- Email: [email protected]
CLINICAL LECTURES ON SURGERY,
LONDON, SATURDAY, MARCH 9.
[1832-33.
spot, and discovered a tumour there ; and on his admission soroe days afterwards, SURGERY, there was a tumour at the anterior and middle part of the biceps, on the tract of the DELIVERED AT THE brachialis muscle. It was as large as a HOTEL DIEU, PARIS, small-sized hen’s egg, free from heat, the colour of the sidn unchanged. It was also BY immoveable, nevertheless the flexion of the M. LE BARON DUPUYTREN, fore-arm on the arm seemed to bring it down a little. According to the patient’s During the present Session, 1832-3. story, the swelling was but eight or ten days old, but decidedly it appeared to be of much [Revised, before translation, by the Baron himself.] greater duration. Several questions suggested themselves 0B HYDAT1D TUMOURS DEVELOPED as to the cause of this tumour. Was it WITHIN MUSCLES AND THE VISCERA. determined bv extravasation? The skin I HAVE sometimes observed hydatid tu- did not offer the violet colour characteristic of ecchymosis. Was the artery injured? mours situated on the traject of muscles, the growth of which often more or less imped- The tumour did not present the movements ed the functions of those parts. The effects of expansion and collapse, synchronous with beatings of the heart, and which conthey produce are of singular variety ; in the stitute the essential signs of aneurism. The to act like these general cysts appear existence of the affection was evidently, foreign bodies, namely, by,driving back or then, anterior to the late accident of the pa of the in the midst parts compressing Could it, consequently, be regarded which they are situated ; thus their symptoms are often confounded with those of as of a scirrhous nature? The absence of and the existence of an obmany other affections, especially with those lancination, fluctuation, overturned this supposi. encysted tumours, which contain scure Examining the swelling with innothing but serosity or albuminous matter tion. creased attention, I was led to suspect it to variable of aspect. be formed by an hydatid cyst, and this Cases of Hydatid Tumours in the Biceps and opinion seemed to me the more probable from an analogous fact that occurred to mv Temporal 31,ttscles. recollection. A young girl of 20 came It is especially the cysts of the acephalo- once to my consultation, with a tumour in cyst variety (situated in the limbs or other the temple, attributed to a violent blow from parts of the extremities of the body) that it a whip she had received from a carter. I is difficult to distinguish during life from made an exploring puncture, which, by the the simple membranous cyst-as is shown way, should always be practised where the by the case I am about to describe. A man, nature of the disease is uncertain. A jet s’tat. about 27, was admitted early this year of serous fluid immediately gushed out. into the Salle Saint Marthe, No. 34. This Increasing the opening, I pressed on both individual, of moderately good constitution, its sides, a large white sac escaped ; it lymphatic temperament, and a printer by was an hydatid developed in the body of trade, was about three weeks before his ad- the temporal muscle. But before ’*’ mission employed in charging his press.* ing these means in the case of the Having been obliged to make an unusually resolvents and astringents were applied for great effort, he states that he experienced a fortnight without producing any change. a smarting in the left arm, opposite the belly On the 15th January the tumour presented of the biceps muscle. He applied his hand most decided fluctuation, and I then took the step of the exploring puncture. Had Query, pulling a sheet."—Pritt. Deu. we, contrary to all expectation, cut upon an to the
CLINICAL LECTURES
ON
tient.
of ordinary
employprinter,
.
No. 497
"
738
abscess, compression with the hand wouldI invariably transparent, and like water. quickly have arrested the hemorrhage, and Sometimes, but rarely, rather larger cysts the ligatures would have been at once ap- are found, containing only a solitary aceplied. If the swelling depended on an ab- pha’.o-cyst. These are probably but of scess, the purulent collection would have recent formation. found
an
issue, and
the end. of incision been
There is
no
authentic
case
of the deve-
accomplished. A bistoury was accord- lopment of acephalo-cysts in the natural ingly introduced; a great quantity of serous cavities of the body. They always origi. in a cyst inserted in the very tissue of fluid, which was scarcely tinged with blood, made its escape from the edges of the some organ. It is true that they have been wound. In pressing on. each side of the seen to escape from different natural cavi. opening, a little white substance was ejected, ties, but there are strong reasons to believe which was recognised to be a muscular that this only takes place after the cysts acephalo-cyst, of oval shape, with very thin which contain the worms have broken in walls, and quite transparent. Two days these situations. Such was incontrovertafter the operation, the patient was in the ibly the case in the individual of whom we best possible state ; he experienced no pain; spoke in a lecture delivered last session. the muscle had resumed its position ; nevertheless a slight inflammation occurred, Paralysis and Atrophy of the Tongue,from an Hydatid in the anterior Condyloid Forawhich terminated by a scanty suppuration. men, pressing on the Lingual Nerve. In eight days he was quite well. When the patient now mentioned left the Characters of Hydatid Cysts. Hotel Dieu, he had a paralysis of the left The acephalo-cysts have long been con- side of the tongue, which had occasioned founded with other morbid vesicles ; but, on the atrophy of this part, but he preserved the more careful cultivation of pathological the sense of taste, which led us to suppose anatomy, it was perceived that a great dif- that the lesion influenced the great hypoference existed between the membranous glossal nerve. In about twoyears after, we vesicular tumour, firm, and strongly con- heard that he had died at the H6pital
thus
nate
nected with the tissue of the organs, and Cachin. M. Gendrin, who had the kind. those softer vesicles, which devoid of all ness to communicate some details about him, adhesion, roll about in accidental cavities states that he retained his intellectual faordinarily lined by these substances. The culties to the last moment. The paralysis former are membranous cysts, of a texture and atrophy of the left side of the tongue analogous, sometimes with the serous,were still more marked than when he left sometimes with the fibrous membranes. The the Hotel Dieu. The sense of taste had latter, on the contrary, are true vesicular slightly diminished at the side affected. The acephalo-cyst is indeed one His generative organs were much weakworms. of the simplest of all animals ; it exhibits ened. Some days before death, symptoms the form of a membranous bladder, of a of compression set in, under which he died. semi-concrete albuminous consistence, in On careful dissection, a great quantity of which the eye, even when aided by the serosity was found in the ventricles of the microscope, can detect no particular organ. brain ; but what is still more remarkable The structure of the cysts in which these is, that a considerable number of hydatids worms are lodged, is rather complicated. were discovered at the base of the cerebel. Their presence is invariable, and it is an one of them had introduced itself into error to assert that they may be deficient.the anterior condyloid foramen, and com. In these cysts we always find a fibrous tisthe nerve in the most sue, of the nature of that of the articular liga- evident manner. Thus was our diagnosis ments and tendons, composed of fibres cross- substantiated. This fact is the more curious, ing each other in various ways, and often as it supports the opinion of the physiovery irregularly. The interior of the cysts logists who believe this nerve to be more is sometimes white, and somewhat smooth, destined to motion and nutrition. but it never presents a surface so even as M. Gendrin has pretended that these hydathat of the serous cysts; but from these it lids were not but it is probable encysted, is further well distinguished by its fibrothe envelopes were torn, and this is aponeurotic aspect. A great number of the still further proved bv the fact of the liver acephalo-cysts are usually present in the containing a considerable number of these same sac. They float in a liquid, which which were comprised in a sometimes, as that contained m their ca- acephalo-cysts,
lum; pressed
hypoglossa.1
specially that
single
cyst. is absolutely pure water, but which Situations of Acephalo-Cysts. often also is yellowish, troubled, puriform, and more or less thick in consistence. But ’ Acpphalo-cysts have been fcund in alwhatever be the nature of the liquid within . most of the human frame. Cysts every tLe cyst, that of the 3cephaJo.cJst is almost full of these ftnim,l1s have been met with in
vities,
B
part
739
thyroid gland, in the folds
