Identifier: treatiseonner00sach (find matches)
Title: A treatise on the nervous diseases of children, for physicians and students
Year: 1905 (1900s)
Authors: Sachs, Bernard, 1858-1944
Subjects: Nervous system Children
Publisher: New York, W. Wood and company
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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the spinal cord (gliosis, tumor); and finallythe conditions of the vesical and rectal reflexes should be 46 THE NERVOUS DISEASES OF CHILDREN. recorded; though in regard to them the influence or lackof previous trainingof the child must be taken into ac-count. A sudden loss of control is often associated withserious cerebral and spinal disease. Lumbar Puncture is a recent addition to our methodsof examination. It is practised for the purpose of with-drawing some of the cerebro-spinal fluid. The examinationof this fluid may render valuable aid in the diagnosis ofcerebral and cerebro-spinal affections. Its value as a ther-apeutic measure is still in doubt. Lumbar puncture was introduced by Quincke. Hisdirections are as follows: The patient is to lie on his leftside, near the edge of the bed, with knees well drawn up.The trocar is to be inserted in the median line between thethird and fourth or between the fourth and fifth lumbarvertebrae (Fig. 38). After reaching the dural sac the trocar
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Fig. 38. (After Quincke.)Slightly Modified ; the Horizontal Lines Correspond to the Lumbar Vertebra1 needle is withdrawn and the cerebro-spinal fluid will flowout. Quincke advises connecting the canula with a smallrubber tube and a glass manometer. If there is no ob-ject in measuring the pressure at the time of tapping,the trocar is sufficient and the fluid may be received in atest-tube. INTRODUCTION—METHODS OF EXAMINATION. 47 To determine the site for the puncture, draw a line at atangent to the crest of the ilium ; this will strike the fourthlumbar space. General or local anaesthesia is unnecessary except in un-ruly patients. Do not withdraw more than 20 to 30 c. c. ata sitting. Use sterilized test-tubes.

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