LUMBAR PUNCTURE I29 



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 

 tissues picked up during its passage 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 perforating it : when this is the case a 

 short sharp push with the wire will probably puncture the 

 membrane, and the point of the needle will slip in. A piece of 

 steel wire is best. 



Since cultures may have to be taken, it is advisable to have 

 some sort of a handle which may be sterilized with the needle and 

 avoid any necessity for a very elaborate sterilization of the liands. 

 I use a pair of artery forceps, one blade of which is passed inside 

 the barrel and the other outside, and the instrument clipped on. 



^Sc 



Fig. 30. — Author's Needle for Lumbar Puncture. 



The two are sterilized together and the forceps used as a handle, 

 and not removed until the puncture has been made. Where 

 a sterilizer large enough to take the two instruments fixed 

 together is not at hand the needle may be placed point down- 

 ward in a test-tube half full of water, and the forceps inserted 

 as far as it will go by its side. The tube is boiled for ten 

 minutes and the needle removed by clipping it with the forceps, 

 as above. The handle will not be sterilized, but that does not 

 matter. 



I have devised a curved needle with a handle fitting into a 

 socket (Fig. 30), which also answers well. It has the advantage 

 that it can be put in a wide tube plugged with cotton-wool, 

 sterilized by dry heat, and taken to the bedside ready for 

 immediate use. 



2. Materials for disinfection of the patient's skin and (if cultures 

 are to be taken) the hands of the operator. Hot water, soap, 

 alcohol, ether, perchloride lotion (i in 1,000). 



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