332 



FOETUS. 



found in the foetal lungs a calcareous concre- 

 tion. 



Pleuritis. The effects of inflammation at- 

 tacking the pleura before birth are not unfre- 

 quently seen. Billard relates the case of a 

 child which died on the fourth day after birth, 

 in whom the pleura was found greatly thick- 

 ened, and there were existing between its oppo- 

 site surfaces bands of adhesion as firmly orga- 

 nized as those found in an adult, eight or ten 

 years after a pleurisy.* 



In a case described by Cruveilhier, the child 

 died thirty-six hours after birth, and there was 

 found double pleurisy with effusion of a sero- 

 lactescent pseudo-membranous fluid; and in 

 another instance described by the same writer, 

 in addition to anasarca, ascites, and purpura, 

 there existed hydrothorax, in a seven months' 

 child, which had lived only twelve hours :f 

 other instances are related by Veron, Orfila, 

 and others. 



Purulent effusion. The formation of pus 

 has been frequently observed in the foetus, both 

 in the form of secretion from the lining mem- 

 branes of cavities, and in distinct circumscribed 

 abscesses. 



In cases of pleuritis and peritonitis, as alrea- 

 dy noticed,}; the abdominal and thoracic cavi- 

 ties have contained sero-purulent fluid. Cru- 

 veilhier found pus between the dura mater and 

 skull in a still-born child. 



Abscesses have been found in the thymus 

 and thyroid glands and in the supra-renal cap- 

 sules, see p. 334 ; and Andral found several in 

 one lung.|| 



Ollivier (d'Angers) has given an account of 

 the examination of a foetus of three months and 

 a half, under the skin of whose neck an abscess 

 was found .1[ 



I have very often seen small superficial ab- 

 scesses or pustules existing at birth, especially 

 about the neck, face, and head. 



Dropsical effusions. Several forms of serous 

 effusion have been already mentioned as taking 

 place during foetal life, and affecting either the 

 cellular tissue, the great cavities of the abdo- 

 men and thorax, those of the brain, or confined 

 to particular organs and their appendages. 



Thus notice has been taken of the occurrence 

 of general anasarca, ascites, hydrothorax, hydrops 

 pericardii, serous infiltration of the lung, hydro- 

 cephalus, and hydro-rachitis or spina bifida. 

 In one instance which I examined some years 

 since there was general anasarca and serous 

 effusion into every one of the cavities ; the mo- 

 ther was healthy, but was in the habit of drink- 

 ing enormous quantities of ardent spirits. 



The degree to which the head sometimes be- 

 comes enlarged in utero by dropsy is as extraor- 

 dinary as it is well known, and the difficulty of 

 delivery thus produced is equally a matter of 

 frequent observation with practitioners in mid- 



* Op. jam cit. p. 501. 



t Anat. Pathol. )iv. xv. pi. xi. p. 2, obs. 4. 

 j See Billard, Malad. des Enfans, p. 445. 

 $ Liv. xv. pi. xi. p. 6, obs. 10. 

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

 p. 703. 

 f Arch. Gen. de Med. Mai 1834. 



wifery. In one specimen in my possession, the 

 long diameter of the head is six inches, the trans- 

 verse five and five-eighths, and the circumference 

 nineteen inches : this case gave rise to the ne- 

 cessity of performing cephalotomy. In another 

 instance of twins I was called in, in conse- 

 quence of delivery of the first child being found 

 impracticable, the head being firmly retained 

 after the expulsion of the rest of the body. I 

 succeeded in extricating it, without perforation 

 or instruments of any kind ; it measured eight- 

 een inches and a half in circumference.* In a 

 case related by Perfect, f the head, when extri- 

 cated from the pelvis, measured more than 

 twenty-four inches in circumference. In an 

 instance of an hydrocephalic twin, described by 

 Dr. Patterson,^ the circumference of the head 

 was nearly twenty-one inches. 



Cases have also occurred in which enlarge- 

 ment of the foetal belly from ascites has been 

 sufficient to impede delivery ; no such case has 

 come under the writer's observation, but others 

 have met with them. In another section of 

 this article a case is noticed, in which immense 

 distension of the foetal bladder produced great 

 difficulty in effecting the delivery. See p. 335. 

 In such cases hydrocele has been sometimes 

 observed at birth, and in other instances also.|| 



Ollivier (d'Angers) has described a case of 

 dropsy confined to the cavity of the great epi- 

 ploon in a well-formed child dead-born at the 

 eighth month : the laminae of the peritoneum 

 were separated by a serous fluid of a yellow 

 colour, and perfectly limpid, in which were 

 floating flakes of albumen : the posterior layer 

 of the epiploon was slightly opaque. The 

 tumour distended the abdomen enormously, 

 and there was fluctuation as in ascites : there 

 were present all the characters of circumscribed 

 inflammation of the epiploon. U" 



Induration of the cellular tissue. This pe- 

 culiar affection, in the great majority of 

 instances, does not invade the system for some 

 days after birth, and even then it is of rare 

 occurrence. My experience has not afforded 

 me an opportunity of examining more than 

 two cases, which were not congenital. 



It has been already described in this work 

 (see CELLULAR TISSUE, p. 516), and it ap- 

 pears only necessary to add here that the 

 affection is sometimes found fully established 

 at birth. " Many children," says Andral,** 

 " come into the world with this affection," and 

 we have the testimony of Billardff and others 

 to the same effect. Jaundice has been more 

 frequently found than any other affection in 



* An accurate cast of it is preserved in the wri- 

 ter's museum. 



t Cases in Midwifery, vol. ii. p. 525. 



j Lond. Med. and Surg. Journ. Sept. 17, 1836, 

 p. 86. 



See Gardien, Traite complet d'Accouchemens, 

 torn. iii. p. 106 ; Duges, Diet, de Med. et de Chir, 

 Pratique, torn. viii. p. 303. 



|| Graetzer, Die Krankheiten des Foetus, p. 159 ; 

 Billard, Malad. des Enfans, p. 630. 



1[ Archives Generates de Med. Mai 1834. 



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

 p. 580. 



ft Malad. des Enfans, p. 178. 



