F(ETUS. 



not long since, presented a nearly similar case 

 to the Academy of Surgery at Paris. 



In another case, the cast of which was sent 

 to the writer by Dr. Gason of Enniskerry, the 

 hernia appears to have taken place at the ante- 

 rior forxtanelle. J. Cloquet met with a case 

 where it protruded through the posterior fonta- 

 nelle.* A remarkable case of this affection, 

 occurring in a very unusual situation, was ob- 

 served at the Hotel Dieu at Paris : a child of 

 about a year and a half old was admitted on 

 account of a small tumour, supposed to be a 

 ganglion, about as large as a nut, and situated 

 at the root of the nose, exactly under the nasal 

 process of the frontal bone. At birth it had 

 been only as large as a pea ; it was increased in 

 size, and became redder when the child cried; 

 the child was very irritable; pressure on the 

 tumour gave pain, and produced a general 

 agitation. Dupuytren suspected that the tu- 

 mour was formed by a prolongation of the 

 brain through some congenital opening in the 

 base of the skull, and on consulting with M. 

 Breschet, the latter declared that he had met 

 with a precisely similar case, in which, on 

 dissection, he had found that the tumour was 

 formed by a portion of one of the anterior lobes 

 of the brain, which was prolonged through a 

 slit in the centre of the ethmoid and sphenoid 

 bones down to the root of the nose.t 



As tumours of a very different character 

 are frequently observed on the foetal head at 

 birth, it is of consequence to be satisfied of 

 the diagnostic characters of the encephalocele, 

 which is at first a rather tense, smooth, and 

 semitransparent tumour, giving generally a 

 more or less distinct sense of fluctuation; it 

 afterwards collapses and becomes wrinkled and 

 smaller in dimension ; the integument over it 

 is thin but not discoloured, not unfrequently 

 pale : in shape the tumour is globular or oval, 

 and frequently tapers to a neck where it issues 

 from the head, (see Jig. 151,) at which point a 

 circular aperture can be detected in the bone, 

 the edges of which are in general smoothly 

 rounded off; the tumour is not painful, but, if 

 it be compressed by the hand, so as to cause a 



Fig. 151. 



* Diet, de Med. torn. viii. p. 52. 

 + La Lancette Fransaise, Mars, 1835. 

 VOL. II. 



considerable diminution in its volume, the child 

 appears to suffer much distress, sometimes 

 has the features slightly convulsed for the mo- 

 ment, and is rendered stupid and paralytic, as 

 under other circumstances of cerebral oppres- 

 sion ; pulsations are to be felt in the tumour 

 synchronous with those of the heart; and, 

 lastly, the volume of the tumour is suddenly 

 increased by any effort on the part of the child, 

 as by coughing, straining, crying, &c. 



Most children so affected are either still- 

 bora or live but a very short time; to this, 

 however, there are exceptions; one has already 

 been mentioned, another has been related on 

 the same authority,* and Guyenot brought 

 before the Royal Academy of Surgery in 1774, 

 a man of thirty-three years of age, with ence- 

 phalocele in the forehead, who had never ex- 

 perienced any disturbance of his intellectual 

 faculties. Lallemand attempted to remove a 

 tumour from the occipital region of a young 

 woman of twenty-three, under the idea that it 

 was a wen ; but unfortunately, on attempting 

 to operate, he found that it was an encephalo- 

 cele; inflammation ensued, and the patient 

 died. 



Spina bijida. An affection in many respects 

 analogous to that just described to which the 

 foetus is liable, is that which has received the 

 name of spina bifida, and consists of a tumour 

 situated on some part of the spinal column, 

 most frequently over the lumbar vertebrae, but 

 it may be found at any point along the whole 

 length of that column. The writer lately saw a 

 case of it in which the tumour was situated so 

 high on the cervical vertebrae, that it was diffi- 

 cult to determine whether it arose there, or from 

 the base of the occipital bone. A similar case 

 is recorded by Dr. Collins, in which a child 

 was born with a tumour projecting from the 

 back of the head nearly as large as the head 

 itself; it burst, and the child died in ten hours: 

 " The tumour to a considerable extent was 

 covered with hair, the remainder being bare 

 skin of a thin texture, with a blueish tinge ; 

 with the exception of one spot the size of a 

 shilling, which had almost the appearance of 

 serous membrane. 



" The ventricles of the brain were much dila- 

 ted and communicated freely with the sac. The 

 membranes were extremely vascular, and the 

 whole contents of the cranium in a dark con- 

 gested state. The opening through which the 

 tumour had formed was about three-eighths of 

 an inch in diameter, and half an inch behind 

 the foramen magnum. The bones of the head 

 generally were very imperfect as to ossifi- 

 cation.'^ 



The most unusual form of it is that in which 

 the tumour appears at the very extremity of the 

 sacrum, where it joins the coccyx. Ruysch, 

 however, met with an instance of the kind, and 

 Genga with another, in which there was also 

 hydrocephalus, the fluid of which was eva- 

 cuated by opening the tumour on the spine.} 



* Loc. jam cit. p. 341. 



t Practical Treatise on Midwifery, p. 511. 



$ Vide Morgagni, epist. xii. art. 9. 



