050 



TERATOLOGY. 



3. Fissure of the anterior abdominal Wall. 



a. Complete ectopia of the abdominal viscera. 

 The abdominal cavity is in general the last 

 closed. When it alone remains open, the 

 abdominal viscera only lie out of the body. 

 The fissure is mostly extended from the ensi- 

 form process of the sternum to the pubic 

 bones. One of the umbilical arteries is in ge- 

 neral wanting. Commonly this malformation is 

 complicated with adhesion of the membranes 

 of the ovum or of the placenta to the divided 

 integuments of the abdomen, with a cloaca, 

 with defective generative or uropoietic organs, 

 and with an incomplete pubic articulation. . 



b. Congenital umbilical hernia. In a less 

 degree of deformity, the fissure is limited to 

 the epigastric region, above the insertion of 

 the umbilical cord, because this part of the 

 abdomen remains longest open. This gives 

 origin to congenital umbilical hernia. The 

 umbilical cord passes under the viscera, which 

 lie exposed, or are only covered by the peri- 

 toneum. In the last case a sort of hernial 

 sac is formed, which has a cylindrical or glo- 

 bular form, and is produced by the two coats 

 of the ovum. 



The external coat is that part of the amnion 

 which is the covering of the umbilical cord; 

 the internal, the peritoneum, which is con- 

 sidered by Meckel as a continuation of the 

 chorion from the umbilical cord. All these 

 facts prove that congenital umbilical hernia is 

 caused by an arrest of developement at that 

 stage, in which a part of the abdominal viscera 

 are contained in the sheath of the umbilical cord. 

 The size of the tumor is variously modified 

 by the number and by the volume of the 

 viscera contained in it. When it contains 

 the liver, it is of a bluish colour. The viscera 

 lying in it, are always in an imperfect con- 

 dition. Only four cases are known, in which 

 the life of the malformed child lasted for any 

 time after birth (Meckel, Cruveilhier, Ribke, 

 Van der Voort) ; in the case of Van der 

 Voort for eight, in that of Ribke for twelve 

 months. In all these cases the external coat 

 of the hernial sac has mortified, and the tu- 

 mor has become gradually covered by the skin. 

 An accurate diagnosis of this malformation is 

 of great value. In two cases, in which it was 

 not accurately recognised, a ligature was put 

 round the tumor, and it was cut off. One of 

 these cases was the subject of an interesting 

 law proceeding. 



c. Congenital ventral hernia. The abdo- 

 minal cavity may also remain open, below the 

 umbilical cord (Fried, Hasenest, Bouchard). 

 This produces congenital ventral hernia. The 

 viscera lie exposed, or are covered by the 

 peritoneum. 



d. Acquired umbilical hernia. Hernia in the 

 umbilical cicatrix ought to be distinguished 

 from all these forms of ectopia. It is not 

 a congenital deformity, but is produced after 

 birth by an expansion of the umbilical cicatrix 

 to a globular, a cylindrical, or a conical tumor. 

 It is often observed in adults. If we adopt 

 for these the name of acquired, and for those 



of new-born children that of congenital hernia, 

 it would be better to give to the true con- 

 genital umbilical hernia the name of hernia 

 funiculi umbilicalis (Seiler). 



4. Fissure of the pubic and hypogastric Regions. 



It sometimes happens that the pubic region 

 alone remains open. For a correct idea of the 

 malformations produced by it, it should be 

 borne in mind that in the Mammalia, and, as re- 

 cent observations teach, also in Man (Bischoff, 

 Wagner, A. Thompson, Coste, Sevres, Ar- 

 nold), the urinary bladder is formed by the 

 allantois. This is originally in communication 

 with the inferior part of the intestinal canal, 

 so as to form for both a common outlet, called 

 a cloaca, from which are evolved at a later 

 period the peripheral openings of the in- 

 testinal tube, and of the uropoietic and ge- 

 nerative organs. The pubic bones are formed 

 later than the iliac (Meckel) and the pre- 

 viously existing ischiatic bones. Their forma- 

 tion proceeds from the outside to the inside ; 

 therefore they are at first separated from each 

 other by a large interval, and subsequently ap- 

 proach each other, in a gradual manner, for the 

 formation of an amphiarthrosis. The foetus may 

 be arrested at this period of incomplete pubic 

 articulation. In an observation of Walter, 

 there was a fissure in the pubic region, though 

 the genital and uropoietic organs were not 

 malformed. This is the normal condition of 

 some mammalia, and of the majority of birds. 

 An arrest of deve'.opement may also take 

 place at the period when there exists a fusion 

 between the rectum and the allantois. Of 

 this various forms occur. 



a. Formation of a cloaca. A cloaca is said to 

 exist, when the generative and urinary organs 

 and the rectum have a common outlet. This 

 is often complicated with ectopia of the tho- 

 racic and abdominal viscera. The cloaca may 

 also exist alone. In its highest degree, the 

 ureters, the imperfect organs of generation, 

 and the opening of the rectum, are situated 

 close to each other in a circular depression 

 (Petit). In other cases, which approach 

 more to the natural condition, there is a 

 primordial urinary bladder, formed of two se- 

 parate parts (Mery), or merely constituted 

 by its bare posterior wall. Fig. 602. shows 

 how the fissured urinary bladder may be 

 complicated with the formation of a cloaca. 



In most of the cases which I have pub- 

 lished, the opening through which the faeces 

 are evacuated, is formed by the ileum, and 

 the rectum is closed or wanting. This con- 

 firms the original formation of the intestinal 

 tube by a mouth- and anus-gut. In a case men- 

 tioned by Jung these two portions are quite 

 separate, and have each its separate open- 

 ing on the prolapsed posterior wall of the 

 urinary bladder. When these two openings 

 are fused, the cloaca persists, but approaches 

 more to the natural condition. This may take 

 place in different ways: 1. The orifices of the 

 ureters only may be found on the posterior 

 wall of the bladder, or in the so-called in- 

 verted bladder, while the rectum still coheres 



