CLINICAL BACTERIOLOGY AND H^MATOLOGY , 



fluid. In " basic meningitis " I have seen several cases in which 

 the patient's life was saved by it : the urgent pressure symp- 

 toms are often relieved at once, the temperature falls, and the 

 patient's general condition is greatly improved. The symp- 

 toms frequently recur, necessitating repeated punctures, but 

 in favourable cases the period of relief gets longer and the 

 relapses milder, until the disease is cured. In a case in which 

 I performed the operation recently a single puncture was 

 followed by immediate relief, though the symptoms were 

 most grave, and complete and permanent cure ensued. Great 

 temporary relief may also be given in the severe headache of 

 uraemia and chlorosis. 



It is not advisable to do it on a "walking" patient, since it 

 may be followed by a severe " puncture headache," which 

 occurs irrespective of the amount of fluid drawn off. It may 

 be most severe, and last a week or more. It is at once relieved 





ft 



FIG. 28. AUTHOR'S NEEDLE FOR LUMBAR PUNCTURE. 



by the recumbent position, with the head low, and nothing else 

 seems to have much effect. 



Requisites. i. A suitable needle. In children the spinal 

 meninges will be reached at a depth of 3 to 4 centimetres 

 (roughly i to ij inches), whilst in adults the depth may be* 

 twice as great. The needle should not be less than 2j inches 

 long for an infant and 4 inches for an adult, and should be 

 sharp and strong. An antitoxin needle will usually serve very 

 well. A syringe is unnecessary, and the fluid should never 

 be sucked out of the spine, or injury to the nerve-roots may 

 result. The needle should always have a sharp and stiff wire 

 inside it when the puncture is made, otherwise it may become 

 blocked by a shred of fibrous tissue picked up during its pas- 

 sage through the parietes, and time may be lost in sterilizing 

 a wire with which to clear it. Another use for the wire arises 

 from the fact that when the intracerebral pressure is low 

 the needle may push the membrane in front of it, instead of 



