We pass over those deviations of congenital development which we have already discussed, and devote this section to the consideration of the remaining anomalies, although we have already cursorily touched upon most of them.

We not unfrequently meet with a hypertrophy of the foetus, or of individual organs and sections of the foetal body. Children are sometimes born, either at the proper period or later, of excessive dimensions, over-nourished and endowed with all the characters of over-ripeness. Among the partial hypertrophies we have to specify those of the brain, of the thyroid and thymus glands, the hypertrophy of certain parts of the skeleton, as the premature development of the cranium, the excess in the digital phalanges of the hands or feet, the so-called hypertrophies of the liver and the spleen.

The entire foetus may be atrophic, in consequence of the cachectic state of the mother; but those cases are of greater importance which result from disease of the membranes, the placenta, and the cord; and if occurring at the earliest period of embryonic life, may cause the embryo to disappear entirely, or so far as to leave but mere traces. Partial atrophy, as a result of disease in the nervous centres, occasionally affects the extremities; in rare cases, it may be the consequence of pressure exerted by the uterus on the funiculus umbilicalis.

The most various curvatures and malpositions of the bones (pes equinus), curvatures and dislocations of the joints, may be brought on by contraction of the uterine cavity, external pressure, convulsions, and tonic spasms of the foetus. Convulsions or traumatic injuries may induce fractures of the bones, and even rupture of the abdominal viscera, and especially of the liver and the intestines.

To these lesions of continuity we have to add the spontaneous amputations of extremities (Simpson, Montgomery), occurring at an early stage of embryonic life; they have not as yet been sufficiently accounted for, and are to be carefully distinguished from cases of arrest of development.

The foetus may be affected by general plethora, as well as by congestion of separate organs, which ultimately degenerates into hemorrhage and apoplexy. The brain and spinal marrow and their membranes, the thyroid gland, the liver, the kidneys, and the suprarenal capsules are particularly liable to be attacked.

A Most Important Morbid Process

A Most Important Morbid Process and one of very frequent occurrence, the peculiarities of which in the foetus are almost unknown, is inflammation. Its terminations and consequences are of great value in regard to the doctrine of deviations of formations, for a reconstruction of which we are particularly indebted to Simpson, whose views on the subject are of peculiar interest. Inflammation attacks almost all the organs, including those peculiar to foetal life, the thymus, and the suprarenal capsules. Its terminations and consequences the more resemble those which it presents in the infant and adult, the more mature the foetus, the more developed the tissues attacked, are. It gives rise to plastic products with adhesions between adjoining organs, accompanied by the most various new formations; it induces suppuration and suppurative destruction, though very rarely induration. On the other hand, it causes in very delicate embryos, and in particular tissues of peculiar delicacy, a very rapid dissolution, or liquefaction, either of a benignant or a malignant character.

Dropsy of the different cavities and anasarca, have been noticed in the foetus; among the former, hydrocephalus and hydrorrhachis are both in themselves, and on account of the consequent arrest of development and the malformation of the cranium and of other parts, of chief importance. Cutaneous dropsy sometimes attacks the foetus in a very eminent degree, and is generally combined with dropsical accumulations in the large cavities. It has been particularly and repeatedly observed in the children born of women who had themselves suffered from dropsy during pregnancy (West); it also occurs under other circumstances, and in these cases probably originates in obstacles to the circulation through the umbilical vessels and the foetal portion of the placenta.

Even adventitious growths occur, though rarely, in the foetus; we occasionally discover cysts, particularly the simple cyst, lipomatous, sarcomatous, and even cancerous products. Although many of the cases that have been considered as cancerous, rest upon a misapprehension, the occurrence of carcinoma is undoubted and of peculiar interest. Foetal cancer is allied to the cancer, and especially to the medullary variety, occurring during infancy; we communicate the following case that we have ourselves observed, as one of peculiar interest.

A female infant, of 16 1/2 inches in length, and 27 days old, presented in the region of the pudenda, anus, and sacrum, a tumor tensely invested by the cutaneous covering. It was of the size of a goose's egg, and had, towards the sacral and lower lumbar vertebrae, a conoid process of the size of a hazel-nut. On its left side were noticed the vaginal and anal opening, which were pushed downwards and separated, the latter appearing in the shape of an excoriated semilunar fissure. The child was born with this tumor. It lay external to the pelvis, under the skin and the perineal muscles; posteriorly, fibres of the glutaeus magnus spread over it. It was surrounded by a fibrous sheath, and consisted of various tissues; the inferior third, and the portion that lay more to the right, resembled the reddish-gray cerebral substance of an infant's brain, whereas the two upper thirds presented a follicular tissue with small loculi, containing a grayish gelatine. The tumor extended into the pelvis by the inferior aperture, in the shape of an oval serous cyst of the size of a walnut, the internal surface of which appeared here and there to contain a black pigment, and presented a few ridge-like duplicatures. The follicular portion of the morbid product also forced its way through the sacral fissure into the medullary canal, and then presented a process closely resembling the external conical process, except that it was smaller.

This adventitious product is nothing more than a combination of areolar and medullary cancer, the circumference of which is converted into a cyst.

Tubercle occurs but in very rare cases in the foetus; we ourselves have never observed it.

The foetal fluids are undoubtedly liable to numerous acute and chronic morbid affections, as is evidenced by the occurrence of various exanthe-matic and impetiginous diseases, as well as cachectic disorders, such as rickets, syphilis, tubercle, peculiar hypertrophies of the liver, the spleen, the lymphatic glands.