Presented to the Brooklyn Pathological Society, April 12, 1888.
On September 25th, 1888, was called to attend Mrs. H. in confinement.
Patient was a primipara about twenty years of age, and a native of
Mexico. Both she and her husband were free from any deformity, and had
always enjoyed excellent health. Duration of pregnancy about nine
months. Upon examination, I found the breech presenting. Labor
progressed favorably, and nothing occurred worthy of special note,
except that about half an hour before delivery, while making a digital
examination, I discovered over the sacrum of the child a loose flap or
fold of tissue, the nature of which at that time I was unable to
satisfactorily determine.
After delivery I found the following condition: Over the lumbosacral
region were two flaps, each two inches and a half long and about an inch
wide; the outer borders were free, the middle portions of the inner
borders were attached over the spinal column, and at this point of
attachment there was an opening which communicated with the spinal
canal. This opening was about large enough to admit the tip of the
little finger. The anterior surface of the flaps was simply a
continuation of the integument, the posterior surface was a continuation
and expansion of the membranes of the spinal cord. The edges of these
folds were straight and showed no signs whatever of having been torn or
lacerated. There was atrophy and complete paralysis of both lower limbs.
No other deformities existed. Flaps were placed in close apposition over
the opening into the spinal canal, and upon them was put a thick
compress, held in place by a wide bandage. The child continued to do
well until the morning of the fourth day, when convulsions developed,
and death took place in a few hours.
Dissection showed that there was a fissure of the spinal canal extending
from the second lumbar vertebra down to the sacrum, the laminæ being
absent. Both sciatic nerves were given off in the usual manner.