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/lit25760/343/
FŒTUS. 
335 
was much enlarged, contained several tuber- 
culated cells filled with pus. He considers it 
a tubercular affection of the thymus, or in 
other words, a chronic inflammation of that 
organ .* 
Veronf found the thymus at birth very volu¬ 
minous, much inflamed, and containing a 
quantity of pus. 
The thyroid gland.—This organ has been 
found exhibiting similar lesions to those just 
described, instances of which are recorded by 
Francus,! Carus,§ Hufeland,|| and others. 
Abnormal conditions of the fœtal bladder.— 
The consideration of this subject necessarily in¬ 
volves the disputed question, whether urine 
be secreted by the child before birth, of which, 
however, the writer feels fully convinced by 
facts within his own observation. 
In the year 1824 I attended a patient who 
was delivered of a still-born child, which had 
an unusual prominence of the lower part of the 
abdomen ; on laying my hand over the part, I 
ascertained the existence of a tumour of extra¬ 
ordinary firmness, which, on opening, I found 
to be the bladder, distended to the size of a 
large orange, remarkably tense, and containing 
a fluid having the appearance of urine : it was 
not, however, chemically examined ; the ure¬ 
ters were so distended that their coats were 
diaphanous, the diameter of those canals being 
nearly an inch, and they were very much con¬ 
voluted in their length, which greatly exceeded 
what is usual : the pelves of the kidneys were 
in a similar state of distension ; the urethra, 
where it joined the bladder, was completely 
impervious. 
In the course of the last year I was in 
attendance on a lady who had in her former 
labours suffered frightfully from haemorrhage 
coming on after the birth of the child; as a means 
of preventing the recurrence of so dangerous 
an accident, I conducted the delivery with the 
greatest caution, and allowed the uterine con¬ 
traction to effect the expulsion of the child, 
even to the feet : but while it was lying with 
the legs and thighs still within the vagina, the 
penis became partially erected, and a stream 
of urine was expelled in an arch, to the amount 
of at least six or seven ounces. 
The following case, related by Mr. Fearn, 
is a striking example of the degree to which 
the bladder may be affected before birth. After 
the expulsion of the child’s head, the extrac¬ 
tion of the body was found impracticable, even 
after mutilation of the upper extremities, and 
evisceration of the thorax. An elastic tumour 
was now felt in the situation of the diaphragm ; 
this was punctured, and immediately an im¬ 
mense quantity of reddish watery fluid escaped, 
and the delivery was easily completed. On 
* Anat. Pathol, liv. xv. pi. ii. fig. 2. 
t Mem. dans la seance de l’Acad. Royale de 
Med. 26 Août, 1825. 
î Eph. N. C. Dec. 11, an. v. obs. 223. 
$ Leipz. Lit. Zeit. 1816, p. 238 ; 1817, p. 301 ; 
Î253P* 4®^ > 1820, p. 241, and Gynaekologia ii. 
P’|| Journal, 1827, Bd. 64, p. 26. 
II See Lancet, vol. ii. for 1834-35, p, 178. 
examination, the child appeared to have arrived 
at the seventh or eighth month ; the parietes of 
the abdomen were large and flaccid, and in its 
cavity was an immense sac, the coats of which 
were three or four lines in thickness, and tra¬ 
versed in every direction by numerous large 
vessels gorged with blood. This sac was, after 
careful dissection, distinctly made out to be 
the urinary bladder which had been enormously 
distended by the secretion from the kidneys ; its 
muscular fibres were much hypertrophied ; it 
had no communication with the urethra ; the 
penis was well developed, but the urethra passed 
down along it only as far as its membranous 
portion. The kidneys were flabby, and their 
secreting and tubular portions much attenuated, 
owing to the distension the pelvis of each had 
undergone; the ureter on each side, when 
inflated, was nearly an inch in diameter, and at 
one side the valvular opening into the bladder 
was large enough to admit readily the point of 
the little finger. The bladder when filled with 
water contained upivards of two quarts. The 
rectum terminated in a blind pouch in the pelvic 
cavity, and there was, consequently, no anal 
opening.* There was besides an arrest of de¬ 
velopment of the right lower extremity, the 
limb becoming suddenly wasted immediately 
below the knee, and having attached to it a 
foot no larger than, and in every way resem¬ 
bling that of an embryo of the tenth or twelfth 
week. The body appeared in other respects to 
have been tolerably well nourished. 
In a case mentioned by Dr. Lee,f which 
occurred to Mr. Hay of Osnaburg-street, the 
child’s abdomen was so large at birth in the 
eighth month that it passed with difficulty 
through the pelvis, and the enlargement was 
found to arise from an accumulation of fluid 
within the kidneys, produced by an impervious 
state of the ureters. The right kidney, which 
resembled a thin cyst filled with a watery fluid, 
was larger than the head of the child ; the left 
did not exceed half this bulk ; it contained four 
ounces, and the other nine, of a fluid resem¬ 
bling urine, and which, when examined by Dr. 
Prout, was found to contain the chemical con¬ 
stituents of that fluid. The child had also a 
double hare-lip and clubbed feet. 
Mr. Howship examined the body of a child 
which died a few hours after birth in the eighth 
month ; it had distorted feet, imperforate anus, 
and the lower part of the abdomen was occupied 
by a large circumscribed tumour, which proved 
to be the bladder, the coats of which had ac¬ 
quired a very extraordinary degree of strength 
and thickness ; the ureters were thin and mem¬ 
branous from distension and curiously con¬ 
torted, and terminated in what appeared like a 
congeries of small hydatids no larger than garden 
peas, loosely connected together by a cellular 
texture ; these were the kidneys in a morbid state : 
the urethra was impervious. Mr. Howship 
alludes to two other nearly similar cases.J 
* The writer had lately an opportunity of ex¬ 
amining a specimen of this peculiarity in Dr. Mur¬ 
phy’s collection. 
t Med. Chir. Trans, vol. xix. p. 238. 
t Treatise on the Urine, &c. 1823, p. 374, 6.
        

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