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While no one today questions the value or practica- bility of a blood count or urine examination, there still remain a goodly number of practising physicians who deny their little patients the benefit which may be derived from an early lumbar puncture, carefully performed. Dr. Neal (2), of the laboratory of the Depart- ment of Health, of the City of New York, says: "Spinal puncture and the examination of the con- tents are our most reliable aid in the recognition of order cleocin online poliomyelitis." La Fetra (3) wrote as follows: "Lumbar puncture may show bloody fluid where intracranial hemorrhage is diagnosed." Holt (4) in his book states that lumbar puncture "is the most important means of diagnosis we possess," and further says "I believe it to be absolutely free from danger if properly performed." Koplik (5) may be quoted as follows: "Lumbar puncture is devoid of danger and should be cleocin suppositories performed without delay in all cases in which we have reason to suspect meningitis. The aim should be to puncture early, for delay means spread of the inflammation and the rapid advance of the disease." Heiman cleocin 600 mg (6) says: "The procedure itself is harmless and is of the greatest diagnostic value." I believe that quoting the conclusions gained from experience by these clinicians cleocin topical solution will help convince those cleocin t pads who are still skeptical, as to both the value and the safety of this procedure. There is buy cleocin t another group of men who are fairly well convinced of the value of lumbar puncture, but who constantly har- bor fears of infecting the spinal canal and its meninges in making a lumbar puncture. •Read before the East New York Medical Society, May cleocin topical gel 20, 1920. 1022 APFEL: LUMBAR PUNCTURE. [New York Medical Journal. It is not at all rare for one to hear that a lumbar puncture might have been resorted to, but the fear of a fatality as a result was held out. In fact, the case which cleocin cost suggested to me the topic of this paper as being tiinely for discussion was that of a new- born baby seen by me with Dr. A. Koplowitz, where we made the diagnosis of intracranial hemor- rhage and a lumbar puncture was quite naturally suggested. The parents readily consented, cleocin suspension but a relative of the family from New England, who unfortunately happened to be a physician, strenu- ously objected to the procedure as being a dangerous operation, and no reasoning could convert him to the contrary. That patient died, in accordance with the prognosis, within twenty-four hours, having been denied the probable benefit of a lumbar punc- ture with the consequent relief of pressure. Having established the exactness of the diagnosis by cleocin 900 mg the presence of bloody fluid, an immediate operation might have saved that child's life. Even cleocin cream acne though the number of patients who recover are few, the fear of infection should not deter anyone from doing a lumbar puncture, for the same reason that no surgeon would hesitate to do a laparotomy for fear that he may infect the peri- toneum. Michael, of cleocin t acne Chicago (7), states: "The meninges are very difficult to infect by lumbar puncture." It is understood that the most stringent rules of asepsis should be observed in the prepara- tion as well as throughout the course of the opera- tion. Of all the numerous lumbar punctures which I have done, both in the wards, in the outpatient clinic, as well as in my private practice, not one case resulted in infection. Pfaundler (8) reported two hundred cases of lumbar cleocin antibiotic puncture without a single bad result, except in one case, where there was collapse due to the removal of too much fluid. Northrup (8) reported no ill effects in fifty cases. Gumprecht (8), in 1900, collected fifteen cases of cleocin tablets sudden death and added two cases of his own, following lumbar puncture, but in not one of these cases could it be proved with satisfaction that death was due to the limibar cleocin oral puncture itself. McDonald (9) reports no bad results except in one case where cleocin 100 mg the patient suft'ered from headache and syncope, following the removal of fluid. Here also it is possible an exces- sive amount of fluid was removed. Weinlander (10) reports a fatal outcome in a boy of twelve, cleocin iv but his patient suffered from acute nephritis and uremia at the cleocin 2 time of puncture, a sufficient cause for the end result even without his having done a lumbar puncture. During the last epidemic of poliomyelitis, a thousand punctures (4) were performed at the Kingston Avenue Hospital with no ill cleocin phosphate effects in any case. It is perhaps timely to repeat the ad-

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