firmer than indurated white of egg. The greater part of it was of a reddish tint, rendering it rather opaque, and apparently proceeded from the cyst, having been stained with blood. I sought on the exterior of this vesicle for the little opening by which the body issues, and is externally developed ; but I could not distinguish it ; probably, because the worm had been kept li,) some hours in spirits of wine ; I then opened the caudal vesicle; the substance it thigh, shoulder, and many other situations. contained was of the form of a slightly elongated tubercle, of a yellowish-white colour, opaque, and of the size of a cherryCase of Cysticerca Ladracea in the Great stone. It adhered to the parietes of the Po’CM6MS. vesicle by means of a white, opaque, moist The acephalo-cyst is not the only worm substance, which, when pressed, allowed of man. Some years some little drops of a milk-white fluid to developed in the since, I met the cysticera ladracea in the exude. The matter itself was amorphous. great peroneus muscle. This worm is al- externally tubercular, in size nearly equal that of the substance to which it adhered ways shut up in a cyst biadder, and lives there all alone. The cavity of this cyst, continuity of surface. It appeared to lined by a membranous layer, contains be- have escaped from this substance by a kind sides the cysticerca, which is free, a serosity eventration analogous with that sometimes of the same nature as that contained in the obsetved in some long worms, such as the caudal vesicle of this worm. It principally and lumbrical ascarides. The body, inhabits the muscular, or, rather, the cel- i pressed out between two plates of glass, lular tissue, which connects the different was an inch long, a line and a half in diafibres that compose the muscle. The growth at its base, and about half a line at of this vesicle in the pig is the cause of ! the head. With the microscope, the crown a very serious disease, commonly known by of hooks and the four suckers were very the name of " ladrerie."* easily distinguished. The case just alluded to, is one I saw Hydatids are often met with in dissecabout thirty years since ; 1 found the worm but it is rare to find them in the living in the great peroneus muscle of a man. and even when their existence is This worm, which was at once readily re- ascertained, it is easily understood how cognised as a cysticercus finnus, presented difficult must be the treatment ofa tumour some remarkable peculiarities relative to its devoid of heat or redness, and which the body and containing cyst. The ovoid cyst, patient believes to be owing to some very about eight lines long, adhered strongly by recent cause. We m’lst in this case, as I its external face to the muscular fibres, to have so often insisted on in others, assure the fat and the surrounding cellular tissue. ourselves that the tumour presents no moveIt was lined almost completely by a yellow- ment of expansion or retraction, and then ish matter, scanty in quantity, rather firm, we must make an exploring puncture, which friable in some points, elsewhere more firm, is the best mode of avoiding all mistakes. whitish, or slightly red, Mnd rather like the ! Muscular hydatids should not be confibrin of blood. The proper membrane of with those developed under the the cyst was evidently fibrous, and exhi- annular ligaments of the carpus and tarsusbited a texture and firmness analogous with their seat, their nature, and their symptoms, those of lateral articular How- establish sufficiently marked distinctions. the
of the
peri-
toneum, in the lungs, in the different parts of the cellular tissue external to the perito neum, between the coats of the intestines, between the folds of the epiploon, in the tissue of the liver, in the kidneys, the ovaries, the womb (where they form the majority of vesicular moles), in the anteof the os tancte, in the substance of rior the parietes of the abdomen, in the inter. muscular cellular tissue of the neck, back,
body
to
byof
crinous
meter
tion,
body,
founded
ligaments.
the fibres were more transparent, Case of Ilydatid Cust in the Liaer, successmore intimately bound together, and in this full.1f treated. respect resembled the millcv tint and iromogeueous structure of cartilage, from which, As to visceral hydatids, their characters however, they differed in their flexibility. are generally so obscure, that they are not This proper membrane of the cyst was of recognised during life. There arp, how. unequal tiiickness-in some parts more than ever, some cases wherein the diagnosis half a line. Its fibres were, in part of its may be accomplished. M. Recamier has extent, dyed of a red blood-like colour. The even succeeded in curing an hydatid cyst vesicular worm contained in this cyst, had a the liver, by an exploring puncture-the substance shut up in the caudal bladder, of i application of caustic potash, and the inabout five lines in length, formed of a thin, ! of liquids. uniform membrane, destitute of fibres, and jection i the case in question is so curious, that an extract from it must possess consider* T:,., s:aturan furnish no English fur this term, able ifiterest. An individual, ætat. 20, a ever,
of
740
The cysts in a shop produce a true iliac passion. was working in where the floor fell in; he droptinto a cellar the tissue of the liver give rise to very dif. ten or twelve feet deep, and immediately ferent morbid phencmena, intense in probecame insensible. Next day, a yellowish portion to the volume of the hydatids. tint began to develop itself on the face, and Generally there is a feeling of weight, it soon overspread the whole body. Three rarely of acute pain, sometimes a tumour days after, severe pain was felt in the right more or less manifest in the right hypohypochondriac region, the decubitus on chondrium. The respiration is, in some either side became impossible. On the cases, much embarrassed, and there is a 5th of May, seventh day of the accident, degree of anxiety and uneasiness which the patient came to the Hotel Dieu. The perpetually make the patient change his right hypochondriac region was the seat of position. Sometimes there is jaundice, an irregular tumour, extending from the vomiting, nasal hemorrhage, diarrhoea, and ensiform cartilage within about three fin- obstinate constipation. There is, in some ders’ breadth below the umbilicus. Ob- cases, a trembling of the parts, like the scure fluctuation was perceived, and several movements of a mass of jelly. Aceph.thardish, projecting, and unequal, sub- lo-cysts of the kidneys are only declared by stances, apparently immoveable, were felt the pain they occasion. In the ovaries their effects are quite the same as in the throughthe narietes of the abdomen. In order to learn the nature of the tu- membranous cyst or ovarian dropsy. In mour, it was punctured with a very fine the womb they occasion very different plietrocar, a cupping-glass was applied over nomena, accorùing to the manner in which the canula, and some drops of a very limpid they are lodged in that viscus. When situliquid, in every respect like that of hy- ated deeply in the substance of its walls, a datids, escaped. The subsequent days a feeling of weight is the only immediate large piece of caustic potash was placed on symptom ; but when they are developed the most projecting point of the tumour, between the lining membrane and the subclose to the false ribs. By means of a new stance of the uterus, they eventually dilate application of the caustic, the tumour con- the organ, its neck thins and widens, and tained in the abdomen opened spontane- all the ordinarv phenomena of pregnancy ously, and without pain through the lesion take place ; the acephalo-cysts then constiin the skin, and waves of a yellowish and tute the affection termed the vesicular limpid fluid, mixed with a great number of mole." Hydatids of the lungs occasion hydatids, were expelled with force. The dyspncea in different degrees, the cause of same day an injection of barley- which it is generally impossible to suspect. water was made into the cyst, in order to Case of Hydatid Cyst in the Liver, ivith im. prevent the entrance of air. This injection mense Pulmonary Hydatid Tumour’s. was successively replaced bv saline water, a decoction of barley and The following case, however, is one of and a solution of chloruret of lime. The area of those in which the visceral hydatid has been the cyst soon began to diminish, and when most accurately recognised in the living the patient left the hospital, there only re- person. A young man, æt. 18, had a pemained a small fistula, givingissue to a ripneumony, which was perfectly cured. little greenish foetid, pus. Some particles At 24 he had a violent and obstinate cold, of alimentary and stercoral matter had es- accompanied by very acute pain in, and inability to lie on, the left side. These pains caped through the wound. We see in this remarkable case, that M. ceased with the cold, but reappeared on the Recamier observed the precept we have so slightest occasion. In July, 1800, the pain lone inculcated, of having recourse to an of the side and cough reappeared with such exploring puncture in tumours of doubtful ) violence, that the patient dreaded every He soon complained of a little nature. the seat of which he stated to be in tumour, Symptoms of Visceral Hydatids. the right hypochondrium. ’1 his tumour soon We have said that visceral hydatids a certain volume, and the cough could not, in the great majority of cases, was now accompanied by momentary suffobe recognised in the living subject. The ! cations. In May, 1803, the patient was in following are some symptoms which have the following condition :-He was very been observed in the individuals who thin. When laid down to have the tumour present this affection :-Their presence in ’ examined, it appeared of a volume so coathe cellular tissue, external to the perito- siderable, that the hand could scarcely cover half of it. It was so hard, that it did neum, or in that connecting the tunics of the stomach or intestines, occasions some de- ! not yield to the finger. Its surface seemed rangement in the digestive functions, some- very smooth. It was moveable, and could times even exerting such a strong degree be readily displaced, whether to the right left. The beatingof the heart was so of compression on the intestinal canal as to
house-painter,
"
honeyed
quinquina,
movement.
