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November 3, 1900


JAMA. 1900;XXXV(18):1159. doi:10.1001/jama.1900.02460440033004

In a critical summary of the literature on the diagnostic and therapeutic value of lumbar puncture, Alfred Hand1 reaches the conclusions that lumbar puncture has a wider field as a diagnostic aid than as a therapeutic measure. As so often is the case it is not safe to draw conclusions when the examination of the fluid withdrawn gives negative results—positive results only are of decisive import. Lumbar puncture is of therapeutic value in cerebrospinal meningitis—the withdrawal of fluid promotes recovery; in tuberculous meningitis it gives comfort; and in other forms of excessive pressure it may remove conditions immediately threatening to life. Nothing is said of the dangers of this procedure, the technique of which is so simple: the introduction of a needle, under conditions of surgical cleanliness, "between the third and fourth lumbar vertebræ, 5 to 10 mm. to one side of the median line, the direction of the