The degree of paralysis in spina bifida cystica depends more on the nature and level of the lesion than on the way it is treated; reports of an improvement in the neurological state of infants treated by immediate as against delayed repair have not been confirmed. Ventriculo-atrial drainage, however, is a real advance in the treatment of the hydrocephalus which often accompanies severe spina bifida, If the survivors of the author's series of cases are typical, about 145 places in schools for physically handicapped children will be required per million of population. The intelligence of those who did not develop hydrocephalus is normally distributed. The average I. Q. of the hydrocephalic survivors is about 80.