. A practical treatise on medical diagnosis for students and physicians . sed to withdraw the fluid. The syringe itself maybe removed and the fluid allowed to ooze through the needle drop bydrop. A needle 4 cm. in length and 1 mm. in diameter is suitable forinfants; a longer needle for children over ten years and for the puncture is made between the third and fourth lumbarvertebra? to one side or the other of the median line. The point at whichthe needle enters the skin should be at the level of the lower end of thespinous process of the fourth lumbar vertebra, one-half inch
. A practical treatise on medical diagnosis for students and physicians . sed to withdraw the fluid. The syringe itself maybe removed and the fluid allowed to ooze through the needle drop bydrop. A needle 4 cm. in length and 1 mm. in diameter is suitable forinfants; a longer needle for children over ten years and for the puncture is made between the third and fourth lumbarvertebra? to one side or the other of the median line. The point at whichthe needle enters the skin should be at the level of the lower end of thespinous process of the fourth lumbar vertebra, one-half inch to one position of the fourth lumbar vertebra may be determined in one ofthree ways : (1) By counting carefully from the vertebra promiyiens—this EXPLORATORY PUNCTURE. is difficult unless the patient is emaciated, and even then there may betrouble in distinguishing the individual spines of the dorsal vertebrae. Theattachment of the twelfth rib can usually be made out, and the spine belowit corresponds to the twelfth dorsal vertebra, and is almost immediately. Lumbar puncture—introducing the trocar. above the body of the first lumbar vertebra. (2) The method of Jacoby,which depends upon the fact that a line drawn through the crests of theilia across the back intersects the spinous process of the fourth lumbarvertebra. (3) The spinous process of the fifth lumbar vertebra is con-
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