. Some points in the surgery of the brain and its membranes . ractice of lumbar puncture. This gives uscertain and valuable information respecting thenature of the fluid in the meningeal spaces, butdoes not afford equally certain evidence as toits amount and distribution. It should not beforgotten that there is no direct gross com-munication between the subdural and the sub-arachnoid space ; the fluid obtained by lumbarpuncture may be derived from the one or fromthe other, and we cannot tell from which. In the skull, as elsewhere, the disease may bearrested in the serous stage, or other inflam
. Some points in the surgery of the brain and its membranes . ractice of lumbar puncture. This gives uscertain and valuable information respecting thenature of the fluid in the meningeal spaces, butdoes not afford equally certain evidence as toits amount and distribution. It should not beforgotten that there is no direct gross com-munication between the subdural and the sub-arachnoid space ; the fluid obtained by lumbarpuncture may be derived from the one or fromthe other, and we cannot tell from which. In the skull, as elsewhere, the disease may bearrested in the serous stage, or other inflamma-tory lesions may arise. Inflammation of the pia mater is neitherclinically nor anatomically distinguishable frominflammation of the arachnoid, but either thesubdural or the sub-arachnoid space may bethe exclusive or the chief seat of the inflam-matory exudation, a fact not without significancein the treatment. Diffuse suppuration in the subdural cavity isuncommon except as the result of direct infec-tion by injury, but I have seen it occur in i OF THE CEREBRAL MEMBRANES 51 Certain varieties of pus seem to have butlittle tendency to perforate serous membranes(such as the arachnoid or peritoneum) and butlittle irritant effect upon them. The pus maybe spread out in a sheet of greater or less thick-
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