’ acquired
’one
! or
741
violent, that in the epigastric region it was was in one respect more extraordinary woman came to perceptible to the eye. He occasionally than the preceding. A on account of an Hotel Dieu in 1811, expectorated a little blood, and trembled almost continually. The dyspnoea and feel- inflammatory swellingat the umbilicus. I ing of strangulation had increased in seve- was at first unwilling to touch it, but the
the
rity. These symptoms were worse in cold, fluctuation having become manifest, and rupimproved in mild weather. His pulse ture of the skin being imminent, an inciwas completely natural. By January, 1804, sion was made, which gave issue to a great all the symptoms had increased. In the be- quantity of pus, and hydatid cysts. The ginning of June, he experienced two pa. woman died, and on the examination of her and
roxvsms
of extreme violence, with
an
inter-
body a communication
was
found between
valrof one day, and was almost sufloeated. the opening in the umbilicus and
Perceiving his dangerous
a
cavity
state, he came to contained within the lung, by means of a Paris to obtain medical advice. He per- canal formed through the diaphragm, beformed the journey of ten leagues in a car- tween the liver and the parietes of the abdoriage, went to his apartments, feeling’ him- men. The lung contained a great quantity self comfortable, and supped moderately. of hydatids, and was evidently the primary In a few hours, however, he was attacked seat of the disease. bv another paroxysm of strangulation, in Symptoms coittinved.-T)-eatment. which he died. The body was opened by From the preceding facts it is seen, that M. Geoffroy and myself. Aiitopqy.-Wefound in the left lobe of the symptoms of the presence of these acethe liver a cyst, partly concealed in the sub- phalo-cysts are absolutely the same with stance of this organ, and partly projecting those of many other diseases. The absence into the abdominal cavity, resembling a of other characters of better known maladies bladder, which could be moveJ and dis- is often the only sign which permits us to placed at pleasure. The parietes of the suspect the presence of these animals. We cyst were thin, and, nevertheless, fibrous. can sometimes be convinced of it, however,
They seemed retracted on themselves. of
Their when the cysts which contain them break, either into some of the cavities lined by mucous membranes, or on the external sur.. face of the body, as when they escape through two as large as the yolk of an eg’g. The the parietes of the abdomen. The rupture part of the hydatid cyst external to the of the cysts into mucous cavities has geneliver, adhered strongly to the smaller cur- rallyfavourable results, andarthas even imivature of the stomach ; still there existed no tated nature in this respect. Nevertheless, trace of cicatrix on the external membrane Professor Lassus, in his researches on the of this organ. The thorax was of consi- encysted dropsy of the liver, has related derable dimensions ; the heart,pushed down- several cases in which incision of the cysts wards, corresponded with the upper part of has not saved the patients, but has even acthe epigastrium ; both lungs, compressed, celerated death. According to my own exflattened, and reduced to a thin fold, were perience, incision is usually favourable in thrust towards the anterior part of the those hydatids which attack the external chest, behind the costal cartilages. The parts of the body. It seems even that the rest of the pleural cavities was occupied by disease may disappear without either a natwo very voluminous tumours, each extend- tural or an artificial opening. In these cases ing from the top of the chest to the dia- it is probable that the acephalo-cysts perish phragm, adhering intimately to the ribs, spontaneously, and that the thin part of and to the entire of the rnediastinum; toge- their fluid is absorbed. The cyst then conther forcing the heart out of the thoracic tracts on itself, like an aneurism after Hiinc,ivity. Both tumours, equally tense and ter’s operation, and at the end of a certain fluctuating, had a white, fibrous, thin, but time there remains nothing more than a resisting’ envelop, and each contained an small mass of a substance of a yellowish enormous hydatid, exact!y filling the cyst, colour, in which are seen layers of fragand apparently adhering to it by means of a ments of the former acephalo-cysts. glutinous substance. On measuring the Case a Cyst containingaHuman Fœtus, in of limpid fluid contained in the hydatids, it the Mesentery of a Boy. was found to amount to five and a half pints The visceral in each. These hvdatids were about eleven developed in the inches long. cavity of the pelvis may be confounded with a crowd of tumours too numerous to Ca’e ofPulmonary Ifildatids, enacuaied at name, and which, moreover, have been rethe Umbilicus. peatedly studied. But there is one espeA second case of pulmonary hydatids, ci.ll1y deserving attention from its extreme whuh eshall clescribe hi a few words, and which has been described
cavity contained—1st, a quantity
yellow fluid; 2nd, a great number of little hydatids, generally about the size of a pea, but one or
hydatids
-
.
f curiositv,
742 The marasmus, howa periodical, now difficult to be procured, ter had taken place. namely, the "Recueil des Mémoires de la ever, proceeded, and after some months use-
in
Faculté de Medecine de Paris," and entitled less case
of
a
"
CYST
CONTAINING A
HUMAN
:F(ETUS DEVELOPED IN THE MESENTERY OF A
FOURTEEN." AMÉDÉE BISSIEU,
BOY OF "
treatment he
was
sent
home.
