l'(KTUS. 



310 



Fig. 148. 



gone from home, shortly after the time of con- 

 ception, and the accident to have occurred in 

 tin 1 same way, the female might have sustained, 

 though most unjustly, a severe injury to her 

 reputation. 



Hernia. Hernia is a very frequent occur- 

 rence in the foetus, especially at the umbilicus, 

 where, in the earlier periods of foetal life, the 

 anterior wall of the abdomen is deficient and 

 the intestines covered by the expansion of the 

 slieatli of the cord, into which they project, in 

 some instances considerably ; of this there are 

 several specimens in the writer's museum ; not 

 unfreqiiently this natural deficiency remains 

 up to the time of birth, and congenital umbi- 

 liral liernia is found in the child. 



In the simpler forms of this affection the her- 

 nial sac contains intestine only, but in other 

 instances which have occurred to the writer, 

 some of which also he has preserved, it con- 

 tains the liver and stomach in addition to 

 almost the whole tract of intestines: such ag- 

 gravated forms are in general connected with 

 other malformations, such as spina bifida, spon- 

 taneous amputation, &c. which combinations 

 are noticed under their respective heads in the 

 present article. In a specimen which occurred 

 recently in the writer's practice the liver was 

 protruded into the sheath of the cord, but all 

 the rest of the abdominal viscera were con- 

 tained in the natural cavity. Inguinal hernia 

 sometimes exists before birth, but is rare. Her- 

 nia cerebri is noticed elsewhere. 



Diaphragmatic hernia, or protrusion of the 

 intestines through the diaphragm into the ca- 



vity of the thorax is of rather rare occurrence, 

 or perhaps, more properly speaking, is less 

 frequently observed, because it presents no 

 extenial physical alteration of form to attract 

 attention. 



Like umbilical hernia in the foetus, it is the 

 result of incomplete developement, because in 

 the earlier periods of fatal life the diaphragm 

 does not exist, and the thoracic and abdominal 

 cavities are one ; and as the muscle afterwards 

 becomes developed from its circumference to- 

 wards the centre, there occurs occasionally an 

 arrest of formation, and in consequence an 

 api-rturc is left, through which the intestines 

 and other abdominal viscera, as they increase 

 in size, pass into the cavity of the thorax, dis- 

 placing the heart and lungs, the latter of which 

 organs are thereby frequently so pressed upon 

 that their developement is prevented, and there 

 is sometimes but a very small portion of them 

 discoverable, especially of the one at the side 

 where the hernia principally exists; which, in 

 a vast majority of the cases which have been 

 met with, has been the left, and then the heart 

 has been pushed over to the right side, where 

 its pulsations in children bom alive have some- 

 times given the first intimation of the existence 

 of the lesion under consideration. In general, 

 children so affected in utero have been either 

 still-born, or have died very soon after birth, a 

 consequence which it appears reasonable to 

 suppose results from the state of the lungs. 

 Hut in some instances the children have sur- 

 vived under such circumstances. Becker saw 

 one that lived five years; and in a case re- 

 corded by Diemerbroeck, where the diaphragm 

 was entirely absent, the child lived seven years, 

 annoyed only with a frequent cough. Riviere 

 and .1. I,. Petit mention instances of life much 

 more prolonged, in the same condition. 



The writer has before him a beautiful speci- 

 men of this abnormal condition, for the oppor- 

 tunity of examining which he is indebted to 

 Dr. E.W. Murphy, as well as for permission 

 to have a drawing taken from the preparation 

 in his possession. (See Jig. 149.) 



The opening in the diaphragm in this case is 

 at the left side, rather anterior to and to the 

 left of that which naturally transmits the 

 oesophagus, and appears to arise in this case 

 from separation of the fibres of the muscle ; a 

 very large quantity of the small intestine is 

 lodged in the left side of the thorax, from 

 which the heart is pushed away over to the 

 right ; the right lung, which lies behind the 

 heart, is natural in structure, but the left does 

 not equal in size half the kernel of an almond, 

 and does not possess the natural pulmonary 

 structure, but appears nearly as solid as the 

 liver. The stomach, spleen, and liver were in 

 their natural situation. The child had also a 

 spina bifida tumour which covered the whole 

 of the sacrum, and deformity of one hand, 

 the thumb of which was attached by a small 

 pedicle to the side of the index finger. In a 

 case related by M. le Docteur Anthony,* which 

 occurred in his practice, the child, which lived 



Sec Journal Hcbdomadairc. Fevricr, 1835. 



