. Some points in the surgery of the brain and its membranes . s always sur-rounded by a zone of tissue tense and soddenwdth serum, and, indeed, before the pus becomesvisible the site of the coming abscess is the siteof serous effusion or oedema. The same sequenceof events occurs in the cerebral meninges. Inthe subdural space, which is not divided intocompartments, a pond of fluid will form, whilein the sub-arachnoid space of the cortex thetissue, under normal circumstances being tra-versed by countless rivulets of fluid (like marshyground), will become cedematous and swollen. The following cas
. Some points in the surgery of the brain and its membranes . s always sur-rounded by a zone of tissue tense and soddenwdth serum, and, indeed, before the pus becomesvisible the site of the coming abscess is the siteof serous effusion or oedema. The same sequenceof events occurs in the cerebral meninges. Inthe subdural space, which is not divided intocompartments, a pond of fluid will form, whilein the sub-arachnoid space of the cortex thetissue, under normal circumstances being tra-versed by countless rivulets of fluid (like marshyground), will become cedematous and swollen. The following cases show the symptoms pro-duced by meningeal effusion and the beneficialeffect of lumbar puncture. Probably in some OF THE CEREBRAL MEMBRANES 47 cases the removal of fluid under pressure fromthe intra-dural spaces will prevent the occurrenceof suppurative meningitis :—- Case I.—J. C, aet. 19, female.—Admitted with otorrhoea and large mass of breaking-downglands on the right side of the neck. The radical mastoid operation was done, and all the. Fig. 26.—Sub-arachnoid space between the convohitions. (Key and Retzius.) The sub-arachnoid space is here broken up into a number of channels, throughwhich the cerebro-spinal fluid finds its way. At each systole the fluid in theventricles is pumped into the spinal theca and into the great cisterns at the base ofthe brain. It escapes from the spinal theca along the sheaths of the nerves, andfrom the cisterna it passes upwards in the sub-arachnoid rivulets between the con-volutions to reach the Pacchionian bodies and the superior longitudinal sinus. affected glands in the neck were removed. The glandular disease was tubercular. The temperature for a few days was normal andthe pulse quick. The condition of the patient thenchanged. The temperature rose, the pulse becameslower, sickness occurred, and she lay in bed in anapathetic state, with eyes closed and mouth puncture was done, and with the withdrawal 48 SOME P
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