. II is the duly of one assistant, facing the flexorsurface of the patients body, to effect forced flexion of the spine byapproximating tIn* patients neck and knees; to accomplish tins theassistant grasps with his right hand the nape of the childs neckand with his lefl hand the childs legs. Tln re are three advantagesin this position: It prevents struggling of the patient; brings into. prominence the lumbar spines; and increases the elastic pressureof the spinal fluid. It is the duty of a second assistant, while theoperator is sterilizing his hands, to asepticize in the usual surgicalway the skin at the site and vicinity of puncture. At the edge ofthe table and on the floor are spread wet bichloride towels, and steriletowels about the field of operation. As a rule no anesthetic is re-quired. In a case of tetanus, however, treated about one year agoby subarachnoid injections of tetanus antitoxine, I employed chloro-form anesthesia because of the patients extreme hyperesthesia andviolent convulsions. HEIMAN : LUMBAR PUNCTURE IN CHILDREN. 117 Instruments: The Quincke Needle and Manometer. (See Fig. 1) —Needles constructed according to the directions of Quincke have forseveral years been accessible to New York physicians, and the oldermethods of employing a syringe needle or canula and trocar withor without a handle are fast passing into di
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