Ilusson examined two children, one of which was dead-born in the seventh month, and had tubercles softened and in a state of suppuration in the lungs, the mother being healthy. I have met with instances of tuber cles in the lungs at birth, but in the cases which came under my observation, the mothers were affected with consumption ; under which circumstances I have, in several instances, found in the placenta a deposit of what appeared to be perfect tubercular matter.
CruveilhierS has noticed instances of tuber cular induration, grey consolidation, scattered masses of tubercular character containing pus, and, in one case, there was serous infiltration of the pulmonary tissue, which was of an olive green colour. Billard" relates similar cases of pulmonary lesion, as does also Lobstein,f f who 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 :t 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.11 011ivier (d'Angers) has given an account of the examination of a fetus of three months and a half, under the skin of whose neck an abscess was found.11 I have very often seen small superficial ab scesses or pustules existing at birth, especially about the neck, face, and head.
Dropsical forms of serous effusion have been already mentioned as taking place during fetal 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 anasarea,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 wifcry. In one specimen in my possession, the long diameter of the head is six inches, the trans verse five and five-eightlis,and the circumference nineteen inches : this case gave rise to the ne cessity of performing eephalotomy. 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. [ 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 MS 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.II 011ivier (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 lamina; 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.t" 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.