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January 12, 1918


JAMA. 1918;70(2):93. doi:10.1001/jama.1918.02600020027015

The present wide utilization of lumbar puncture and the examination of the cerebrospinal fluid for diagnostic and therapeutic purposes has focused attention on the fluid as never before. To speak of it merely as the lymph of the brain, as has sometimes been customary, conveys to the average physician no very clear conception of its function or physiologic relations, even though the arrangement of the perivascular and perineuronal systems, filled as they are with cerebrospinal fluid, certainly resembles that of a lymphatic system. Furthermore, it appears no longer to be justifiable to class the cerebrospinal fluid as a lymph of the familiar type. The very essence of a lymph, said Halliburton,1 in his presidential address before the Section of Neurology of the Royal Society of Medicine, is that it should be in free communication with the blood stream, except for an intervening membrane, and that this membrane should be

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