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From a cold abscess it is diagnosed by the history and progress of the swelling and by the absence of fluctuation. When situated over one of the hernial openings, it closely simulates a hernia; and when it occurs in the middle line of the face, head, or back, it may be mistaken for such other congenital conditions as meningocele or spina bifida.
Tucker describes a baby born in the Sloane Maternity in New York, October 1, 1894, who had a third leg hanging from a bony and fleshy union attached to the dorsal spine. The supernumerary leg was well formed and had a left foot attached to it. Larkin and Jones mention the removal of a meningocele and a supernumerary limb from an infant of four months.
Occasionally a deficiency in the osseous material of the cranium or an abnormal dilatation of the fontanelles gives rise to a hernia of the meninges, which, if accompanied by cerebrospinal fluid in any quantity, causes a large and peculiarly shaped tumor called meningocele. If there is a protrusion of brain-substance itself, a condition known as hernia cerebri results.
The guess may be hazarded that cephalhematoma, hydrocephalus, meningocele, nevi, or an excessive amount of vernix caseosa were the conditions indicated, but a wider acquaintance with the meaning of the cuneiform characters is necessary before any certain identification is possible.
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