Cruveilhier relates a case of a child which lived only a few minutes, and under whose sternum there was a large collection of pus which was lodged partly in the thymus and partly in the anterior mediastinum; the thymus was much enlarged, contained several tuber culated cells filled with pus. Ile considers it a tubercular affection of the thymus, or in other words, a chronic inflammation of that organ.* Veront 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,§ Ilufeland,l1 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 hemorrhage 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,11 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 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 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 dev eloped, 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 if 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. Lec,t 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.