Abstract
In investigations of this barrier by the Walter bromide method, 1 , 2 , 3 , 4 , 5 the value of the procedure as an aid in the diagnosis and the control of treatment of mental diseases was demonstrated. The practical application of the method, however, was seriously hampered by technical drawbacks, one being the comparatively large amount of spinal fluid (8 cc.) necessary for the performance of the test. Such quantity at one puncture is, with few exceptions, contra-indicated in most cases of disease of the central nervous system. In most instances it may be followed by headache, vomiting, backache, etc. In some diseases (such as intracranial tumors) it is quite dangerous and in some cases followed by death. The removal of small quantities is practically never dangerous if carried out with a reasonable degree of care. We have therefore searched for a modification of the original method that would enable us to carry out the test with a smaller quantity of fluid.
We here describe such a modification and its application in 119 cases where both methods were used and checked against each other, and where the large quantity necessary for both determinations could be taken without any untoward sequelae.
After administration of bromides and preparation of patient, 1 15 cc. of venous blood is taken and treated with trichloracetic acid and gold chloride. 1 The solution is then read in a colorimeter against a standard of known bromide content, and the bromide concentration in the blood computed.
Three cc. of spinal fluid is then obtained by lumbar puncture and to this 0.6 cc. of 30% trichloracetic acid is added. After allowing this to stand for 15 minutes, it is filtered and to 2 cc. of the filtrate 0.4 cc. of 0.5% gold chloride is added.
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