3*20 



I'CETUS. 



Fig. 149. 



Diaphragmatic Hernia. 



a. The heart, b, b. The intestines which had 

 passed through the diaphragm and occupy the left 

 side of the thorax, displacing the heart, c, c. Por- 

 tions of intestine below the diaphragm, d. The 

 stomach, e. The liver. 



half an hour, had no external appearance of 

 any thing abnormal ; but, on examination after 

 death, the left side of the diaphragm was 

 found not to exist, and the small intestines 

 and spleen were contained in the thorax ; in all 

 other respects the condition of the child exactly 

 resembled that described above.* 



Hernia cerebri or encephalocele. The af- 

 fection to which these names are applied is not 

 of unfrequent occurrence in the foetus. It con- 

 sists of a tumour protruding from the cavity of 

 the cranium through an aperture in the bony 

 structure, covered externally by the integuments, 

 lined internally by the dura mater and arach- 

 noid, and containing portions of the cerebrum 

 or cerebellum, together with serous fluid, with 

 which the cerebral structure is in general infil- 

 trated and softened down ; sometimes the con- 

 tents of the tumour appear to be completely 

 fluid. 



This affection is most frequently situated on 

 some point of the central line of the head, 

 commencing at the root of the nose and ter- 

 minating at the foramen magnum of the occi- 

 pital bone ; these being the situations in which 

 the foetal head, during a considerable period, 

 consists only of membrane; the writer has seen 

 it in the centre of the forehead at the anterior 

 and posterior fontanelle and in the centre of 

 the occipital bone. According to the observa- 

 tions of Mr. Adams,t the tumour is most fre- 

 quently situated at some point in the middle 

 line of the proper occipital portion of the os 



* For other instances of this affection, see Ar- 

 chives Generates, torn. vii. p. 142. Transactions 

 Medicales, torn. xii. p. 359. 



t See an excellent paper by him in the Dublin 

 Medical Journal, vol. ii. p. 321. 



occipitis, as in Dr. Collins's case, to be noticed 

 presently ; but it has happened to the writer to 

 observe it more frequently in the other situa- 

 tions above mentioned. In one of the cases 

 related by Mr. Adams, it occurred just over 

 the right eye, and the subject of it had reached 

 his twentieth year when the account of his case 

 was published. (See/g. 150.) 



Fig. 150. 



In such instances the bony vault of the head 

 is usually much smaller than in ordinary cases, 

 being proportioned to the diminished quantity 

 of its contents, and the sutures and fontanelles 

 are found closed. 



In the first case of this affection which came 

 under the writer's notice, a tumour, about the 

 size and somewhat of the shape of a fresh fig, 

 hung from the centre of the child's forehead 

 down over the face ; it was only partially filled, 

 and apparently with a gelatinous fluid ; when 

 compressed towards the forehead the contents 

 were diminished, but, in the same proportion, 

 the child appeared distressed, and the features 

 began to be distorted, the vault of the cra- 

 nium was in a great measure deficient of its 

 proper developement, the parietal and frontal 

 bones rising very little above the base of the 

 cranium, when they turned over to form the 

 roof of the skull. The child did not present 

 any other external deviation in form ; it lived 

 ten days, taking food, digesting, and perform- 

 ing the other common functions like other chil- 

 dren, but then pined away and died. On exa- 

 mination after death, it was found that the 

 bag which had protruded and hung over the 

 face was lined by the dura mater and arachnoid, 

 that the cerebrum was entirely absent, as was 

 also part of one side of the cerebellum ; the 

 aperture in the frontal bone, through which the 

 hernia passed, was situated just over the root 

 of the nose, in the line of 'the suture, was about 

 three-sixteenths of an inch in diameter, and 

 with smoothly rounded edges; the sutures and 

 fontanelles were quite closed up. M. Moreau, 



