Book - Umbilicus (1916): Difference between revisions

From Embryology
Line 753: Line 753:
VI. Umbilical Hernia 466-467  
VI. Umbilical Hernia 466-467  


VII. Exstrophy of the Bladder 484-485  
VII. Exstrophy of the Bladder 484-485
 
 
==Chapter XXXVIII. Bleeding from the Urachus into the Bladder==
 
The literature on this subject is a negligible quantity. W. Ramsay Smith *
reports a case which, although somewhat obscure, may be mentioned here.
 
The patient, a female infant, was born August 3d. The labor was short, and
the child brought away with forceps. The cord appeared to be normal. On the
second night, August 5th, a large quantity of bright-red blood was noticed on the
infant's binder. It appeared on that night only, and the nurse noticed that it was
coming not from the cord,- but from the umbilicus at the side of the cord. Two
days later (August 7th) the child had an attack of diarrhea, and there was a good
deal of blood in the stools, and it was noticed that this blood was coming from the
urethra. On August 8th the bleeding was very severe, there being over two teaspoonfuls at a time. The blood always appeared when the bowels moved, but it
came from the urethra. The diarrhea ceased, and the bleeding stopped on August
9th. Smith thought that the bleeding took place from the hypogastrics, and
escaped to the bladder along the urachus. Ballantyne felt somewhat reluctant
to accept this explanation, but said that, under the circumstances, it was difficult
to suggest any that was more satisfactory.
 
A few years ago, while discussing diseases of the umbilical region with Dr.
Edward Reynolds, of Boston, he mentioned the fact that on several occasions he
had noted bleeding from the urachus into the bladder. Later I wrote asking him
kindly to furnish me with the data he had bearing on the subject. His reply was as
follows :
 
"With regard to my recent hematuric case, the patient was a physician about
thirty-five years old, from whom I removed the appendix about two years ago.
She came to me on the seventh of February, saying that, after very hard and long
automobiling over rough country roads a few days before, she had been seized by
a sudden urgent desire to urinate, and had passed a quantity of bloody urine.
Since then urination had been normal, but the urine was slightly blood-stained.
She informed me that she had noticed that the first part of the urine was clear and
that the blood came with the last few drops. When I first looked into her bladder
the small amount of urine was clear (she had just emptied it). I inspected the
trigonum and fundus of a normal bladder carefully in the knee-chest position, and,
on turning the point of the cystoscope forward, found that in the interval the urine
had become distinctly pink. I then emptied the bladder thoroughly with the
evacuator, and saw a small stream of blood flowing from the orifice of the urachus.
The patient has written me since that the hematuria stopped within forty-eight
hours after her visit to me, and that there was no recurrence. I told her that I
thought there was no other treatment than the removal of the urachus; that I
should not advise that unless the symptoms were persistent; that I should advise
 
* Smith, W. Ramsay: Obstet. Trans., Edinburgh, 1892-93, xviii, 53.
 
647
 
 
 
648 THE UMBILICUS AND ITS DISEASES.
 
it if the hematuria were recurrent. I asked her to keep me informed of her progress, and I think that she will do so.
 
''This is not my first case of the kind. A good many years ago, when I was
doing a large out-patient clinic and making a great many cystoscopic examinations,
I saw a number of cases, I should guess from half a dozen to a dozen, in which minor
vesical symptoms seemed to be associated with a reddened, eroded condition of the
vesical mucous membrane immediately about a small orifice in the upper and anterior part of the bladder, which, after some study, I grew to consider as the orifice
of a patent urachus, and which, on close inspection, I could recognize in a considerable proportion of bladders in which it was not making trouble. I believe that this
slight anomaly is very common, and that it is a not unimportant lurking-place for
bacteria in infected bladders. In at least two cases in these old days I saw bleeding
from this orifice; I think in more than that number, but the conditions of the
clinic made careful record keeping very difficult. I should say that the hematuria
was transient but recurrent. I do not know the ultimate outcome. The patients
in that clinic were all of a class which it is difficult to follow up afterward."
 
Dr. Reynolds' observation clearly demonstrates that in some cases blood does
escape from the persistent urachus into the bladder. His suggestion that the
urachal opening is probably the lurking-place of bladder infections is fully borne
out by the cystitis frequently noted where a partially patent urachus exists.
 
 
 
CHAPTER XXXIX.
TUBERCULOSIS OF THE PATENT URACHUS.
 
I have been able to find only two cases of this character in the literature. The
first case was recorded by Briddon and Eliot, the second by Eastman.
 
Dr. Thacher, who made the pathologic report on the extirpated urachus in
Briddon and Eliot's case, after giving a very careful and guarded description,
decided that the condition was probably tuberculous. Dr. Eastman sent us his
specimen and we have been able to demonstrate tubercle bacilli in the urachus.
 
