. Röntgen ray diagnosis and therapy . Fig. 89.—Rhachitic Pelvis. if a portion of the fluid can be reduced into the spinal canal bypressure. Paralysis of the lower extremities, of the rectum andbladder point to the existence of myelomeningocele; but all thesesigns are far from being absolutely reliable. Considering onlythis one point—that in meningocele aspiration should be triedfirst, while in the other varities extirpation must be resorted to—it must be admitted that our deficiency in scientific knowledgemakes itself rather strongly felt as regards therapy. Some au-thors advise opening the lo
. Röntgen ray diagnosis and therapy . Fig. 89.—Rhachitic Pelvis. if a portion of the fluid can be reduced into the spinal canal bypressure. Paralysis of the lower extremities, of the rectum andbladder point to the existence of myelomeningocele; but all thesesigns are far from being absolutely reliable. Considering onlythis one point—that in meningocele aspiration should be triedfirst, while in the other varities extirpation must be resorted to—it must be admitted that our deficiency in scientific knowledgemakes itself rather strongly felt as regards therapy. Some au-thors advise opening the lower portions of the tumour first, inorder to ascertain whether the spinal column is open, as in myelo-meningocele, or not, as in meningocele. Koenig and Hildebrandgo so far as to emphasize the necessity to ascertain how the nerve ABDOMEN 137. strings are dispersed, by first making a lateral incision into thetumour, even after they can state that there is a myelomeningocele. All these procedures, thereason for which no surgeonwould dispute until recently,may now be rendered super-fluous by the Rontgen skiagraph shows not onlywhether there is an openingin the bone, but also tells ofthe presence and sometimeseven of the expansion of thenerve substance in the sacFig. 85 shows the meningo-cele of a boy of two Fig. 86 the communicatingopening in the column can berecognised. In those rare cases inwhich the presence of lipomaor fibromyoma is in question,it is again the skiagraph whichgives the needed 87 represents a spec-imen of the lumbo-sacral type of spina bifida in a boy of fiveweeks. The integrity of the spinal column and the cystic char-acter of the contents of the sac are apparent. Fig. 88 illustrates the same case in antero-posterior projection. In this case gangrene of the surface of
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