Even when the fluid is allowed to flow out slowly, in order to avoid a too sud den evacuation, the death of the patient, often within twenty-four hours, is not prevented. (Le Bull. M6d., Oct. 28, '94).
Puncture regarded as not a dangerous procedure if carried out under antiseptic precautions, and if the fluid be evacuated in small quantities at intervals of sev eral weeks. The employment of perma nent drainage is more dangerous than evacuation of the fluid by puncture or even aspiration.
Puncture is indicated in those cases in which, in a previously healthy child, symptoms of hydrocephalus rapidly de velop; if a progressive enlargement of the head be distinctly noticeable; if marked bodily or mental impairment be threatened. Raczyski (Oesterr-ungar. Centralb. f. d. Med. Wissen., No. 20, '95).
In a child of 10 months who developed internal hydrocephalus six weeks after symptoms of meningitis, the writer punctured the right lateral ventricle through the anterior fontanelle, which was still widely open. He withdrew by aspiration 40 cubic centimetres of fluid, and applied a supporting dressing, with decided improvement.
During the succeeding days there was some recurrence of the symptoms. The left lateral ventricle was then punctured and 70 cubic centimetres of fluid with drawn. From this time the improve ment in the patient was permanent. Grosz (Archly f. Kinderh., xxvii, Nos. 3 and 4, 1900).
Case of chronic hydrocephalus in which a cure followed the systematic use of lumbar puncture, and a second in which slight, but persistent, improvement occurred. Whenever the pressure of the contained fluid was allowed to fall below 100 millimetres, marked temporal head ache and even clonic convulsion resulted. The fluctuations in the level of the Hui& during crying or strong expiration could' also he well observed. A. Groben
(Miinchener med. Woeli., Feb. 20, 1900):.
In regard to tapping in cases of hy drocephalus and introducing aseptic am, the provisional conclusions warranted by personal limited experience are few:— 1. 1Vith due precautions the fluid of citroniv hydrocephalus may be com pletely evacuated from the yet unclosed skull of infants, and aseptic air may be allowed to take its place. This opera tion may be repeated without detriment and with scareely more risk than be longs to the usual method of para centesis.
2. In favorable cases attended with moderate effusion a single operation may sufliee. Continued oozing from the puncture for a few days after the removal of the tubes is not unfavorable.
3. In cases of considerable effusion an obvious indication is to relieve the brain from the weight and from the pressure of the fluid. The evacuation is facilitated by the introduction of asep tic air. In a ease witnessed this proved to be of decided advantage. By a timely repetition of the operation a hydro cephalic infant might he enabled to carry the weight of the head, and if the treatment were begun sufficiently early, permanent damage to the brain tissue might be averted and a development might perhaps ensue.
4. In large heads, while hydrocephalus persists, a considerable splashing sound is readily obtained. There is obvious risk in eliciting this sound by forcible suceussion, and for the same reason any abrupt movement- of the head should be avoided. William Ewart and W. Lee Ifiekinsou (Thediatrics, Oct. 15, 1901).
Every effort should be used to increase the nutrition of the patient by codliver oil, tonics, massage, and careful feeding, in the hope that the effusion may become self-limited and permit of life's being continued with more or less impairment of the mental and physical health.