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gradually diminiftied, or even made to difappear entirely by 

 preffure ; but it always returns again immediately when the 

 preflure is removed. The fluftuation of a fluid is diltinaiy per- 

 ceptible to the touch. The integuments retain their natural 

 colour and appearance. However, the children feem to ex- 

 perience pain when the tumour is comprefied, or when they 

 are placed upon their backs. The fize of the IweUmg is ex- 

 tremely various, it does not often exceed that of an orange ; 

 but, in a few inttances, it is much more confiderable. 



The generality of children affefted with fpina bifida are 

 deficient in (Irength and vigour, and are fubjeft to frequent 

 diarrhoea. Some cannot retain their urine and feces. A 

 weaknefs and emaciation are often particularly obfervable in 

 the lower extremities, which, indeed, are fometimes almoft 

 paralytic. Though molt children agree with this account, 

 it deferves notice, that many others are, in every relpedl ex- 

 cept tlie tumour, perfeAly healthy and well formed. 



When a fpina bifida is diifetted, the fwelling is found to 

 confift. of a fac, filled with an aqueous fluid, and compofed 

 of the integuments, and of the membranous (lieath which 

 lines the canal of the fpinal marrow. The lining of the 

 fpinal canal protrudes through a fiflure in the vertebras. 

 This fiflure is owing to an imperfeft formation of thefe 

 bones, and is commonly found at their pofterior part, where 

 the fpinous procelies would otherwife be. The preternatu- 

 ral opening is fometimes confined to one bone, and then the 

 fwelling frequently has a fmall bafe. In many inltances, the 

 ofRfication of feveral of the vertebrae is not completed be- 

 hind, fo that the canal for the fpinal marrow refembles an 

 open furrow. Even the whole Ipine, from one end to the 

 other, has been found thus imperfeft. (Maret, Mem. de 

 Dijon, vol. ii. p. 105.) The aperture has been known to 

 extend through the body of the affefted vertebra, fo that 

 the finger could be pafled quite through into the abdomen. 

 (Saltzmann, De Tumoribus quibufdam Serofis externis.) 

 In one example, there was not only a furrow in the verte- 

 brae, all the procelies of thefe bones were wanting. Rich- 

 ter's Chir. Bibliothck, 4 b. 2 ft. p. 350. 



In general, the fac is filled with a clear, tranfparent 

 fluid ; but occafionally, the contents are turbid, yellowifh, 

 and bloody. The portion of the fpinal marrow furrounded 

 by the fluid is generally foftened, and almoll like mucus, or 

 thin matter. Mem. de I'Acad. de. Dijon, vol. ii.; and 

 Richter's Anfangfgr. der Wundarzneykunft, band 2. 

 p. 236, Dritte Auflage. 



Children afflifted with this difeafe fometimes fufFer at the 

 fame time from hydrocephalus. They feldom live longer 

 than a year after birth. The tumour generally continues to 

 enlarge. Occafionally it inflames and ulcerates, and then 

 death vei-y foon follows. Children are obferved to live 

 longeil when the fwelling is remote from the head. The in- 

 ftances of perfons attaining a middle age with this diforder 

 are rare, and thefe fubjefts have moftly had their lower ex- 

 tremities in a paralytic ufelefs ftate. Examples, however, 

 are recorded, in which patients labouring under this aflhc- 

 tion, have lived to the ages of eight, feventeen, twenty, and 

 fifty. Acrell K. Vetenfkaps, Ac. Haedhgar, 1748, p. 91. 

 Warner's Cafes in Surgery, p. 136, ed. 4. Hochftaetter, 

 DifT. de Spina Bifida, Altoif, 1703. 



Experience has proved, that punfturing the tumour with 

 i lancet, and thus difcharging the fluid, either at once or 

 gradually, cannot be praftifed without inducing fatal confe- 

 quences. Alfo, when the fwelling ulcerates and burfts of 

 itfelf, the child perilhes ; nor has tying the pedicles of fuch 

 fpinse bifida; as have narrow bafes proved more fuccefsful. 

