Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol. 2: Dia-Ins
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit25760/329/
r 
FŒTUS. 
not long since, presented a nearly similar case 
to the Academy of Surgery at Paris. 
In another case, the cast of which was sent 
j to the writer by Dr. Gason of Enniskerry, the 
hernia appears to have taken place at the ante- 
\ rior fontanelle. J. Cloquet met with a case 
where it protruded through the posterior fonta¬ 
nelle.* A remarkable case of this affection, 
occurring in a very unusual situation, was ob¬ 
served at the Hotel Dieu at Paris : a child of 
about a year and a half old was admitted on 
: account of a small tumour, supposed to be a 
ganglion, about as large as a nut, and situated 
at the root of the nose, exactly under the nasal 
process of the frontal bone. At birth it had 
been only as large as a pea ; it was increased in 
size, and became redder when the child cried ; 
1 the child was very irritable; pressure on the 
tumour gave pain, and produced a general 
agitation. Dupuytren suspected that the tu¬ 
mour was formed by a prolongation of the 
brain through some congenital opening in the 
base of the skull, and on consulting with M. 
Breschet, the latter declared that he had met 
with a precisely similar case, in which, on 
dissection, he had found that the tumour was 
formed by a portion of one of the anterior lobes 
! of the brain, which was prolonged through a 
slit in the centre of the ethmoid and sphenoid 
bones down to the root of the nose.f 
As tumours of a very different character 
are frequently observed on the foetal head at 
birth, it is of consequence to be satisfied of 
the diagnostic characters of the encephalocele, 
which is at first a rather tense, smooth, and 
semitransparent tumour, giving generally a 
more or less distinct sense of fluctuation; it 
afterwards collapses and becomes wrinkled and 
:: smaller in dimension ; the integument over it 
is thin but not discoloured, not unfrequently 
pale : in shape the tumour is globular or oval, 
and frequently tapers to a neck where it issues 
from the head, (see fig. 151,) at which point a 
circular aperture can be detected in the bone, 
I the edges of which are in general smoothly 
T rounded off; the tumour is not painful, but, if 
it be compressed by the hand, so as to cause a 
Fig. 151. 
* Diet, de Méd. tom. viii. p. 52. 
+ La Lancette Française, Mars, 1835. 
VOL. II. 
321 
considerable diminution in its volume, the child 
appears to suffer much distress, sometimes 
has the features slightly convulsed for the mo¬ 
ment, and is rendered stupid and paralytic, as 
under other circumstances of cerebral oppres¬ 
sion ; pulsations are to be felt in the tumour 
synchronous with those of the heart; and, 
lastly, the volume of the tumour is suddenly 
increased by any effort on the part of the child, 
as by coughing, straining, crying, &c. 
Most children so affected are either still¬ 
born or live but a very short time; to this, 
however, there are exceptions; one has already 
been mentioned, another has been related on 
the same authority,* and Guyenot brought 
before the Royal Academy of Surgery in 1774, 
a man of thirty-three years of age, with ence¬ 
phalocele in the forehead, who had never ex¬ 
perienced any disturbance of his intellectual 
faculties. Lallemand attempted to remove a 
tumour from the occipital region of a young 
woman of twenty-three, under the idea that it 
was a wen ; but unfortunately, on attempting 
to operate, he found that it was an encephalo¬ 
cele ; inflammation ensued, and the patient 
died. 
Spina bifida.—An affection in many respects 
analogous to that just described to which the 
fœtus is liable, is that which has received the 
name of spina bifida, and consists of a tumour 
situated on some part of the spinal column, 
most frequently over the lumbar vertebrae, but 
it may be found at any point along the whole 
length of that column. The writer lately saw a 
case of it in which the tumour was situated so 
high on the cervical vertebrae, that it was diffi¬ 
cult to determine whether it arose there, or from 
the base of the occipital bone. A similar case 
is recorded by Dr. Collins, in which a child 
was born with a tumour projecting from the 
back of the head nearly as large as the head 
itself; it burst, and the child died in ten hours: 
“ The tumour to a considerable extent was 
covered with hair, the remainder being bare 
skin of a thin texture, with a blueish tinge ; 
with the exception of one spot the size of a 
shilling, which had almost the appearance of 
serous membrane. 
“ The ventricles of the brain were much dila¬ 
ted and communicated freely with the sac. The 
membranes were extremely vascular, and the 
whole contents of the cranium in a dark con¬ 
gested state. The opening through which the 
tumour had formed was about three-eighths of 
an inch in diameter, and half an inch behind 
the foramen magnum. The bones of the head 
generally were very imperfect as to ossifi- 
cation.”f 
The most unusual form of it is that in which 
the tumour appears at the very extremity of the 
sacrum, where it joins the coccyx. Ruysch, 
however, met with an instance of the kind, and 
Genga with another, in which there was also 
hydrocephalus, the fluid of which was eva¬ 
cuated by opening the tumour on the spine.J 
* Loc. jam cit. p. 341. 
+ Practical Treatise on Midwifery, p. 511. 
% Vide Morgagni, epist. xii. art. 9. 
V
        

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