SOME OBSERVATIONS ON THE CEREBROSPINAL FLUID IN CLOSED HEAD INJURIES.

SINCE the introduction of lumbar puncture as a therapeutic and diagnostic procedure in acute head injuries by Quincke in 1904, much has been written on the subject, particularly in regard to the indications and contra-indicationsfor the procedure. Nevertheless, whilst the alteration in pressure, cytology and chemistry of the cerebrospinal fluid occurring in the acute state following a head injury has already been frequently discussed (usually in terms of clinical impressions) in the literature, there still seems to be room for further factual studies of the resultant changes on the lines notably adopted by Ritchie Russell (1932); particularly as these changes naturally have an important bearing on the treatment of acute head injuries, on which there are not a few conflicting views at the present time. This investigation was undertaken, therefore, with a view to assessing the actual changes in cerebrospinal fluid pressure, the frequency and the degree of subarachnoid bleeding demonstrable by early lumbar puncture in acute head injuries, as well as the relation of these changes to such factors as severity of injury and the resultant alteration in the mental state.