 Some years ago, Mr. Abernethy fuggefted the method of 

 ktting out the fluid, healing the punfture direftly after- 



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wards, and repeating the fame proceedings as often at ne- 

 cen"ary. (See Abernethy's Surgical and Phyfiological 

 Effays, parts i. and iii.) This gentleman tried the plan in 

 one inllance, and though it was not attended with ultimate 

 fuccefs, it did not feem to bring on the fudden fatal fymp- 

 toms, which arc the ufual effefts of letting out the fluid in 

 the common way. 



This laft propofal, which originated with Mr. Abernethy, 

 is important, inafmuch as recent obfervations have proved, 

 that a praftice founded on the foregoing principles may 

 aftually effeft a cure of a difeafe that, until very lately, 

 always baffled the art of furgery. It is to Mr. A. Cooper 

 that we are indebted for the mode of punfturing fpinac bifida: 

 with a fine needle, thus letting out the fluid from time to time, 

 and promoting a clofure of the opening in the fpine, by ap- 

 plying a comprefs and bandage. The adhefive inflammation, 

 in faft, obliterates the cavity in which the fluid coUefts, and 

 the difeafe ultimately does not return. In one cafe, Mr. A. 

 Cooper feems to have accompliflied in this manner a perfeft 

 cure. See Medico-Chirurgical T.-anf. vol. ii. cafe 2, 

 p. 326. 



This eminent furgeon, however, purfues two modes of 

 treatment for the relief of children afflifted with fpina 

 bifida ; one paUiative, the other radical. 



The firft confilts in treating the cafe as a hernia, and ap. 

 plying a trufs to prevent its dcfcent ; the fecond, in pricking 

 the tumour with a fine needle, and in producing an adhefion 

 of the fides of the fac, fo as to clofe the opening in the fpine, 

 and ftop the difeafe altogether. The firft is attended with 

 no rifli ; the fecond expolcs the patient to much conltitu- 

 tional irritation ; but, if fucceTsfnl, hinders the future re- 

 currence of the difeafe. Even when the adhefive procefs 

 cannot be effeftually accompliflied by the fccjnd plan, the 

 palliative method may yet be tried. See cafe 4, lib. 

 fupra cit. 



Unfortunately, there are numerous cafes of fpinx bifidae 

 which leave no hope of cure. The following examples of 

 this defcription are pointed out by Mr. A. .Cooper. 



If the tumour is connecled with an unnatural enlargement 

 of the head, hydrocephalus intcrnus is conjoined with fpina 

 bifida, and the water will accumulate in the ventricles of the 

 brain, whether the radical or paUiative treatment of the 

 tumour on the back be tried. 



If the lower extremities are paralytic, or the feces and 

 urine are difcharged involuntarily, there is no hope of 

 relief. 



If the tumour has burft at the time of birth, or foon 

 afterwards, little expeftation of a cure can be indulged ; 

 for although the opening in the ikin may be clofed with lint 

 and adhefive plaftcr, and union be produced, fo that no more 

 of the fluid can efcape, yet hydrocephalus internus will 

 follow. 



The deficiency of the fpine is fometimes fo great, that 

 the tumour, at the time of the child's birth, is very confi- 

 derable ; the nerves are protruded out of the fpinal canal ; 

 the fpinal marrow is injured ; and all attempts at a cure mult 

 be unavailing. Medico-Chirurgical Tranf. vol. ii. 



In this diieafe, purgatives and diuretics have been tried in 

 vain ; and no outward applications, excepting preflure, have 

 been found to do the leaft good. Richter has fuggefted 

 making two ifTues near the tumour ; but the propofal hardly 

 brings with it a promife of utility. In fliort, in the prefent 

 ftate of our knowledge, the praftice tried by Mr. A. Cooper 

 is the only one in favour of which fafts and aftual experience 

 can be adduced ; and, if we except the cafes publiflied by 

 this gentleman, we have no inftance on record of a fpina 

 bifida being cured or benefited. 



When 



