. The diseases of children : medical and surgical. on. A small cavitystill remains. The child died some time afterof scarlet fever. rare for hydrocephalus to appearlater ; hence the mortality, direct orindirect, among these cases is veryhigh. As already mentioned, in certaincases the sac becomes shut off fromthe general cavity of the membranes and the cyst remains without com-munication with any important structures : such result can only occur inmeningoceles ; the tumour then usually requires no treatment ; it may, how-ever, be tapped or injected and excised with probably impunity. These case
. The diseases of children : medical and surgical. on. A small cavitystill remains. The child died some time afterof scarlet fever. rare for hydrocephalus to appearlater ; hence the mortality, direct orindirect, among these cases is veryhigh. As already mentioned, in certaincases the sac becomes shut off fromthe general cavity of the membranes and the cyst remains without com-munication with any important structures : such result can only occur inmeningoceles ; the tumour then usually requires no treatment ; it may, how-ever, be tapped or injected and excised with probably impunity. These casesand sacral spina bifida are the ones most likely to be successfully treated byexcision. In connection with spina bifida must be mentioned the so-called sacralor coccygeal dimple described by Lawson Tait and others. This is asmall dimple or depression in the skin over the lower part of the sacrum orupper part of the coccyx ; it can often be obliterated by traction upon theskin. It probably results from imperfect obliteration of the dorsal 570 Diseases of the Nervous System a sort of incomplete spina bifida. Fig. 125 shows a more marked conditionof the same thing, which was associated with tahpes. It has been pointedout by Dr. Dunlop, of Jersey/ that the dimple may be associated with bendingback of the coccyx. Another view of the ori-gin of this little depression, which is quite com-monly to be found, is that it represents the pos-terior umbilicus, or blastopore. It has beensupposed to be the remains of the neurentericcanal. Congenital sacral fistulse are a moremarked condition of the same thing : they maycause trouble by retention of sebaceous secretionand require removal ; a tuft of hair or caudalappendage has been found in the neighbour-hood of these fistulee (Terrillon, Gueniot, &c.).The case here figured (fig. 125)appears to beanintermediate condition between the ordinaryspina bifida and the rare condition described as spina bifida occulta, in which the laminse ofo
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