A Case of Spina Bifida
Boston Medical and Surgical Journal
parue. He also thinks that the position of the fracture of the skull is suspicious, when the jerk which would be given to the body at the moment of rupture of the umbilical cord is taken into consideration. On -the other hand, the limited nature of the injury to the skull is iu favor of the womau's account, as infanticide is usually attended with greater violence. The opinion given is that the child lived a short time after birth, the full expansion of the lungs being in favor of a more
... r of a more prolonged period of respiration than would transpire in the act of falling from the mother to the ground ; and that the umbilical cord was torn across by the hands, the injury to the head being subsequently produced by iutentional violence. Clinical Department. The child whose photograph I send you herewith was born December 19, 1890, iu Lowell, Mass. The parents are healthy, and have three other perfectly formed and healthy children. Tho occipito-frontal circumference of the child's head was at birth twelve and a quarter inches, while the circumference of the tumor was thirteen and threequarter inches, so that the tumor was slightly larger than the head. The contents of the tumor seem to be entirely fluid. The pedicle is thick and large, its largest diameter being two and one-half inches. The child was born naturally, though the labor was rendered somewhat difficult by the fact that the tumor threw the head into a face presentation, the chin forward. The child is well nourished, nurses well aud is otherwise perfectly formed. A case very similar to this occurred in my practice at the Wayne County (Mich.) Almshouse in 1873, and was then reported in the Western Medical Advance. The woman was a primipara, twenty years old. There was no instrumental interference though the face presented. The tumor was somewhat larger than this recent case, it being fifteen inches in circumference; tho pedicle, however, was only two inches in circumference, The tumor was removed and the parts stitched to getlier, taking care to avoid the brain meniugeB, which extended into the tumor about au inch. The child was not strong aud gave little promise of life iu any case. It died in about twenty-four hours after the operation. The autopsy revealed an opening at the centre of the occipital bone, oval in shape, three-eighths of an inch in its longest diameter. This opening was undoubtedly at the " centre of development " where in early foetal life there was a space between the four parts going to form the occipital boue. The accompanying cut íb taken from a photograph, the head having been stuffed with cotton to preserve its shape.