334 



FOITUS. 



tion on the skin, as in the cases recorded by 

 Cruveilhier,* Dr. Collins,f and others. 1 

 am indebted to Dr. Collins for a very accurate 

 drawing of one of his cases; the skin of the 

 child generally was of a very dark hue ; scat- 

 tered over different parts of the body were 

 brownish or copper-coloured blotches, inter- 

 mingled with pustules and with large vesicular 

 patches containing a straw-coloured purulent 

 fluid, along with which there were also nume- 

 rous superficial ulcerations of a bright red 

 colour. 



Affections of the heart and pericardium. 

 Independently of the innumerable irregularities 

 of structure and malformation to which the 

 heart is liable, experience has shewn that both 

 it and its pericardium are sometimes attacked 

 by disease in utero. 



Denis gives an account of a case of hyper- 

 trophy of the heart at birth.J The following 

 case of scirrhous tumours in the heart is 

 described by Billard. On opening the body 

 of a child of three days old he found on the 

 anterior surface of the heart along the iuter- 

 venlricular line three projections of a whitisli 

 colour ; they were buried in the substance of 

 the wall of the left ventricle and the inter- 

 ventricular septum, projecting a little into the 

 cavity of the organ. When cut into, they 

 creaked under the scalpel, and the cut surface 

 exhibited closely interlaced fibres, perfectly 

 resembling, both in appearance and form, those 

 of scirrhus. Cruveilhier details a highly 

 interesting case of aneurism of the right auricle 

 and ventricle in consequence of the obliteration 

 of the orifice of the pulmonary artery. The 

 child was born at eight months and a half in a 

 state of extreme debility, and lived only five 

 days, all which time the respiration was im- 

 perfect, embarrassed, and almost convulsive. 

 On examination the heart was found enor- 

 mously enlarged, filling more than half the 

 thorax, and pushing back the lungs, which were 

 of small size. The right cavities were so en- 

 larged as to constitute seven-eighths of the 

 whole organ ; the valve of the right auriculo- 

 ventricular opening was attached and fixed in 

 such a way that the blood passed as freely 

 from the ventricle into the auricle as in the 

 opposite direction, and there were floating 

 granulations on the free edge of the valve. 

 The orifice of the pulmonary artery was com- 

 pletely obliterated, but otherwise the artery 

 and its divisions were healthy.|| " How could 

 life," asks Cruveilhier, " be maintained for five 



* Anatomic Pathol. liv. xv. pi. 11, p. 6, obs. 



t PracticalTrcatise on Midwifery, Sec. p. 508, 11. 

 On this subject see Doublet, Meraoirc sur la Verole 

 des Enfans nouvcaux-ncs, Paris, 1781. Dr. Beatty, 

 Trans. Assoc. Coll. Phys. in Ireland, vol. iv. p. 31. 

 Haase, de Syphilidis recens natorum pathogenia, 

 Lipsia:, 1828. J. F. H. Albers, Ueber die Er- 

 kenntniss und fiir der Syphiliscbnn Hautkrank- 

 heiten, 1832. Wendt, Kinderkrankheiten iii. Aufl. 

 p. 109. Duges, Diet, de Med. et de Chir. Pra- 

 tique, vol. viii. p. 298. Colics, Practical Obser- 

 vations on the Venereal Disease, 1837, p. 262. 



} Rechcrches d'Anat. ct de Phys. Pathol. &c. 

 des Enfans, p. 353, Paris, 1826. 



6 Maladies des Enfans, p. 647. 



|| Anat. Pathol. liv. xv. pi. ii. p. 4, obs. 8. 



days? there did not pass a drop of blood into 

 the lungs from the right ventricle. I think 

 that the entrance of the blood into the lungs 

 was partially accomplished through the ductus 

 arteriosus ; it is probable that life would have 

 been maintained if the foramen ovale had 

 remained free and open." It appears to me 

 that the explanation here offered by the author 

 is probably correct, as I once saw an instance 

 in which a child affected with the morbus 

 coeruleus lived a year and a half, and on exa- 

 mination we found that the aperture of the 

 pulmonary artery was completely obliterated 

 where it should have joined the right ventricle, 

 but the aorta had an opening into it from both 

 ventricles, and the ductus arteriosus was quite 

 open and free ; and my opinion then was that in 

 this way sufficient blood was transmitted to the 

 lungs and revivified for the imperfect support of 

 life; the foramen ovale was open. Billard also 

 met with an instance of aneurism of the ductus 

 arteriosus in a new-born child : the heart was 

 larger than usual, the duct was of the form of a 

 large cherry-kernel and filled with fibrinous co- 

 agula disposed in layers, as they are foiiml in 

 the aneurisms of adults.* How far this affection 

 truly deserves the name of aneurism seems 

 somewhat doubtful ; but the writer, not long 

 since, met with a similar condition of the 

 ductus arteriosus when examining the body of 

 an infant which died suddenly. 



Pericarditis. Evidences of the existence of 

 this disease have also been frequently met with. 

 In a child only two days old Billard found 

 between the opposite surfaces of the pericar- 

 dium adhesions so firm as to lead to the con- 

 clusion that they must have been formed during 

 fetal lifejf and in the case of a child which 

 lived only an hour Cruveilhier found, in addi- 

 tion to anasarca, ascites, and purpura, effusion 

 in the sac of the pleura and a great quantity of 

 fluid in the pericardium.]: Speaking of this 

 affection, Andral says, " It is a fact which one 

 would never imagine, a priori, that irritation 

 of the pericardium terminating in the formation 

 of false membranes or purulent effusion into 

 its cavity is a common enough disease in the 

 fetus, even more so, perhaps, than in the 

 adult." 



The thymus gland. Considering the num- 

 ber of pathological lesions to which we have 

 just seen that the lungs are liable, although 

 being organs in a state of complete quiescence 

 during foetal life, we cannot be surprised that 

 the thymus, which attains so great a degree of 

 development (if not its greatest) before birth, 

 should frequently exhibit evidences of morbid 

 over-action, and accordingly several instances 

 of the kind have been recorded. 



Cruveilhier relates a case of a child which 

 lived only a few minutes, and under whose 

 sternum there was a large collection of pus 

 which was lodged partly in the thymus and 

 partly in the anterior mediastinum; the thymus 



* Op. jam oil. p. 567, and atlas pi. 8. 

 t Ibid, p. 571. 



j Anat. Pathol. liv. xv. pi. ii. p. 3, obs. 5. 

 & Pathol. Anat. by Townsend and West, vol. ii. 

 p. 702, 3. 