On his
arrival, MM. Guerin and Bertin Desmardelles recognised the tumour. A continual cough soon occurred, accompanied by purulent and foetid expectoration, and a purging of matter also fœtid, in the midst of which,
son of M. Bissieu, of Vernueuil, department de 1’Eure, was born in 1790, of a young, well-formed, healthy six weeks before his death,
was found a who had previously borne another parcel of hairs rolled up on themselves. He child, well-formed and of good constitution. died on the 23rd Prairial, au. 12, six On the night during which his mother supmonths after the attack at Rouen. poses he was conceived, one of the alarms then so frequent in France threw the town Autopsy. into violent agitation, and called the inhaThe opening of the budy took place bitants tumultuously to arms. During her next day, in the presence of MM. Guerin pregnancy, Madame Bissieu experienced and Bertia Desmardelles. These physi. some mental afflictions, as well as frequent cians discovered in the left hypochondrium, indispositions ; nevertheless her labour was below the spleen, a large, thick, mem.
woman,
propitious. It was supposed that during branous sac, adhering to all the surrounding labouran unusual quantity of water escaped parts, and especially to one of the large inthrough the vagina. Immediately after birth testines, which they presumed to be the the infant was confided to a nurse, who colon ; and in this cyst, amidst purulent, finding him weakly and unhealthy, almost thick, and yellow matter, two masses were of nearly equal volume, situated transversely despaired of bringing him up. to his father’s house, he complained, from his before the vertebral column, one applied to first lisp, of pain in the left side of the chest the other, but, nevertheless, quite distinct. and belly. The volume of these parts was Of these two masses, one placed inferiorly, so considerable that it was fearedhe laboured was composed of a large handful of tangled, under organic disease ; but the size was, felted hair ; around this were two little parnevertheless, so variable, that nothing was cels of hair, like what passed by stool six done beyond accommodating his clothes to weeks before death. The other mass, situ. these variations. However, as he grew up ated higher, consisted of an oblong, fleshy, these fears subsided, but the boy’s body I and bonv substance, covered with skin. At continued thin ; he continually complained one of its extremities was seen an imperfect of slight pains in the side ; his appetite was head, With natr, teeth, a aetormea nose, a
Returned
I
fantastic and irregular, and he frequently kind of orbit at one side, and an ear at the suffered from indigestion. On dressing other. At the opposite extremity was a him one day it was perceived two of limb-like appendage, ending in some tonguehis left ribs were more elevated and pro- shaped points armed with nails. Lastly, minent than the others ; but this was at- from the centre of the mass proceeded a tributed to the effects of a habit he had con- thick; short ligament, inserted into the tracted of sucking the right thumb, and in- parietes of the cyst. clining his body to that side. Still less at- °’ Deeming the case deserving of more mitention was excited by the circumstance, nute researches, MM. Guerin and Desmaras at this time the lad was distinguished delles lifted the fleshy mass out of the pelfor a degree of gayety, vivacity, and intelli. vis, and took it away, together with the gence, beyond his age. He was sent toa spleen, and a part of the large inboarding-school at Rouen, where having testine. They ascertained, then, that there spent 18 months, he was suddenly attacked, existed no trace of sexual conformation, on the 13th Nivose, year 12, with acute external or internal, and that the sex of pain in the side and left hypochondrium, Amade Bissieux was indisputably mascuwith continued fever, with exacerbations, line. Lastly, they found on dissecting the and a feeling of oppression. Great swell- rest of the body, that the liver was very ing of the pelvic region also occurred. He voluminous, and the lungs whitish and in. was bled and purged. The fever continued filtrated with pus. Twenty-two days aiter and the swelling made progress. On the this, the body was exhumed, in order to 7th day of his illness, M. Blanche, the surthefacts now related. MM. Delgeon, perceived distinctly in the abdomen, zeuzes and Brouard, who were charged with a hard and very painful tumour extending the investigation, found no trace or anv along the false ribs to the crest of the ilium, sexual organ but those belonging to the rout ded from side to side, and of the size of male. The bladder was cautiously sepaa large melon. Calming treatment was em. the vesiculae seminales discoveled: ployed, but the pain did not diminisli until I the rectum examined internally and exteran abundant purging of fcetid purulent matand nothingextraordinary found.
that
stomach,
I
verify
rated,
nally,
743
the external parts of generation were carefullyinspected, and the testicles, vasa deferentia, and penis, were found to be perfect in formation, but small in size."
Lastly,
and
replaced by common organs, which for the existence of both individuals. In the first case, the monstrosity depends are
serve
mechanical cause, in the second it depends on a primary fault in the organiza-
on a
Remarks on the Case. tion of the germs. One of these explanaA fact so extraordinary excited universal tions being admitted, the sex of the indiattention, and M.Planche forwarded the pre. vidual who so long acted the mother to the paration to the Faculty of Medicine of Paris, fcetus in question, becomes altogether indifand I (said M. Dupuytren) was commis- ferent. The fcetus has progressed, but as sioned to report on this great anomaly in extra-uterine conceptions do. In fact, to the laws of nature. whatever part the fecundated germs are The first fact I ascertained relative to the attached, their mode of nutrition is the position of the foetus, was, that it lay in a same. They derive from all, by means of cyst of the transverse mesocolon, which proper vessels, the nutritive fluids they rehad only communicated very recently with quire. They are developed, and increase in the intestine, through the destruction of size, until the time ordained by nature for a partition by which they were separated. their expulsion, and if they cannot then be In this examination, I ascer- expelled, they putrefy and turn into adipotained that the organized mass contained in eire ; they dry, and become ossified, or else the transverse mesocolon had many points they vegetate until their presence, by irri. of resemblance to a foetus, but that it offered tating’ the adjoining parts, determines the also numerous peculiar dispositions, some of’ formation of abscesses, and procures their which depended essentially on vices of con- discharge. Such is what seems to have hap-in the case before us. formation, while others appeared to be dependent on changes of form successively To ascertain the degree of importance of effected by time and the sojourn of the phenomenon, its exact cause should mass in the mesocolic cyst. The dissec- first be known, and then this importance tion of the mass was, however, the surest would be determined by the light thrown on mode of determining the nature of this pro- the natural process, aud occasional irreguduction. I did so with great care, and I larities of the process of generation. How. discovered the trace of some organs of the ever, putting these considerations aside, senses, a brain, spinal chord, very volu. the case does not the less merit our attenminous nerves, muscles degenerated into a from its rarity and interesting phenosort of fibrous matter, a skeleton, composed mena. of a vertebral column, a head, a pelvis, and the rudiments of almost all the limbs. Lastly, in an umbilical cbord, very short, LECTURES and inserted into the transverse mesocoON lon, beyond the cavity of the intestine, an artery and vein ramified in each of their MEDICAL PATHOLOGY, extremities in the fœtus, and the individual to which it belonged. DELIVERED IN THE UNIVERSITY OF PARIS, The existence of these organs sufficed certainly to establish the individuality of BY M. ANDRAL, D.M.P., &c. &c. this organized mass, although in other respects it was destitute of organs of digesLECTURE XII. tion, of respiration, of the secretion of urine, and of generation. But the absence I, EXTREME SENSIBILITY TO EXISTENCE. of these parts, at most, could only render it one of the monstrous fcetuses destined to GENTLEMEN,—In the last lecture, I indicated the lesions of sensation considered perish at the moment of birth. We shall not dwell on suppositions, more in a state of exaltation (Huperœsthesia), as or less problematical, advanced respecting far as the circumstances referred to the life the presence of this fcetus in the body of the of relations. There remains to be noticed Bissieu. We shall only remark, that the phenomena of the transmission to the young it is by no means rare to see twins born brain of certain exaggerated sensations peradhering by the back, belly, head, or by ceived by the organs of the life of nutrition, several parts at once. A degree of compres- when their sensibilitv is increased to such an sion, more or less strong, exercised by the extent that they perceive their own healthy mother’s organs on the soft embryos, eithej physiological condition,-a the beating during conception or soon after it, may pro- of the heart is, in certain cases, perceptiduce these monstrosities. inother cases ble, and even disagreeable, to the patient, not extremely rare, the twins are so identi- while the physician finds that its normal is not deranged in the least degree. fied, that many organs are deficient in each
continuing
pened
this
tion,
or
action
[1832-33.