"Tubercular Degeneration of the Patent Urachus
in the Adult.* — R. M., aged nineteen, Roumanian; married. Admitted July
17, 1899. No tubercular family or personal history. The patient has always been
well until five weeks ago, when she began to have slight pain, with heat, redness',
and swelling in the region of the umbilicus, the navel having previously been always
normal in appearance. The symptoms increased for two weeks, at the end of
which time there was a small red tumor, the size of a pea, in the region of the
umbilicus. During this time the patient suffered intensely from severe, sharp
pain, almost constantly present, in the hypogastric region, with well-marked
vesical tenesmus, increased frequency of micturition (often voiding urine every
hour), and occasionally a small amount of blood in the urine. At the end of the
two weeks the swelling opened spontaneously, discharging some cloudy fluid with
a uriniferous and foul odor, the pain and swelling soon subsiding. About four
days after the discharge of fluid at the umbilicus, she ceased to pass water normally,
and since then she has had a constant discharge of cloudy fluid of a uriniferous
odor, at times slightly blood-stained, through the opening at the umbilicus. She
has lost considerable flesh and strength during the period of five weeks.
 
"Physical Examination. — The patient is markedly anemic and is apathetic.
The facies is flushed; the tongue is moist and not heavily coated. The superficial
glands are not enlarged. In the heart there is a hemic murmur over the pulmonic
area, systolic in time. Percussion of the lungs is normal, but the breathing is
rather poor. The abdomen is soft, retracted, and no masses can be felt. At the
inferior portion of the umbilicus is a small sinus with everted and ulcerated edges,
which discharges a seropurulent fluid of uriniferous odor. A probe introduced into
the sinus goes downward and extends evidently as far as the bladder. The bladder
does not percuss high, but there is some tenderness on pressure over the suprapubic
region. Urine analysis at the time of admission showed very turbid and cloudy
urine, with specific gravity of 1014, 15 per cent of sediment, reaction strongly
alkaline, and odor foul and ammoniacal. There was 10 per cent of albumin, no
blood, a large amount of mucus, much pus, and many vesical cells, with many
crystals of triple phosphate. No casts were found. She was placed upon bladder
irrigations twice daily, with warm 0.5 per cent, boric-acid solution, and salol (gr. v)
 
* Briddon, C. K., and Eliot, E.: Med. and Surg. Reports, Presbyterian Hospital, New York,
January, 1900, iv, 30.
 
649
 
 
 
650 THE UMBILICUS AND ITS DISEASES.
 
three times a day. There was no improvement under this treatment, either in the
character of the urine or in the patient's general condition, except that she had
slightly less pain. At the end of a week the bladder irrigation was changed to
carbolic acid, in strength of 1 : 120. This also seemed to have no effect upon the
urine, frequent examinations up to the time of operation giving about the same
result. As at the first analysis, the specific gravity never rose above 1014; the
urine always remained alkaline and was full of pus and mucus. The temperature
course was irregular, varying between 99.5° F. and 102° F., and did not seem to be
influenced in any way by the bladder washing. During a period of several days of
fairly constant low temperature the patient gave a moderately characteristic
tuberculin reaction. The average daily amount of urine voided by the urachus
varied from 15 to 20 ounces. At intervals of several days she voided a few drams
or an ounce of urine per urethram.
 
" Owing to the obstinate, unyielding cystitis, it was thought advisable to do
a suprapubic cystotomy for purposes of drainage.
 
" Operation (August 25th) . — Dr. Eliot. Nitrous oxid and ether; asepsis; dorsal position. A catheter was introduced through the urethra into the bladder and
urine was withdrawn. Four ounces of warm 1 per cent boric-acid solution were
then gently thrown into the bladder by a fountain syringe, six ounces of water,
injected into a Barnes dilator, having been previously inserted into the rectum.
A 23^-inch median incision was then made above the pubis and deepened down to
the space of Retzius. The soft cellular tissue here being pushed aside and the
bladder presenting, two silk sutures were passed in a longitudinal fashion through
its wall, separated by a distance of one inch, these sutures being placed for purposes
of traction. The bladder was then opened between the silk sutures, the boricacid fluid pouring out into the wound. The incision in the bladder-wall being
subsequently enlarged upward, disclosed the urachus opening into the fundus of
the bladder. There were several small areas of ulceration on the posterior wall of
the bladder, and parts of the ulcers, together with a portion of the urachus, were
secured for microscopic examination. The ulcerated areas upon the bladder-wall
were cauterized with a thermocautery. The lumen of the urachus was packed
with a strip of iodoform gauze, the cavity of the bladder being drained through the
suprapubic wound in the usual way by means of a tube.
 
