Diseases of the nervous system .. . low the lower border of the spinous process with the needle directed horizontally, thebone will be encountered, while, in the latter case, the needle must be slightlyinclined upward toward the head. In muscular persons the ligamenta inter-spinalia are frequently so strong and tough that a needle punctures them onlywith great difficulty; in such cases I believe it better to make the puncturethrough the skin cm. to the right of the median line, and to give tothe needle such a direction that it enters the dura in the median line. Therule for puncture, the
Diseases of the nervous system .. . low the lower border of the spinous process with the needle directed horizontally, thebone will be encountered, while, in the latter case, the needle must be slightlyinclined upward toward the head. In muscular persons the ligamenta inter-spinalia are frequently so strong and tough that a needle punctures them onlywith great difficulty; in such cases I believe it better to make the puncturethrough the skin cm. to the right of the median line, and to give tothe needle such a direction that it enters the dura in the median line. Therule for puncture, therefore, is the following: Hold the needle horizontally orslightly inclined toward the head and insert it immediately below the spinousprocess in the median line; if the muscles are firm and the ligaments tough,the puncture should be made through the skin cm. to the right of themedian line, and after inserting the needle deeply we should give it a slightinclination toward the median plane—depending upon the presumable thick-. FiG. 132.—Lumbar Vertebral Col-umn OF A Child One Year Old. 1 These preparations have been made in the following manner: After removal ofthe brain, the upper part of the cadaver is raised, and inclined forward upon the abdo-men ; the sacral canal is then opened and at the apex of the dural sac a 10 per cent,lime solution is injected into the subarachnoid spaces of the spinal cord. When thebody cools and rigidity has set in, the vertebral column from the sacrum up to the mid-dle thoracic vertebra is removed and placed in a solution of formalin. After severaldays and when the lime has hardened, the vertebral arches are removed and the duraopened. In Fig 131 6 the vertebrae are not illustrated. 2 These relations may be perceived in Figs. 133 and 134, which have been copiedafter Braun by permission. In a geometric drawing they show the relations of thelumbar vertebrae in a lateral and posterior aspect. Fig. 133 is a preparation with ahorizontal, Fig.
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