. Manual of operative surgery. larger, surroundedby good landmarks and is opposite the terminal en-largement of the dural sheath. Puncture in fourth lumbar will be most convenient to describe the operationas performed for the production of spinal anesthesia. Step I.—Seat the patient with his legs and armshanging in front and body bent well forwards. Cleanthe whole lower part of the back. Palpate the crest ofthe iliac bones; note their high points; join these pointsby a line. This line bisects the fourth lumbar space(Figs. 919, 920). Place and keep a finger on the pointof the four
. Manual of operative surgery. larger, surroundedby good landmarks and is opposite the terminal en-largement of the dural sheath. Puncture in fourth lumbar will be most convenient to describe the operationas performed for the production of spinal anesthesia. Step I.—Seat the patient with his legs and armshanging in front and body bent well forwards. Cleanthe whole lower part of the back. Palpate the crest ofthe iliac bones; note their high points; join these pointsby a line. This line bisects the fourth lumbar space(Figs. 919, 920). Place and keep a finger on the pointof the fourth lumbar spine. Step 2.—Take a hollow needle about 3 inches longand about 3^2 ii^ch (i mm.) in diameter. ProbablyDawbarns is the best needle. Introduce the needle about ^-^ inch from the middle line and slightly below the spinous process. Push the needle slowly and steadilyforwards and slightly inwards until the cerebro-spinal XI Viii .w Fig. 918.—Relationbetween spinal cordand spinous processes.[Poirier and Charpy.). Fig. 919.—Spinal puncture. {Marion.) fluid escapes drop by drop. If the operation is performed for diagnosis orrelief of tension collect the fluid in sterile test-tube. In children the needlemust usually penetrate i to i}/i inches, in adults i}4, to 2^ inches or more. SPINAL MEXIXGITIS 757 Step 3.—As soon as the liquid begins to escape fix a hypodermic syringe tothe needle. The syringe should contain the sterilized powder to be injected(tropacocain; stovain; novocain). Slowly withdraw the piston of the syringeand thus draw cerebro-spinal fluid into the syringe. As soon as the fluid hasdissolved the powder reinject slowly. Remove the needle. Dress the puncturewound with collodion. The operation may be performed with the patient inthe lateral posture, lying down with the back thoroughly flexed.
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Keywords: ., bookcentury1900, bookdecade1920, bookpublisherphila, bookyear1921
