The records for the years 1964 through 1971 of 38 indigent children with meningomyelocele treated at a municipal hospital and 52 nonindigent children with meningomyelocele treated at a private hospital were reviewed. In those cases not lost to follow-up, there was a 50% mortality in the indigent children compared with a 22% mortality in the nonindigent children. Forty-five percent of indigent patients who had shunt procedures became infected, in contrast to 15% of nonindigent children who had shunt procedures. Possible factors influencing success or failure of treatment are discussed, and methods to decrease morbidity and mortality in indigent patients with meningomyelocele are reviewed.