Puncture of the Cisterna Magna

Since Wegeforth, Ayer and Essick,1in the early part of 1919, worked out the anatomic relationships of the cisterna cerebellomedullaris, and Ayer,2in 1920, made his first report of the clinical use of puncture of the cisterna magna, this procedure has grown of increasing importance from the diagnostic as well as the therapeutic point of view. One cannot help but feel that this operation has not reached the internists, pediatricians and general practitioners for whom it should be of the greatest clinical importance in the early treatment of diseases, especially epidemic cerebrospinal meningitis. The main drawback is that it has been considered a procedure for specialists. This fact limited its employment to a comparatively small group, mainly neurologists and neuropsychiatrists who have made careful studies of the cadaver as emphasized by Ayer in all his reports. However, with the extension of graduate courses and demonstration clinics, knowledge of