CHAPTER Ⅰ HISTORY OF CEREBROSPINAL FLUID 21
Knowledge of Existence of Cerebrospinal Fluid in Pathologic Conditions 21
Discovery of the Existence of Cerebrospinal Fluid in Normal Individuals 25
Investigations Concerning the Physiology of Cerebrospinal Fluid 28
Discovery of Methods of Removing Cerebrospinal Fluid From the Living 30
Modern Research on Cerebrospinal Fluid 38
CHAPTER Ⅱ ANATOMY OF THE STRUCTURES ASSOCIATED WITH THE CEREBROSPINAL FLUID 43
The Ventricles 43
The Chorioid Plexus 44
The Meninges 47
The Subarachnoid Spaces 48
The Cisterns 49
Communications 50
Pacchionian Bodies 52
CHAPTER Ⅲ PHYSIOLOGY OF THE CEREBROSPINAL FLUID 54
Rate of Formation 54
Circulation 54
Rate of Absorption 55
Channels of Absorption 57
Permeability 58
Function 61
Origin 63
CHAPTER Ⅳ NORMAL CEREBROSPINAL FLUID．PRESSURE 72
Type of Apparatus 73
Position of the Needle 80
Previous Withdrawal of Fluid 80
Age 81
Position of the Patient 81
Site of Puncture 82
Intracranial Arterial and Venous Pressures 83
The Queckenstedt Sign 84
Rate of Formation and Rate of Absorption 84
Brain Volume 85
Summary 85
CHAPTER Ⅴ NORMAL CEREBROSPINAL FLUID．PHYSICAL AND PHYSICOCHEMICAL PROPERTIES 88
Physical Properties 89
Amount 89
Color 89
Lack of Sediment 89
Physicochemical Properties 90
Specific Gravity 90
Conductivity 91
Surface Tension 91
Viscosity 91
Refractometric Index 91
Freezing Point 92
Spectroscopic Analysis 92
Crystallization 92
Reaction of Normal Cerebrospinal Fluid 95
Alkali Reserve 104
CHAPTER Ⅵ NORMAL CEREBROSPINAL FLUID．CHEMICAL PROPERTIES 108
Early Investigations 109
Recent Investigations 111
Inorganic Constituents 111
Total Solids 111
Calcium 112
Magnesium 113
Sodium and Potassium 114
Chlorides 114
Inorganic Phosphorus 115
Other Inorganic Substances 116
Organic Constituents 117
Organic Matter and Organic Index 117
Total Protein 118
Nitrogen 119
Sugar 120
Cholesterol 122
Lactic Acid 122
Cholin 122
Organic Phosphorus 122
Urobilin and Bilirubin 123
Other Organic Constituents 123
Comparison of Cerebrospinal Fluid and Blood Chemistry 123
CHAPTER Ⅶ NORMAL CEREBROSPINAL FLUID．BIOCHEMICAL PROPERTIES AND CYTOLOGY 133
Catalase 133
Amylase 133
Oxidase 134
Diastase 134
Proteolase 134
Lipase 134
Glycolytic Ferment 134
Opsonin 134
Alexin 134
Hemolysin 134
Toxicity 135
Antitoxins 135
Bactericidal Action 135
Cytology 135
Type of Cell 137
CHAPTER Ⅷ PATHOLOGIC CEREBROSPINAL FLUID．GENERAL CONSIDERATIONS 139
Infection of the Meninges 139
Irritation of the Meninges 144
Trauma and Other Factors 147
CHAPTER Ⅸ PATHOLOGIC CEREBROSPINAL FLUID．PHYSICAL AND PHYSICOCHEMICAL PROPERTIES 149
Physical Changes 149
Color 149
Increase in Amount of Obtainable Fluid 149
Pressure 150
Foam 150
Pellicle，Coagulum or Sediment 151
Physicochemical Changes 154
Spectrum Analysis 155
Crystallization 155
Turbidity 158
Protein Charges 159
The Colloidal Gold Reaction 163
Mastic Reaction 163
Benzoin Reaction 163
Other Colloidal Tests 164
Ninhydrin Reaction 164
Changes in the Reaction of the Cerebrospinal Fluid 164
Precipitation 173
Permeability of the Meninges 176
