Studies in spina bifida cystica. I. General survey and reassessment of the problem.

Nicolai Tulp, the physician whose features are immortalized in Rembrandt's painting 'The School of Anatomy', first suggested the name 'spina bifida' (Tulpius, 1652), though the condition was known to Hippocrates, and the mediaeval Arab physicians are said (Denuce, 1906) to have specifically recognized the absence of the spinous processes in the affected area. Ruysch (1691) distinguished between the paralytic and non-paralytic forms of spina bifida cystica and came near to discovering its association with hydrocephalus when he remarked that the two, allowing for the difference in site, were almost the same disorder. The clear recognition of this association, however, had to wait for Morgagni (1769), and detailed description of the many varieties of spina bifida only began in the later nineteenth century (Marsh, Gould, Clutton, and Parker, 1885; von Recklinghausen, 1886). The literature on the subject of spina bifida is already vast (for bibliography, see Ingraham, Swan, Hamlin, Lowrey, Matson, and Scott, 1943), and it is not without trepidation that we set out to increase it. We do so because not only is spina bifida cystica a common cause of disability in infancy and childhood, but also, as improved medical care allows more crippled children to survive into adult life, it may well become in the future an even greater medical and social problem than it is now (Nash, 1956). It was therefore decided to review a series of cases of spina bifida cystica seen during the years 1948-58. All but 10 ofthese have been traced and the minimum period of follow-up of the survivors is two and a half years.