STUDY OF HUMAN SPINA BIFIDA MONSTER WITH ENCEPHALOCELES 



AND OTHER ABNORMALITIES. 



BY THKODORA WHEELER. 



The specimen described in this study is a human female monster with spina 

 bifida, in which there is total subcutaneous involvement of the spine and a defective 

 occiput. The thoracic and cervical regions of the spine are much shortened, 

 and encephaloceles and numerous other abnormalities are present. The type, 

 though a rather unusual variety of spina bifida, occurs frequently enough to have 

 been recognized and grouped by itself for some time past, and to this group the 

 term iniencephaly has been applied. Because of the striking appearance of these 

 specimens, one or more are usually to be found in any museum of pathology. In the 

 embryological collection of over 1,600 specimens belonging to the Department of 

 Embryology of the Carnegie Institution of Washington, the only example is the 

 one presented in this paper, No. 862 a. It was through the courtesy of the Bridge- 

 port General Hospital that this specimen was obtained. 



Only a short review of the literature on spina bifida will be given here. More 

 complete historical accounts with extensive bibliographies are to be found in articles 

 by Kermauner and by Ernst in Schwalbe's Morphologie der Missbildung (1909), 

 and also in a chapter on spina bifida by Tillmann, in his volume of Deutsche 

 Chirurgie, v. 62 a (1905). The earliest references to many teratological conditions 

 are supposed to be found in folklore and in mythological tales of centaurs, 

 cyclops, mermaids, and such creatures, and it has been suggested that among such 

 stories may likewise be found the first record of spina bifida. Possibly the hairy 

 and cloven-hoofed satyr was originally a fairly normal individual with spina bifida, 

 hypertrichosis, and club feet, whose abnormalities gradually developed through 

 excited hearsay into the hind-quarters of a beast. Even in recent times, in 

 connection with scientific work on this condition, such inaccuracies have only 

 too frequently been paralleled by superficial observations and indefinite specula- 

 tions. However, it is not surprising that a good deal of vagueness has existed in 

 regard to spina bifida, as the subject-matter includes widely dissimilar and very 

 complicated conditions. 



As described among human forms, two chief types are distinguished : the flat- 

 spine type (rachischisis, spina bifida aperta) and the subcutaneous type (cystic, 

 occulta). In both of these forms the greatest variations exist as to location and 

 amount of spinal involvement. In some instances only a single segment is affected ; 

 in others the whole spinal column, together with the cranium, may be involved. 

 Combinations of these two forms are to be found, and also conditions where the 

 two varieties merge into one another. Associated with every type of the condi- 

 tion are found innumerable other abnormalities. 



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