spot, and discovered a tumour there ; and on his admission soroe days afterwards, SURGERY, there was a tumour at the anterior and middle part of the biceps, on the tract of the DELIVERED AT THE brachialis muscle. It was as large as a HOTEL DIEU, PARIS, small-sized hen’s egg, free from heat, the colour of the sidn unchanged. It was also BY immoveable, nevertheless the flexion of the M. LE BARON DUPUYTREN, fore-arm on the arm seemed to bring it down a little. According to the patient’s During the present Session, 1832-3. story, the swelling was but eight or ten days old, but decidedly it appeared to be of much [Revised, before translation, by the Baron himself.] greater duration. Several questions suggested themselves 0B HYDAT1D TUMOURS DEVELOPED as to the cause of this tumour. Was it WITHIN MUSCLES AND THE VISCERA. determined bv extravasation? The skin I HAVE sometimes observed hydatid tu- did not offer the violet colour characteristic of ecchymosis. Was the artery injured? mours situated on the traject of muscles, the growth of which often more or less imped- The tumour did not present the movements ed the functions of those parts. The effects of expansion and collapse, synchronous with beatings of the heart, and which conthey produce are of singular variety ; in the stitute the essential signs of aneurism. The to act like these general cysts appear existence of the affection was evidently, foreign bodies, namely, by,driving back or then, anterior to the late accident of the pa of the in the midst parts compressing Could it, consequently, be regarded which they are situated ; thus their symptoms are often confounded with those of as of a scirrhous nature? The absence of and the existence of an obmany other affections, especially with those lancination, fluctuation, overturned this supposi. encysted tumours, which contain scure Examining the swelling with innothing but serosity or albuminous matter tion. creased attention, I was led to suspect it to variable of aspect. be formed by an hydatid cyst, and this Cases of Hydatid Tumours in the Biceps and opinion seemed to me the more probable from an analogous fact that occurred to mv Temporal 31,ttscles. recollection. A young girl of 20 came It is especially the cysts of the acephalo- once to my consultation, with a tumour in cyst variety (situated in the limbs or other the temple, attributed to a violent blow from parts of the extremities of the body) that it a whip she had received from a carter. I is difficult to distinguish during life from made an exploring puncture, which, by the the simple membranous cyst-as is shown way, should always be practised where the by the case I am about to describe. A man, nature of the disease is uncertain. A jet s’tat. about 27, was admitted early this year of serous fluid immediately gushed out. into the Salle Saint Marthe, No. 34. This Increasing the opening, I pressed on both individual, of moderately good constitution, its sides, a large white sac escaped ; it lymphatic temperament, and a printer by was an hydatid developed in the body of trade, was about three weeks before his ad- the temporal muscle. But before ’*’ mission employed in charging his press.* ing these means in the case of the Having been obliged to make an unusually resolvents and astringents were applied for great effort, he states that he experienced a fortnight without producing any change. a smarting in the left arm, opposite the belly On the 15th January the tumour presented of the biceps muscle. He applied his hand most decided fluctuation, and I then took the step of the exploring puncture. Had Query, pulling a sheet."—Pritt. Deu. we, contrary to all expectation, cut upon an to the
CLINICAL LECTURES
ON
tient.
of ordinary
employprinter,
.
No. 497
"
738
abscess, compression with the hand wouldI invariably transparent, and like water. quickly have arrested the hemorrhage, and Sometimes, but rarely, rather larger cysts the ligatures would have been at once ap- are found, containing only a solitary aceplied. If the swelling depended on an ab- pha’.o-cyst. These are probably but of scess, the purulent collection would have recent formation. found
an
issue, and
the end. of incision been
There is
no
authentic
case
of the deve-
accomplished. A bistoury was accord- lopment of acephalo-cysts in the natural ingly introduced; a great quantity of serous cavities of the body. They always origi. in a cyst inserted in the very tissue of fluid, which was scarcely tinged with blood, made its escape from the edges of the some organ. It is true that they have been wound. In pressing on. each side of the seen to escape from different natural cavi. opening, a little white substance was ejected, ties, but there are strong reasons to believe which was recognised to be a muscular that this only takes place after the cysts acephalo-cyst, of oval shape, with very thin which contain the worms have broken in walls, and quite transparent. Two days these situations. Such was incontrovertafter the operation, the patient was in the ibly the case in the individual of whom we best possible state ; he experienced no pain; spoke in a lecture delivered last session. the muscle had resumed its position ; nevertheless a slight inflammation occurred, Paralysis and Atrophy of the Tongue,from an Hydatid in the anterior Condyloid Forawhich terminated by a scanty suppuration. men, pressing on the Lingual Nerve. In eight days he was quite well. When the patient now mentioned left the Characters of Hydatid Cysts. Hotel Dieu, he had a paralysis of the left The acephalo-cysts have long been con- side of the tongue, which had occasioned founded with other morbid vesicles ; but, on the atrophy of this part, but he preserved the more careful cultivation of pathological the sense of taste, which led us to suppose anatomy, it was perceived that a great dif- that the lesion influenced the great hypoference existed between the membranous glossal nerve. In about twoyears after, we vesicular tumour, firm, and strongly con- heard that he had died at the H6pital
thus
nate
nected with the tissue of the organs, and Cachin. M. Gendrin, who had the kind. those softer vesicles, which devoid of all ness to communicate some details about him, adhesion, roll about in accidental cavities states that he retained his intellectual faordinarily lined by these substances. The culties to the last moment. The paralysis former are membranous cysts, of a texture and atrophy of the left side of the tongue analogous, sometimes with the serous,were still more marked than when he left sometimes with the fibrous membranes. The the Hotel Dieu. The sense of taste had latter, on the contrary, are true vesicular slightly diminished at the side affected. The acephalo-cyst is indeed one His generative organs were much weakworms. of the simplest of all animals ; it exhibits ened. Some days before death, symptoms the form of a membranous bladder, of a of compression set in, under which he died. semi-concrete albuminous consistence, in On careful dissection, a great quantity of which the eye, even when aided by the serosity was found in the ventricles of the microscope, can detect no particular organ. brain ; but what is still more remarkable The structure of the cysts in which these is, that a considerable number of hydatids worms are lodged, is rather complicated. were discovered at the base of the cerebel. Their presence is invariable, and it is an one of them had introduced itself into error to assert that they may be deficient.the anterior condyloid foramen, and com. In these cysts we always find a fibrous tisthe nerve in the most sue, of the nature of that of the articular liga- evident manner. Thus was our diagnosis ments and tendons, composed of fibres cross- substantiated. This fact is the more curious, ing each other in various ways, and often as it supports the opinion of the physiovery irregularly. The interior of the cysts logists who believe this nerve to be more is sometimes white, and somewhat smooth, destined to motion and nutrition. but it never presents a surface so even as M. Gendrin has pretended that these hydathat of the serous cysts; but from these it lids were not but it is probable encysted, is further well distinguished by its fibrothe envelopes were torn, and this is aponeurotic aspect. A great number of the still further proved bv the fact of the liver acephalo-cysts are usually present in the containing a considerable number of these same sac. They float in a liquid, which which were comprised in a sometimes, as that contained m their ca- acephalo-cysts,
lum; pressed
hypoglossa.1
specially that
single
cyst. is absolutely pure water, but which Situations of Acephalo-Cysts. often also is yellowish, troubled, puriform, and more or less thick in consistence. But ’ Acpphalo-cysts have been fcund in alwhatever be the nature of the liquid within . most of the human frame. Cysts every tLe cyst, that of the 3cephaJo.cJst is almost full of these ftnim,l1s have been met with in
vities,
B
part
739
thyroid gland, in the folds
