KKTUS. 



323 



Tin- spinal marrow is sometimes healthy, 

 but more frequently it is morbidly affected and 

 sometimes deficient; it is sometimes displaced 

 from the spinal canal and lodged in the cavity 

 of the tumour, es|K-cially whrn the latter occurs 

 over the lumbar vertebrae; sometimes the eauda 

 fijuina has been contained in the tumour, and 

 its component nerves found separated and 

 floating in the fluid, or spread over the walls of 

 the tumour. 



Children thus affected seldom survive, what- 

 ever treatment may be adopted ; some rare 

 exceptions have, however, been met with, in 

 which life has been continued even up to 

 adult age; as in the case related by Mr. 

 Jukes,* in which the woman had arrived at the 

 age of twenty at the time of writing the ac- 

 count ; the tumour, which had been at birth 

 about the size of a pigeon's egg, had acquired 

 dimension.- much greater than those of the 

 head ; after birth, the limbs, which had been 

 well formed, became in a few years curved 

 inwards, and the woman was gradually reduced 

 to a most miserable condition. A similar case 

 of survival to the age of twenty is mentioned 

 by \\ arner.f 



A case has been recently recorded in which 

 an enormous tumour of this kind delayed the 

 delivery of the body of the child for two hours 

 after the birth of the head, which it equalled 

 in size, extending from the third cervical verte- 

 bra to the eighth rib, and containing a quart of 

 fluid, which communicated with the ventricles 

 of the brain. J 



were two tumours, the lower one of very consider- 

 able size, and on its posterior wall constricted 

 along the mesial line ; this tumour occupied the 

 whole sacral region. It was distended by a clear 

 straw-coloured fluid ; and an imperfect septum, 

 corresponding in situation to the constriction already 

 mentioned, projected into its cavity. The second 

 tumour was in the lumbar region, and seemed to 

 be a hernia of the spinal meninges, occasioned by 

 a deficiency in the laminae on one side of only two 

 lumbar vertebra: ; it was consequently small, and 

 communicated with the canal by a narrow neck. 

 The lining membrane of this tumour was over- 

 spread by an intricate plexiform arrangement of 

 nerves. In ihis case there were several malforma- 

 tions ; one ankle-joint was in a state of luxation 

 occasioned by the non-devclopcment of the articular 

 extremities of the bones. The intestinal canal was 

 very imperfect, the small intestine composed of a 

 very few coils, and only the ccecal extremity of the 

 large existing, which opened on the pubic region 

 of the abdominal parictcs. The bladder was absent, 

 each ureter terminating in a small sac, which 

 opened on either side of the misplaced anus just 

 mentioned. For a space about an inch and a half 

 in diameter, immediately around where the ureters 

 and intestine opened, the skin of the abdomen was 

 raw, very red, and resembled greatly the exposed 

 mucous membrane of the bladder in cases of 

 extrophy of that viscus. The left kidney had its 

 hilus directed outwards instead of towards the 

 spine ; the ureter consequently turned in behind 

 the kidney in order to reach its destination. The 

 uterus and vagina were natural. This case has 

 already been alluded loin a note at page 390, vol. i. 

 of this work. ED.] 



* See Lond. Med. and Phys. Journ. vol. xlvii. 

 p. 106. 



t Cases in Surgery, 4th edit. p. 134. 



{ See f.cneet. No. 261, p. 698. 



Cranial tumuun. It has been already sug- 

 gested that there were other tumours obscrvuMc 

 on the head of the child at birth of a totally 

 different character from the encephalocele, but 

 which might be mistaken for it ; an error into 

 which it is said that the celebrated Ledran fell : 

 these tumours are generally the result of pres- 

 sure during labour, producing ecchymosis and 

 sometimes bloody effusion between the scalp 

 and the cranial bones ; they differ in all respects 

 from the encephalocele ; they are darker co- 

 loured, without any pulsation, situated over 

 the solid part of the bones, especially over the 

 parietal of one or other side ; they cannot be 

 diminished at the instant by pressure, nor does 

 pressure cause the internal distress which results 

 From it when applied to the hernia cerebri ; and 

 lastly, no opening can be ascertained in the 

 bone; but with regard to this last point of 

 diagnosis, I wish to direct attention to a cir- 

 cumstance calculated to embarrass the examiner 

 and lead him into error ; in examining tumours 

 of this kind, it is not unusual to find around 

 their base a denned and slightly elevated cir- 

 cular margin, which at first one would be al- 

 most certain was the circumference of an aper- 

 ture in the bone, but on further examination it 

 will be found, that if the point of the finger be 

 pressed within this circular margin, it will 

 there meet with as decided and firm a resistance 

 as it did outside of the base of the tumour. I 

 have known this peculiarity lead to the pro- 

 nouncing of a very erroneous opinion as to the 

 nature and prognosis of such a tumour. 



These tumours have been found to contain 

 bloody serum, or pure blood, either fluid or 

 coagulated, and sometimes both ; the effusion 

 takes place either between the bone and the 

 pericranium, or external to the latter and 

 under the integuments : the former variety has 

 been called cephalaematome by Nsegele,* who, 

 as well as Schmitt, has given an account of it. 



Having stated that these bloody tumours are 

 generally the result of pressure during labour, 

 I should add that I have reason to believe that 

 they are formed occasionally quite indepen- 

 dently of any such cause. I very lately at- 

 tended a patient who gave birth to a child 

 which had hardly arrived at seven months, with 

 an easy and expeditious labour, yet the infant 

 had a very large tumour covering the greater 

 part of the right parietal bone, having all the 

 characters of the cephalaematome, and was not 

 removed till the termination of a month. 



Injuries of the cranial bones. The same 

 causes which give rise to the formation 

 of the bloody tumours just described, not 

 unfrequently produce fractures or depres- 

 sions of the flat bones of the cranium, espe- 

 cially of the parietals ; more particularly iu 

 cases of contracted pelvis, where the promon- 

 tory of the sacrum projects considerably in- 

 wards ; though I have known such accidents 

 happen without the concurrence of any such 

 state of the pelvis, but from the interposition 

 of an arm between the head and the bony wall 



Zeller, Comment, de Cephalematomate, &c. 

 Heidelberg, MKl. 



Y 2 