Bromide Test of Walter 177
Biologic Tests 178
CHAPTER Ⅹ PATHOLOGIC CEREBROSPINAL FLUID．CHEMICAL AND BIOCHEMICAL CHANGES 179
Chemical Changes 179
Inorganic Constituents 179
Chlorides 179
Calcium 180
Magnesium 180
Sodium and Potassium 180
Inorganic Phosphorus 181
Lead 181
Arsenic 181
Organic Constituents 182
Permanganate Reduction or Organic Index 182
Protein 182
Albumoses 184
Urea，Uric Acid and Creatininc 184
Sugar 185
Cholesterol 188
Lactic Acid 189
Cholin 189
Acetone 189
Bilirubin 189
Cytological Changes 190
Prognostic Value of Cytology of Cerebrospinal Fluid in Purulent Meningitis 194
Enzymes 194
Catalase 194
Diastase 195
Other Enzymes 195
Bacteriologic 195
Immunologic 197
Agglutination 197
Inhibition of Saponin Hemolysis 197
Hemolysin 198
Wassermann Reaction 198
Toxicity 199
CHAPTER Ⅺ RELATION OF CEREBROSPINAL FLUID TO VARIOUS FACTORS 202
Relation of Cerebrospinal Fluid to the Time of Day 202
Changes in Cerebrospinal Fluid With the Age of Fluid 202
Cerebrospinal Fluid From Different Loci 203
Postmortem Changes in Cerebrospinal Fluid 206
CHAPTER Ⅻ METHODS OF OBTAINING CEREBROSPINAL FLUID FROM THE LIVING BODY 209
Lumbar Puncture 209
Indications 210
Contraindications 214
Reactions Following Removal of Cerebrospinal Fluid 214
Technic of Lumbar Puncture 218
The Spinal Puncture Needle 223
Failure to Obtain Fluid 226
The Presence of Blood in the Fluid 229
Collection of the Fluid 229
Ventricular Puncture 231
Cistern Puncture 235
Indications 236
Technic 236
Failure and Untoward Effects 237
Special Methods 239
Combined Puncturd 239
Ventriculography 239
Myelography and Eneephalography 239
Lipiodol Injections 240
Orbital Puncture 242
Epidural Injections 242
Sacral Anesthesia 242
Spinal Anesthesia 243
CHAPTER ⅩⅢ METHODS OF EXAMINATION OF CEREBROSPINAL FLUID FOR DIAGNOSTIC PURPOSES 245
Physical 245
Color 245
Foam 246
Film or Pellicle 246
Pressure 247
Queckenstedt＇s Sign 248
Phenolsulphonephthalein Test for Determination of Type of Hydrocephalus 248
Chemical 249
Globulin Tests 249
RossJones 249
NonneApelt 250
Pandy 251
Noguchi 251
Kaplan 252
Weichbrodt＇s Reaction 252
Boltz Test 252
Braun-Husler Reaction 253
Alcohol Reaction 253
Takata-Ara Reaction 253
Taccone Test 253
Sulphosalicylic Acid-Mercurie Chloride Method 254
Relative Value of the Globulin Tests 254
The Permanganate Test 255
Boveri Test 256
Ninhydrin Reaction for Albumoses (Nobel-Kafka) 256
Quantitative Tests for Protein 257
Method of Nisal 257
Sugar 258
Chlorides 261
Physicochemical Methods 263
H-ion Concentration 263
Lange Gold Chloride Test 264
Mastic Test 269
Benzoin Test 271
Relative Value of Colloidal Reactions 271
Tests for Meningeal Permeability 272
Nitrate Test of Mestrezat 272
Uranin Test of Jervell 273
Cytologic Examination 273
The French Method of Cell Counting 273
Chamber Method of Cell Counting 274
Comparative Value of the Two Methods 276
Type of Cells 277
Bacteriologic 278
Culture Media 278
Direct Smear 279
Immunologic 279
Agglutination of Meningococei 279
Precipitation of Cerebrospinal Fluid With Antimentingococeus Serum 284