firmer than indurated white of egg. The greater part of it was of a reddish tint, rendering it rather opaque, and apparently proceeded from the cyst, having been stained with blood. I sought on the exterior of this vesicle for the little opening by which the body issues, and is externally developed ; but I could not distinguish it ; probably, because the worm had been kept li,) some hours in spirits of wine ; I then opened the caudal vesicle; the substance it thigh, shoulder, and many other situations. contained was of the form of a slightly elongated tubercle, of a yellowish-white colour, opaque, and of the size of a cherryCase of Cysticerca Ladracea in the Great stone. It adhered to the parietes of the Po’CM6MS. vesicle by means of a white, opaque, moist The acephalo-cyst is not the only worm substance, which, when pressed, allowed of man. Some years some little drops of a milk-white fluid to developed in the since, I met the cysticera ladracea in the exude. The matter itself was amorphous. great peroneus muscle. This worm is al- externally tubercular, in size nearly equal that of the substance to which it adhered ways shut up in a cyst biadder, and lives there all alone. The cavity of this cyst, continuity of surface. It appeared to lined by a membranous layer, contains be- have escaped from this substance by a kind sides the cysticerca, which is free, a serosity eventration analogous with that sometimes of the same nature as that contained in the obsetved in some long worms, such as the caudal vesicle of this worm. It principally and lumbrical ascarides. The body, inhabits the muscular, or, rather, the cel- i pressed out between two plates of glass, lular tissue, which connects the different was an inch long, a line and a half in diafibres that compose the muscle. The growth at its base, and about half a line at of this vesicle in the pig is the cause of ! the head. With the microscope, the crown a very serious disease, commonly known by of hooks and the four suckers were very the name of " ladrerie."* easily distinguished. The case just alluded to, is one I saw Hydatids are often met with in dissecabout thirty years since ; 1 found the worm but it is rare to find them in the living in the great peroneus muscle of a man. and even when their existence is This worm, which was at once readily re- ascertained, it is easily understood how cognised as a cysticercus finnus, presented difficult must be the treatment ofa tumour some remarkable peculiarities relative to its devoid of heat or redness, and which the body and containing cyst. The ovoid cyst, patient believes to be owing to some very about eight lines long, adhered strongly by recent cause. We m’lst in this case, as I its external face to the muscular fibres, to have so often insisted on in others, assure the fat and the surrounding cellular tissue. ourselves that the tumour presents no moveIt was lined almost completely by a yellow- ment of expansion or retraction, and then ish matter, scanty in quantity, rather firm, we must make an exploring puncture, which friable in some points, elsewhere more firm, is the best mode of avoiding all mistakes. whitish, or slightly red, Mnd rather like the ! Muscular hydatids should not be confibrin of blood. The proper membrane of with those developed under the the cyst was evidently fibrous, and exhi- annular ligaments of the carpus and tarsusbited a texture and firmness analogous with their seat, their nature, and their symptoms, those of lateral articular How- establish sufficiently marked distinctions. the
of the
peri-
toneum, in the lungs, in the different parts of the cellular tissue external to the perito neum, between the coats of the intestines, between the folds of the epiploon, in the tissue of the liver, in the kidneys, the ovaries, the womb (where they form the majority of vesicular moles), in the anteof the os tancte, in the substance of rior the parietes of the abdomen, in the inter. muscular cellular tissue of the neck, back,
body
to
byof
crinous
meter
tion,
body,
founded
ligaments.
the fibres were more transparent, Case of Ilydatid Cust in the Liaer, successmore intimately bound together, and in this full.1f treated. respect resembled the millcv tint and iromogeueous structure of cartilage, from which, As to visceral hydatids, their characters however, they differed in their flexibility. are generally so obscure, that they are not This proper membrane of the cyst was of recognised during life. There arp, how. unequal tiiickness-in some parts more than ever, some cases wherein the diagnosis half a line. Its fibres were, in part of its may be accomplished. M. Recamier has extent, dyed of a red blood-like colour. The even succeeded in curing an hydatid cyst vesicular worm contained in this cyst, had a the liver, by an exploring puncture-the substance shut up in the caudal bladder, of i application of caustic potash, and the inabout five lines in length, formed of a thin, ! of liquids. uniform membrane, destitute of fibres, and jection i the case in question is so curious, that an extract from it must possess consider* T:,., s:aturan furnish no English fur this term, able ifiterest. An individual, ætat. 20, a ever,
of
740
The cysts in a shop produce a true iliac passion. was working in where the floor fell in; he droptinto a cellar the tissue of the liver give rise to very dif. ten or twelve feet deep, and immediately ferent morbid phencmena, intense in probecame insensible. Next day, a yellowish portion to the volume of the hydatids. tint began to develop itself on the face, and Generally there is a feeling of weight, it soon overspread the whole body. Three rarely of acute pain, sometimes a tumour days after, severe pain was felt in the right more or less manifest in the right hypohypochondriac region, the decubitus on chondrium. The respiration is, in some either side became impossible. On the cases, much embarrassed, and there is a 5th of May, seventh day of the accident, degree of anxiety and uneasiness which the patient came to the Hotel Dieu. The perpetually make the patient change his right hypochondriac region was the seat of position. Sometimes there is jaundice, an irregular tumour, extending from the vomiting, nasal hemorrhage, diarrhoea, and ensiform cartilage within about three fin- obstinate constipation. There is, in some ders’ breadth below the umbilicus. Ob- cases, a trembling of the parts, like the scure fluctuation was perceived, and several movements of a mass of jelly. Aceph.thardish, projecting, and unequal, sub- lo-cysts of the kidneys are only declared by stances, apparently immoveable, were felt the pain they occasion. In the ovaries their effects are quite the same as in the throughthe narietes of the abdomen. In order to learn the nature of the tu- membranous cyst or ovarian dropsy. In mour, it was punctured with a very fine the womb they occasion very different plietrocar, a cupping-glass was applied over nomena, accorùing to the manner in which the canula, and some drops of a very limpid they are lodged in that viscus. When situliquid, in every respect like that of hy- ated deeply in the substance of its walls, a datids, escaped. The subsequent days a feeling of weight is the only immediate large piece of caustic potash was placed on symptom ; but when they are developed the most projecting point of the tumour, between the lining membrane and the subclose to the false ribs. By means of a new stance of the uterus, they eventually dilate application of the caustic, the tumour con- the organ, its neck thins and widens, and tained in the abdomen opened spontane- all the ordinarv phenomena of pregnancy ously, and without pain through the lesion take place ; the acephalo-cysts then constiin the skin, and waves of a yellowish and tute the affection termed the vesicular limpid fluid, mixed with a great number of mole." Hydatids of the lungs occasion hydatids, were expelled with force. The dyspncea in different degrees, the cause of same day an injection of barley- which it is generally impossible to suspect. water was made into the cyst, in order to Case of Hydatid Cyst in the Liver, ivith im. prevent the entrance of air. This injection mense Pulmonary Hydatid Tumour’s. was successively replaced bv saline water, a decoction of barley and The following case, however, is one of and a solution of chloruret of lime. The area of those in which the visceral hydatid has been the cyst soon began to diminish, and when most accurately recognised in the living the patient left the hospital, there only re- person. A young man, æt. 18, had a pemained a small fistula, givingissue to a ripneumony, which was perfectly cured. little greenish foetid, pus. Some particles At 24 he had a violent and obstinate cold, of alimentary and stercoral matter had es- accompanied by very acute pain in, and inability to lie on, the left side. These pains caped through the wound. We see in this remarkable case, that M. ceased with the cold, but reappeared on the Recamier observed the precept we have so slightest occasion. In July, 1800, the pain lone inculcated, of having recourse to an of the side and cough reappeared with such exploring puncture in tumours of doubtful ) violence, that the patient dreaded every He soon complained of a little nature. the seat of which he stated to be in tumour, Symptoms of Visceral Hydatids. the right hypochondrium. ’1 his tumour soon We have said that visceral hydatids a certain volume, and the cough could not, in the great majority of cases, was now accompanied by momentary suffobe recognised in the living subject. The ! cations. In May, 1803, the patient was in following are some symptoms which have the following condition :-He was very been observed in the individuals who thin. When laid down to have the tumour present this affection :-Their presence in ’ examined, it appeared of a volume so coathe cellular tissue, external to the perito- siderable, that the hand could scarcely cover half of it. It was so hard, that it did neum, or in that connecting the tunics of the stomach or intestines, occasions some de- ! not yield to the finger. Its surface seemed rangement in the digestive functions, some- very smooth. It was moveable, and could times even exerting such a strong degree be readily displaced, whether to the right left. The beatingof the heart was so of compression on the intestinal canal as to
house-painter,
"
honeyed
quinquina,
movement.
