. The diseases of infancy and childhood. d inthe sac, and usually forms a part ofits wall. The tumor is smaller than the meningocele, the usual size beingthat of a mandarin orange. It is sessile, never pedunculated. As a ruleit is only partly covered by skin, but has a central area, usually ellipticalin shape, where there is only athin, translucent membrane. Thissurface, which is known as the cen-tral cicatrix, is sometimes coveredwith granulations, and frequentlyulcerates. The tumor often has avertical furrow or a central umbil-ication, corresponding to the at-tachment of the cord on its inne
. The diseases of infancy and childhood. d inthe sac, and usually forms a part ofits wall. The tumor is smaller than the meningocele, the usual size beingthat of a mandarin orange. It is sessile, never pedunculated. As a ruleit is only partly covered by skin, but has a central area, usually ellipticalin shape, where there is only athin, translucent membrane. Thissurface, which is known as the cen-tral cicatrix, is sometimes coveredwith granulations, and frequentlyulcerates. The tumor often has avertical furrow or a central umbil-ication, corresponding to the at-tachment of the cord on its inner -plQsurface. The usual relation of theparts is for the cord to run hori-zontally across the upper part ofthe tumor to the central cicatrix,with which it becomes blended, and from which again the nerves arise. These re-enter the canal at the lowerpart of the tumor, and are distributed below as usual. In other cases thecord joins the wall of the sac soon after its entrance, and its attenuated Fio. 122.—Meningocele, iOne Year Old Child. 123.—Meningomyelocele (partiallydiagrammatic). A, the membranes;B, the cord; C, the integument. Theaccumulation of fluid is in front of thecord, the filaments of which are spreadout, forming a part of the wall of thesac. SPINA BIFIDA 799 fibers are found spread out all over the sac, coming together again belowand entering the spinal canal. The following case, upon which an autopsy was made, is a good ex-ample of the common variety: The child died on the third day after birthfrom rupture of the sac. The tumor occupied the sacral region. Thefirst sacral vertebra was normal, and beneath this the cord passed .out ofthe spinal canal, terminating in the cauda equina soon after entering thesac, and continued back to the central cicatrix. Here nerve filamentsblended with the other tissues in an indefinite structure, from whichagain, with tolerable distinctness, the nerve structures could be seen topass over the wall of the sac and return to the canal
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