102 STUDY OF A HUMAN SPINA BIFIDA MONSTER WITH 



On the left side the seratus anterior is very imperfect. It is represented by a 

 thin sheet of fascia, which originates from the first three ribs and is inserted in the 

 scapula along the vertebral margin near the medial angle. A few scattered muscle- 

 fibers, which also probably represent remnants of the serati, arise over the fourth 

 rib near its base and are inserted into the inferior angle of the scapula. The origin 

 of the fascia and these muscle-fibers is shown in figure 21 by dotted lines. Some 

 other muscles on the left chest wall, consisting of irregular projections from the 

 dorsal bundle which covers the proximal part of the first seven ribs, may be serati 

 fibers which remained in their embryonic position close to the axis. Fibers which 

 probably represent intercostal muscles pushed to the outer surface of the ribs are 

 arranged along the lower border of the fourth rib. These extend onto the lower 

 adjoining ribs. At the outer end they are 2 mm. across and near the base of the 

 ribs they measure 20 mm. (See fig. 21.) Three small muscle bundles are situated 

 at the distal end of the above-mentioned fibers. 



The lateral and anterior abdominal muscles are well developed. Each rectus 

 is 7.4 cm. by 3.2 cm. The right rectus has two inscriptiones tendinse in its upper 

 one-third opposite the sixth and seventh ribs. 



To summarize : Those muscles which have undergone most disturbance are the 

 trapezei, the rhomboidei, the serati posteriores superiores, the serati anteriores, and 

 the sacrospinalis and short back muscles. The location of these muscular abnor- 

 malities, situated near the chief skeletal abnormalities, demonstrates still further 

 that the pathological process is a rather sharply circumscribed one, limited to the 

 neighborhood of the axis. The inclusion of the anterior serati in this group does 

 not contradict the statement, as the early anlage of the serati is very near the axis. 



The muscle disturbances of "monsters" have been but little investigated or 

 recorded. From the scattered observations at present obtainable, any correlation 

 is impossible. 



VISCERA. 



On dissection, the viscera are found crowded and somewhat distorted, but, 

 with the exception of the right lung, are well developed. The thyroid is bilobed 

 and measures 1.5 by 1 cm., the thymus measures 6 by 2.8 by 1.1 cm. The esopha- 

 gus measures 4 cm. from epiglottis to cardia. The lesser curvature of the stomach 

 is 1 cm. and its greater curvature 8 cm. The intestines are well formed. The 

 appendix measures 8.5 cm. The colon is much bent upon itself. Because of unskill- 

 ful handling the positions asssumed by the rest of the intestinal tract were not 

 ascertained. The pericardium, pleura, and diaphragm are intact. The heart is 

 well developed. Sagittal section shows it cut through the right ventricle and left 

 auricle. The valves are well formed. The ductus arteriosus is patent. The left 

 lung is approximately normal; its lateral surface is shown in figure 23; it consists 

 of two lobes and measures 3.9 cm. antero-posteriorly by 3.1 cm. perpendicularly 

 by 1.7 cm. in its thickest medio-lateral diameter near the hilum. The right lung, 

 side view of which is shown in figure 22, about equals the left in volume and is 

 roughly a flattened cone-shape with apex directed anteriorly. Its corresponding 

 measurements are 5.1 by 3.2 by 2.9 cm. It is formed of only one lobe. Along the 

 margins four short fissures exist, directed toward the center; one 12 mm. in length 