’ acquired
’one
! or
741
violent, that in the epigastric region it was was in one respect more extraordinary woman came to perceptible to the eye. He occasionally than the preceding. A on account of an Hotel Dieu in 1811, expectorated a little blood, and trembled almost continually. The dyspnoea and feel- inflammatory swellingat the umbilicus. I ing of strangulation had increased in seve- was at first unwilling to touch it, but the
the
rity. These symptoms were worse in cold, fluctuation having become manifest, and rupimproved in mild weather. His pulse ture of the skin being imminent, an inciwas completely natural. By January, 1804, sion was made, which gave issue to a great all the symptoms had increased. In the be- quantity of pus, and hydatid cysts. The ginning of June, he experienced two pa. woman died, and on the examination of her and
roxvsms
of extreme violence, with
an
inter-
body a communication
was
found between
valrof one day, and was almost sufloeated. the opening in the umbilicus and
Perceiving his dangerous
a
cavity
state, he came to contained within the lung, by means of a Paris to obtain medical advice. He per- canal formed through the diaphragm, beformed the journey of ten leagues in a car- tween the liver and the parietes of the abdoriage, went to his apartments, feeling’ him- men. The lung contained a great quantity self comfortable, and supped moderately. of hydatids, and was evidently the primary In a few hours, however, he was attacked seat of the disease. bv another paroxysm of strangulation, in Symptoms coittinved.-T)-eatment. which he died. The body was opened by From the preceding facts it is seen, that M. Geoffroy and myself. Aiitopqy.-Wefound in the left lobe of the symptoms of the presence of these acethe liver a cyst, partly concealed in the sub- phalo-cysts are absolutely the same with stance of this organ, and partly projecting those of many other diseases. The absence into the abdominal cavity, resembling a of other characters of better known maladies bladder, which could be moveJ and dis- is often the only sign which permits us to placed at pleasure. The parietes of the suspect the presence of these animals. We cyst were thin, and, nevertheless, fibrous. can sometimes be convinced of it, however,
They seemed retracted on themselves. of
Their when the cysts which contain them break, either into some of the cavities lined by mucous membranes, or on the external sur.. face of the body, as when they escape through two as large as the yolk of an eg’g. The the parietes of the abdomen. The rupture part of the hydatid cyst external to the of the cysts into mucous cavities has geneliver, adhered strongly to the smaller cur- rallyfavourable results, andarthas even imivature of the stomach ; still there existed no tated nature in this respect. Nevertheless, trace of cicatrix on the external membrane Professor Lassus, in his researches on the of this organ. The thorax was of consi- encysted dropsy of the liver, has related derable dimensions ; the heart,pushed down- several cases in which incision of the cysts wards, corresponded with the upper part of has not saved the patients, but has even acthe epigastrium ; both lungs, compressed, celerated death. According to my own exflattened, and reduced to a thin fold, were perience, incision is usually favourable in thrust towards the anterior part of the those hydatids which attack the external chest, behind the costal cartilages. The parts of the body. It seems even that the rest of the pleural cavities was occupied by disease may disappear without either a natwo very voluminous tumours, each extend- tural or an artificial opening. In these cases ing from the top of the chest to the dia- it is probable that the acephalo-cysts perish phragm, adhering intimately to the ribs, spontaneously, and that the thin part of and to the entire of the rnediastinum; toge- their fluid is absorbed. The cyst then conther forcing the heart out of the thoracic tracts on itself, like an aneurism after Hiinc,ivity. Both tumours, equally tense and ter’s operation, and at the end of a certain fluctuating, had a white, fibrous, thin, but time there remains nothing more than a resisting’ envelop, and each contained an small mass of a substance of a yellowish enormous hydatid, exact!y filling the cyst, colour, in which are seen layers of fragand apparently adhering to it by means of a ments of the former acephalo-cysts. glutinous substance. On measuring the Case a Cyst containingaHuman Fœtus, in of limpid fluid contained in the hydatids, it the Mesentery of a Boy. was found to amount to five and a half pints The visceral in each. These hvdatids were about eleven developed in the inches long. cavity of the pelvis may be confounded with a crowd of tumours too numerous to Ca’e ofPulmonary Ifildatids, enacuaied at name, and which, moreover, have been rethe Umbilicus. peatedly studied. But there is one espeA second case of pulmonary hydatids, ci.ll1y deserving attention from its extreme whuh eshall clescribe hi a few words, and which has been described
cavity contained—1st, a quantity
yellow fluid; 2nd, a great number of little hydatids, generally about the size of a pea, but one or
hydatids
-
.
f curiositv,
742 The marasmus, howa periodical, now difficult to be procured, ter had taken place. namely, the "Recueil des Mémoires de la ever, proceeded, and after some months use-
in
Faculté de Medecine de Paris," and entitled less case
of
a
"
CYST
CONTAINING A
HUMAN
:F(ETUS DEVELOPED IN THE MESENTERY OF A
FOURTEEN." AMÉDÉE BISSIEU,
BOY OF "
treatment he
was
sent
home.
