322 



FCETUS. 



A case occurred not long since in this city, 

 under the observation of Dr. Murphy, in which 

 at the time of the birth of the child, which 

 presented the breech, a membranous bag 

 protruded before it, and was supposed at the 

 moment to be the membranes of the ovum, 

 but it was found to be the covering of a spina 

 bifida tumour, over which the integuments were 

 deficient: it was of considerable size, nearly 

 equalling that of the child's head, and sprung 

 from the very lowest point of the sacrum, as 

 represented in the subjoined sketch : 



In another instance, for the observation of 

 which the writer is also indebted to Dr. Mur- 

 phy, the tumour occupied the whole length of 

 the sacrum, and was conjoined with diaphrag- 

 matic hernia. In some rare instances there have 

 been more than one tumour : in size these 

 tumours vary from the volume of a small nut 

 to that of a child's head at birth ; and in their 

 form there is also considerable variety, some 

 being very exactly globular, while others are of 

 the long oval, some pyriform with the tapering 

 pedicle next the spine, and others broader in 

 that situation than externally, and so rather 

 representing the form of a cone. As a general 

 description of the affection, its pathological 

 anatomy is this : there is a deficiency in the 

 posterior arch of one or more vertebrae, arising 

 either from imperfect development of these bones, 

 or their division ; through the opening thus 

 caused, protrudes a sac consisting of the in- 

 vesting membrane of the spinal marrow, which 

 sac is in general covered externally by the 

 common integuments, which are sometimes in 

 a healthy state, but more frequently diseased, 

 being sometimes extremely attenuated, either 

 wholly or partially and sometimes in a state of 

 ulceration, or approaching to a state of gangrene; 

 occasionally the integuments are altogether ab- 

 sent, and the membranes form the covering of 

 the tumour ; the contents are a fluid of various 

 characters in different cases ; appearing some- 

 times bloody, puriform, and otherwise con- 



taminated, but when presenting its more natural 

 serous condition, it is found, like that of hy- 

 drocephalus, to contain a smaller proportion of 

 albumen than the fluid of other dropsies. 

 Sometimes the fluid contained in the tumour 

 can be made, merely by pressure on the latter, 

 to retreat and pass along the spinal canal into 

 the ventricles of the brain, producing the sym- 

 ptoms of cerebral compression ; and in such 

 cases also, as in encephalocele, efforts, as of 

 crying, coughing, &c. produce an immediate 

 increase in the size of the tumour : and in the 

 case mentioned by Morgagni, the enlargement 

 of the head from hydrocephalus was diminished, 

 when the spina bifida tumour was opened and 

 its contents allowed to flow out.* 



Spina bifida has been found engaging the 

 whole length of the spinal column, which 

 is, however, very rare, and sometimes it has 

 passed, not through a divided or imperfect 

 vertebra, but through a space accidentally ex- 

 isting between the last lumbar vertebra and the 

 first piece of the sacrum. f 



This affection of the foetus, though some- 

 times found unaccompanied by any other, is in 

 many instances complicated with morbid lesions 

 of an important kind, such as hydrocephalus, 

 malformation of the lower extremities, which 

 are apt to be curved inwards, or otherwise 

 distorted, deficiency in the coverings of the 

 abdomen, and umbilical hernia, hare-lip, &c. : 

 in one instance in the writer's museum, in 

 which there was adhesion between the foetus 

 and the amnion, spina bifida is accompanied by 

 malformation of the lower limbs, and an enor- 

 mous umbilical hernia, in which are contained 

 almost all the abdominal viscera.J (See Jig. 

 153.) 



Fig. 153. 



b, a membranous pouch, which contained the 

 abdominal viscera during uterine existence. 



d, the placenta and its membranes. 



e, the liver, f, intestines. 



g, external opening of vagina. 

 h, an aperture in the situation of the meatus 

 urinarius. 



/, spina bifida tumour. 



* Epist. xii. art. 9. 



t Andral, Mohrenheim, Portal. 



$ [Some time ago the Editor was favoured by his 

 friend Mr. Hale Thomson, Surgeon to the West- 

 minster Hospital, with an opportunity of examining 

 a remarkable case of double spina bifida. There 



