spina Bifida. 173 



stiffness or paralysis of given muscles and without hyperthermia. 

 Rigidity and spasms of the muscles are more characteristic of 

 meningeal hemorrhage, and early paralysis of the spinal. An 

 early hypersesthesia is also most significant of an effusion in 

 the cord, Rapid muscular atrophy is also characteristic of 

 this. The two conditions resemble meningitis and myelitis but 

 come on much more suddenly and are unattended by fever. 



Treatment. Such cases are not hopeful. Cold to the affected 

 part of the spine, keeping the patient in slings to solicit the good 

 effect of gravitation, and giving ergot or lead acetate internally 

 are among the first indications. Later, the treatment would be 

 practically the same as for meningitis or myelitis. In case of 

 complete paralysis from a sudden formation of a large clot, it 

 has even been advised to cut down on the seat of the injury, and 

 evacuate the blood, using antiseptic precautions. 



SPINA BIFIDA. 



This is an elastic swelling consisting of the spinal meninges 

 enclosing a liquid, and in some cases the spinal cord as well, 

 and protruding between the unclosed laminae of the verte- 

 bral rings, usually in the region of the sacrum or loins. It is 

 essentially an arrest of development on the part of the vertebrae 

 and enveloping muscles and skin, and an extension of the cord 

 and effusion of the meningeal and central spinal liquids, in the 

 absence of their bony and muscular support. Hydrocephalus is 

 no uncommon complication. 



The diagnosis may be based on the presence of an elastic, some- 

 what transparent tumor, projecting from the vertebral spines, at 

 birth. If it contains a segment of the cord it is usually flattened, 

 depressed on the summit and often associated with paralysis. 



As occurring in the lower animals this need not be treated. In 

 man, careful antisepsis and evacuation followed by injection of a 

 solution of iodine 10 grs. , iodide of potassium 30 grs. , and glyce- 

 rine I oz., have, in favorable cases, secured obliteration of the 

 sac, but even then the recovery has rarely been complete and 

 permanent. Paralysis and death have usually supervened. 