Guinea Pig Inoculation 284
Saponin Reaction 285
The Wassermann Reaction 286
Kahn Test 288
Peterman Microprecipitation Test 292
CHAPTER ⅩⅣ CEREBROSPINAL FLUID IN VARIOUS DISEASES 295
Infectious Meningitides 295
Tuberculous Meningitis 295
Meningococcus Meningitis 307
Staphylococcus Meningitis 309
Influenza Meningitis 309
Colon Meningitis 311
Typhoid Meningitis 311
Anthrax Meningitis 311
Rare Forms of Meningitis 311
Syphilis 312
General Paresis 315
Tabes Dorsalis 315
Syphilitie Meningitis 315
Other Diseases of the Central Nervous System 316
Tetanus 316
Huntington＇s Chorea 316
Epilepsy 316
Rabies 317
Herpes Zoster 317
Postdiphtheritie Paralysis 317
Alcoholic Psychoses 319
Manic-Depressive Psyenoses 319
Dementia Precox and Paranoia 319
Hemorrhage of the Brain 320
Skull Fracture 320
Pachymeningitis Hemorrhagiea Externa 320
Pachymeningitis Hermorrhagiea Interna 320
Cerebral Thrombosis 321
Encephalitis 321
Abscess of the Brain 322
Parasitic Cysts of the Brain 323
Tumor of the Brain 323
Tuberculoma 323
Froin＇s Syndrome (Massive Coagulation) 323
Acute Anterior Poliomyelitis 324
Multiple Sclerosis 330
Amyotrophic Lateral Sclerosis 330
Syringomyelia 330
Paralysis Agitans 330
Subacute Combined Degeneration of the Cord 330
Spinal Muscular Atrophy 330
Cerebral Arteriosclerosis 330
Other Degenerative Conditions 331
Acute Infectious Diseases Without Organic Involvement of the Central Nervous System 331
Meningism 331
Pneumonia 332
Mumps 333
Pertussis 334
Scarlet Fever 334
Typhoid 334
Meningitis Sympathiea 334
Acute Mastoiditis Otitis Media and Sinusitis 335
Lateral Sinus Thrombosis 335
Serum Meningitis 335
General and Metaboliec Diseases 336
Uremia 336
Diabetes Mellitus 336
Jaundice 336
Trichinosis 337
CHAPTER ⅩⅤ CEREBROSPINAL FLUID IN INFANTS AND CHILDREN 341
Cerebrospinal Fluid in Normal Newborn，in Infants and in Children 342
Normal Newborn 342
Normal Infants and Children 343
Cerebrospinal Fluid in Diseases Peculiar to Infancy and Childhood 345
Cerebral Hemorrhage of the Newborn 345
Hydrocephalus 345
Spina Bifida 346
Amaurotic Family Idiocy 346
Mongolian Idiocy 347
Little＇s Disease 347
Convulsions in Infancy 347
Spasmophilia 348
Alimentary Disturbances 349
Congenital Syphilis 349
Chorea of Sydenham 350
Meningitis 351
Meningitis of the Newborn 351
Meningitis in Infants and Children 351
Serous Meningitis 354
Pachymeningitis Hemorrhagiea Interna 354
CHAPTER ⅩⅥ INTRATHECAL TREATMENT 357
Intrathecal Treatment of Meningococcus Meningitis 357
Technic 359
Dosage 361
Agglutination 365
Untoward Effects of Serum 364
Intrathecal Treatment of Pneumococcus Meningitis 366
Intrathecal Treatment of Streptococcus Meningitis 367
Intrathecal Treatment of Tuberculous Meningitis 367
Intrathecal Treatment of Influenza Meningitis 367
Intrathecal Treatment of Acute Anterior Poliomyelitis 368
INtrathecal Treatment of Syphilis of The Nervous Syatem 368
Intrathecal Treatment of Tetanus 370
Intrathecal Treatment of Chorea 370
Spinal Drainage and Lavage 371
APPENDIX MONOGRAPHS ON CEREBROSPINAL FLUID 373