FCETUS. 



335 



was much enlarged, contained several tuber- 

 culated cells rilled with pus. He considers it 

 a tubercular affection of the thymus, or in 

 other words, a chronic inflammation of that 

 organ.* 



Veronf found the thymus at birth very volu- 

 minous, much inflamed, and containing a 

 quantity of pus. 



The thyroid gland. This organ has been 

 found exhibiting similar lesions to those just 

 described, instances of which are recorded by 

 Francus,! Carus, Hufeland,|| and others. 



Abnormal conditions of the fatal bladder.' 

 The consideration of this subject necessarily in- 

 volves the disputed question, whether urine 

 be secreted by the child before birth, of which, 

 however, the writer feels fully convinced by 

 facts within his own observation. 



In the year 1824 I attended a patient who 

 was delivered of a still-born child, which had 

 an unusual prominence of the lower part of the 

 abdomen ; on laying my hand over the part, I 

 ascertained the existence of a tumour of extra- 

 ordinary firmness, which, on opening, I found 

 to be the bladder, distended to the size of a 

 large orange, remarkably tense, and containing 

 a fluid having the appearance of urine : it was 

 not, however, chemically examined ; the ure- 

 ters were so distended that their coats were 

 diaphanous, the diameter of those canals being 

 nearly an inch, and they were very much con- 

 voluted in their length, which greatly exceeded 

 what is usual : the pelves of the kidneys were 

 in a similar state of distension ; the urethra, 

 where it joined the bladder, was completely 

 impervious. 



In the course of the last year I was in 

 attendance on a lady who had in her former 

 labours suffered frightfully from haemorrhage 

 coming on after the birth of the child; as a means 

 of preventing the recurrence of so dangerous 

 an accident, I conducted the delivery with the 

 greatest caution, and allowed the uterine con- 

 traction to effect the expulsion of the child, 

 even to the feet : but while it was lying with 

 the legs and thighs still within the vagina, the 

 penis became partially erected, and a stream 

 of urine was expelled in an arch, to the amount 

 of at least six or seven ounces. 



The following case, related by Mr. Fearn,1[ 

 is a striking example of the degree to which 

 the bladder may be affected before birth. After 

 the expulsion of the child's head, the extrac- 

 tion of the body was found impracticable, even 

 after mutilation of the upper extremities, and 

 evisceration of the thorax. An elastic tumour 

 was now felt in the situation of the diaphragm ; 

 this was punctured, and immediately an im- 

 mense quantity of reddish watery fluid escaped, 

 and the delivery was easily completed. On 



* Anat. Pathol. liv. xv. pi. ii. fig. 2. 



f Mem. dans la seance de 1'Acad. Royale de 

 Med. 26 Aout, 1825. 



$ Eph. N. C. Dec. 11, an. v. obs. 223. 



$ Leipz. Lit. Zeit. 1816, p. 238 ; 1817, p. 301 ; 

 1819, p. 452 : 1820, p. 241, and Gynskologia ii. 

 p. 253. 



|| Journal, 1827, Bd. 64, p. 26. 



^ See Lancet, vol. ii. for 1834-35, p. 178. 



examination, the child appeared to have arrived 

 at the seventh or eighth month ; the parietes of 

 the abdomen were large and flaccid, and in its 

 cavity was an immense sac, the coats of which 

 were three or four lines in thickness, and tra- 

 versed in every direction by numerous large 

 vessels gorged with blood. This sac was, after 

 careful dissection, distinctly made out to be 

 the urinary bladder which had been enormously 

 distended by the secretion from the kidneys ; its 

 muscular fibres were much hypertrophied ; it 

 had no communication with the urethra; the 

 penis was well developed, but the urethra passed 

 down along it only as far as its membranous 

 portion. The kidneys were flabby, and their 

 secreting and tubular portions much attenuated, 

 owing to the distension the pelvis of each had 

 undergone; the ureter on each side, when 

 inflated, was nearly an inch in diameter, and at 

 one side the valvular opening into the bladder 

 was large enough to admit readily the point of 

 the little finger. The bladder when filled with 

 water contained upwards of two quarts. The 

 rectum terminated in a blind pouch in the pelvic 

 cavity, and there was, consequently, no anal 

 opening.* There was besides an arrest of de- 

 velopment of the right lower extremity, the 

 limb becoming suddenly wasted immediately 

 below the knee, and having attached to it a 

 foot no larger than, and in every way resem- 

 bling that of an embryo of the tenth or twelfth 

 week. The body appeared in other respects to 

 have been tolerably well nourished. 



In a case mentioned by Dr. Lee,-f- which 

 occurred to Mr. Hay of Osnaburg-street, the 

 child's abdomen was so large at birth in the 

 eighth month that it passed with difficulty 

 through the pelvis, and the enlargement was 

 found to arise from an accumulation of fluid 

 within the kidneys, produced by an impervious 

 state of the ureters. The right kidney, which 

 resembled a thin cyst filled with a watery fluid, 

 was larger than the head of the child ; the left 

 did not exceed half this bulk ; it contained four 

 ounces, and the other nine, of a fluid resem- 

 bling urine, and which, when examined by Dr. 

 Prout, was found to contain the chemical con- 

 stituents of that fluid. The child had also a 

 double hare-lip and clubbed feet. 



Mr. Howship examined the body of a child 

 which died a few hours after birth in the eighth 

 month ; it had distorted feet, imperforate anus, 

 and the lower part of the abdomen was occupied 

 by a large circumscribed tumour, which proved 

 to be the bladder, the coats of which had ac- 

 quired a very extraordinary degree of strength 

 and thickness ; the ureters were thin and mem- 

 branous from distension and curiously con- 

 torted, and terminated in what appeared like a 

 congeries of small hydatids no larger than garden 

 peas, loosely connected together by a cellular 

 texture ; these were the kidneys in a morbid state : 

 the urethra was impervious. Mr. Howship 

 alludes to two other nearly similar cases.J 



* The writer had lately an opportunity of ex- 

 amining a specimen of this peculiarity in Dr. Mur- 

 phy's collection. 



t Med. Chir. Trans, vol. xix. p. 238. 



j Treatise on the Urine, &c. 1823, p. 374, 6. 