On his
arrival, MM. Guerin and Bertin Desmardelles recognised the tumour. A continual cough soon occurred, accompanied by purulent and foetid expectoration, and a purging of matter also fœtid, in the midst of which,
son of M. Bissieu, of Vernueuil, department de 1’Eure, was born in 1790, of a young, well-formed, healthy six weeks before his death,
was found a who had previously borne another parcel of hairs rolled up on themselves. He child, well-formed and of good constitution. died on the 23rd Prairial, au. 12, six On the night during which his mother supmonths after the attack at Rouen. poses he was conceived, one of the alarms then so frequent in France threw the town Autopsy. into violent agitation, and called the inhaThe opening of the budy took place bitants tumultuously to arms. During her next day, in the presence of MM. Guerin pregnancy, Madame Bissieu experienced and Bertia Desmardelles. These physi. some mental afflictions, as well as frequent cians discovered in the left hypochondrium, indispositions ; nevertheless her labour was below the spleen, a large, thick, mem.
woman,
propitious. It was supposed that during branous sac, adhering to all the surrounding labouran unusual quantity of water escaped parts, and especially to one of the large inthrough the vagina. Immediately after birth testines, which they presumed to be the the infant was confided to a nurse, who colon ; and in this cyst, amidst purulent, finding him weakly and unhealthy, almost thick, and yellow matter, two masses were of nearly equal volume, situated transversely despaired of bringing him up. to his father’s house, he complained, from his before the vertebral column, one applied to first lisp, of pain in the left side of the chest the other, but, nevertheless, quite distinct. and belly. The volume of these parts was Of these two masses, one placed inferiorly, so considerable that it was fearedhe laboured was composed of a large handful of tangled, under organic disease ; but the size was, felted hair ; around this were two little parnevertheless, so variable, that nothing was cels of hair, like what passed by stool six done beyond accommodating his clothes to weeks before death. The other mass, situ. these variations. However, as he grew up ated higher, consisted of an oblong, fleshy, these fears subsided, but the boy’s body I and bonv substance, covered with skin. At continued thin ; he continually complained one of its extremities was seen an imperfect of slight pains in the side ; his appetite was head, With natr, teeth, a aetormea nose, a
Returned
I
fantastic and irregular, and he frequently kind of orbit at one side, and an ear at the suffered from indigestion. On dressing other. At the opposite extremity was a him one day it was perceived two of limb-like appendage, ending in some tonguehis left ribs were more elevated and pro- shaped points armed with nails. Lastly, minent than the others ; but this was at- from the centre of the mass proceeded a tributed to the effects of a habit he had con- thick; short ligament, inserted into the tracted of sucking the right thumb, and in- parietes of the cyst. clining his body to that side. Still less at- °’ Deeming the case deserving of more mitention was excited by the circumstance, nute researches, MM. Guerin and Desmaras at this time the lad was distinguished delles lifted the fleshy mass out of the pelfor a degree of gayety, vivacity, and intelli. vis, and took it away, together with the gence, beyond his age. He was sent toa spleen, and a part of the large inboarding-school at Rouen, where having testine. They ascertained, then, that there spent 18 months, he was suddenly attacked, existed no trace of sexual conformation, on the 13th Nivose, year 12, with acute external or internal, and that the sex of pain in the side and left hypochondrium, Amade Bissieux was indisputably mascuwith continued fever, with exacerbations, line. Lastly, they found on dissecting the and a feeling of oppression. Great swell- rest of the body, that the liver was very ing of the pelvic region also occurred. He voluminous, and the lungs whitish and in. was bled and purged. The fever continued filtrated with pus. Twenty-two days aiter and the swelling made progress. On the this, the body was exhumed, in order to 7th day of his illness, M. Blanche, the surthefacts now related. MM. Delgeon, perceived distinctly in the abdomen, zeuzes and Brouard, who were charged with a hard and very painful tumour extending the investigation, found no trace or anv along the false ribs to the crest of the ilium, sexual organ but those belonging to the rout ded from side to side, and of the size of male. The bladder was cautiously sepaa large melon. Calming treatment was em. the vesiculae seminales discoveled: ployed, but the pain did not diminisli until I the rectum examined internally and exteran abundant purging of fcetid purulent matand nothingextraordinary found.
that
stomach,
I
verify
rated,
nally,
743
the external parts of generation were carefullyinspected, and the testicles, vasa deferentia, and penis, were found to be perfect in formation, but small in size."
Lastly,
and
replaced by common organs, which for the existence of both individuals. In the first case, the monstrosity depends are
serve
mechanical cause, in the second it depends on a primary fault in the organiza-
on a
Remarks on the Case. tion of the germs. One of these explanaA fact so extraordinary excited universal tions being admitted, the sex of the indiattention, and M.Planche forwarded the pre. vidual who so long acted the mother to the paration to the Faculty of Medicine of Paris, fcetus in question, becomes altogether indifand I (said M. Dupuytren) was commis- ferent. The fcetus has progressed, but as sioned to report on this great anomaly in extra-uterine conceptions do. In fact, to the laws of nature. whatever part the fecundated germs are The first fact I ascertained relative to the attached, their mode of nutrition is the position of the foetus, was, that it lay in a same. They derive from all, by means of cyst of the transverse mesocolon, which proper vessels, the nutritive fluids they rehad only communicated very recently with quire. They are developed, and increase in the intestine, through the destruction of size, until the time ordained by nature for a partition by which they were separated. their expulsion, and if they cannot then be In this examination, I ascer- expelled, they putrefy and turn into adipotained that the organized mass contained in eire ; they dry, and become ossified, or else the transverse mesocolon had many points they vegetate until their presence, by irri. of resemblance to a foetus, but that it offered tating’ the adjoining parts, determines the also numerous peculiar dispositions, some of’ formation of abscesses, and procures their which depended essentially on vices of con- discharge. Such is what seems to have hap-in the case before us. formation, while others appeared to be dependent on changes of form successively To ascertain the degree of importance of effected by time and the sojourn of the phenomenon, its exact cause should mass in the mesocolic cyst. The dissec- first be known, and then this importance tion of the mass was, however, the surest would be determined by the light thrown on mode of determining the nature of this pro- the natural process, aud occasional irreguduction. I did so with great care, and I larities of the process of generation. How. discovered the trace of some organs of the ever, putting these considerations aside, senses, a brain, spinal chord, very volu. the case does not the less merit our attenminous nerves, muscles degenerated into a from its rarity and interesting phenosort of fibrous matter, a skeleton, composed mena. of a vertebral column, a head, a pelvis, and the rudiments of almost all the limbs. Lastly, in an umbilical cbord, very short, LECTURES and inserted into the transverse mesocoON lon, beyond the cavity of the intestine, an artery and vein ramified in each of their MEDICAL PATHOLOGY, extremities in the fœtus, and the individual to which it belonged. DELIVERED IN THE UNIVERSITY OF PARIS, The existence of these organs sufficed certainly to establish the individuality of BY M. ANDRAL, D.M.P., &c. &c. this organized mass, although in other respects it was destitute of organs of digesLECTURE XII. tion, of respiration, of the secretion of urine, and of generation. But the absence I, EXTREME SENSIBILITY TO EXISTENCE. of these parts, at most, could only render it one of the monstrous fcetuses destined to GENTLEMEN,—In the last lecture, I indicated the lesions of sensation considered perish at the moment of birth. We shall not dwell on suppositions, more in a state of exaltation (Huperœsthesia), as or less problematical, advanced respecting far as the circumstances referred to the life the presence of this fcetus in the body of the of relations. There remains to be noticed Bissieu. We shall only remark, that the phenomena of the transmission to the young it is by no means rare to see twins born brain of certain exaggerated sensations peradhering by the back, belly, head, or by ceived by the organs of the life of nutrition, several parts at once. A degree of compres- when their sensibilitv is increased to such an sion, more or less strong, exercised by the extent that they perceive their own healthy mother’s organs on the soft embryos, eithej physiological condition,-a the beating during conception or soon after it, may pro- of the heart is, in certain cases, perceptiduce these monstrosities. inother cases ble, and even disagreeable, to the patient, not extremely rare, the twins are so identi- while the physician finds that its normal is not deranged in the least degree. fied, that many organs are deficient in each
continuing
pened
this
tion,
or
action