4 QUATERCENTENARY STUDIES IN PATHOLOGY 



In the present paper I describe this specimen, then give a summary of 

 the structure and relations of the epignathi, and finally review some of 

 the more recent theories as to the origin of epignathus. 



I.— DESCRIPTION OF A CASE OF EPIGNATHUS. 



The maternal history of the case is as follows : — The mother is 

 twenty-six years of age, has been married for six years, and has born 

 three children — two males and one female — in every way normal and 

 healthy. The duration of the present pregnancy, as calculated from the 

 end of the last menstrual period, was only thirty-four weeks ; but, as the 

 foetus is full time, conception must have taken place previous to the last 

 menstruation. Towards the end of the first month of pregnancy there 

 is a very definite history of the mother having received a severe nervous 

 shock. 



No special peculiarity was noted about the foetal membranes, liquor 

 amnii or umbilical cord. The part of the umbilical cord still attached to 

 the foetus is normal, and shows one vein and two arteries. 



The foetus is of the male sex, and well developed, the head only 

 showing a malformation. The hair of the scalp is thick, dark, and as 

 much as i8 mm. in length, the eyelids are open, and the free margins of 

 the nails of the fingers project beyond the tips of the digits. Both 

 testicles lie in the scrotum. The foetus measures in length 488 mm. 

 from vertex to sole of foot, 320 mm. from vertex to tip of coccyx, and, 

 with the tumour mass, weighs 3*2 kilograms. The cranial length is 

 120 mm., breadth 95 mm., and circumference 327 mm. There is a centre 

 of ossification in the lower end of the femur. 



The foetus has all the appearance of having been born at full time. 



From the mouth of the foetus there projects a tumour mass almost 

 as large as the foetal head. As seen from the front, the tumour is 

 roughly pyramidal in shape, its base lying against and obscuring the face 

 of the foetus, while its rounded blunt apex projects downwards in front 

 of the thorax. (Fig. i.) The surface of the tumour is roughly divisible 

 into an upper irregular nodulated part, covered with natural-looking 

 skin, and a smaller part below and to the left, covered by a smooth 

 glistening membrane, varying in colour from greyish to dark red. 



(178) 