"Report by J. S. Thacher, Pathologist.- — A. Minute fragment of tissue from
urachus. Microscopic examination shows a mass of smooth muscle and connective tissue. The muscle-cells vary somewhat in size and shape, and are irregular
in arrangement.
 
"B. Minute fragments from base of bladder. The epithelium is partly destroyed, and the tissues are much inflamed. The inflammation appears to be of
some standing.
 
"The bladder was drained very satisfactorily for ten days by the siphon drainage apparatus, the suprapubic wound remaining comparatively clean and dry. The
patient's temperature was increased for six days following the operation. Recovery
was uneventful. Bladder irrigation with carbolic acid, 1:40, was employed, when
the drainage apparatus was dispensed with, the urine clearing up slightly and the
pain becoming much less severe. She seemed to improve in general health to a
moderate degree. Urine was not voided normally after the suprapubic operation
had been performed.
 
 
 
TUBERCULOSIS OF THE PATENT URACHUS. 651
 
"September 25th: Urine, for about one week, has had much less pus and mucus in it, and hypogastric pain has been much less severe. It was then decided
to attempt an extirpation of the patent urachus, leaving the suprapubic wound
unmolested.
 
"Operation (September 27th). — Dr. Briddon; nitrous oxid and ether; asepsis;
dorsal position. A median incision was made from the umbilicus down to the
suprapubic wound of the previous operation, exposing the linea alba, which was
split up in the line of the incision, exposing granulation tissue forming the wall
of the patent urachus. By blunt dissection this tissue was then dissected free
from the underlying thickened peritoneum, during which process the urachus was
opened longitudinally through a portion of its extent. The walls of the urachus
were nearly a quarter of an inch thick, and their diameter was about half an inch.
At its point of junction with the bladder it was cut transversely and removed, the
general cavity of the peritoneum not being opened. A clean surface was thus left,
whose floor was formed by the thickened peritoneum, and its sides by the divided
portion of the linea alba. This tract was closed by eight interrupted chromic
catgut sutures, passing from one side to the other through the skin and linea
alba, thus approximating the raw edges of the tract. A sterile dressing was
placed on the sutured wound, a rubber drainage-tube and iodoform gauze being
left in the suprapubic wound.
 
" Report of J. S. Thacher, Pathologist. — Extirpation of patent urachus. Microscopic examination : Granulation tissue ; spots of marked infiltration by leukocytes; several small necrotic spots; many giant-cells; some tissue resembling
tubercle tissue — probably tubercular.
 
" Recovery from the operation was uneventful. The bladder was drained satisfactorily for ten days, the wound for urachus extirpation healing by primary union
without complication. Her general health rapidly improved, and she had gradually
less hypogastric pain and discomfort. For a few weeks the patient voided no urine
normally, all being discharged through the suprapubic wound. Since then she
has passed almost every day one or more ounces of urine per urethram, in gradually
increasing quantity. Her general condition is very much improved, the suprapubic
wound is steadily closing, and urinary analysis now gives but 3 per cent, of albumin,
with much less pus and mucus.
 
"Repeated examination of urine failed to discover any tubercle bacilli, and
careful physical examination by G. A. Tuttle failed to detect any evidence of
pulmonary or other visceral tuberculosis.
 
"Examination conducted by Dr. Tuttle, in the pathologic laboratory, of the
small ulcers which were excised from the wall of the bladder at the time of the first
operation, failed to yield positive indications of tuberculosis; conclusive evidence
at last was furnished by the examination by Dr. Thacher of the urachus itself,
removed by Dr. Briddon at the time of the second operation. Inferences are
always uncertain, and although the statement that the tubercular process originated
in the patent remnant of the duct itself is not entirely justifiable, nevertheless, the
fact remains that examination of its wall after removal showed much more abundant
evidence of tuberculosis than did the portion of the bladder-wall removed earlier
by suprapubic cystotomy."
 
In the case under discussion the removal of the urachus was accomplished without opening the general peritoneal cavity.
 
 
 
652
 
 
 
THE UMBILICUS AND ITS DISEASES.
 
 
 
I was particularly anxious to see a section from this case, and accordingly wrote
Dr. Thacher. In his reply, dated New York, April 8, 1914, he gave me the results
of his examination, but said the original slide could not be located.
 
Tuberculosis of the Urachus.* ■ — Dr. Eastman has just recorded
a very interesting case of tuberculosis of the urachus in a girl aged nineteen.
 
"Family History. — Father died of cancer of the stomach at the age of fifty-one;
one brother died during infancy of meningitis; history otherwise negative, particularly as relates to tuberculosis or neoplasms.
 
 
 
 
Fig. 267. — Tuberculosis of the Urachus.
 
This is a low-power photomicrograph from Dr. J. R. Eastman's case. At a is an area of caseation surrounded by
tissue closely resembling that found in tuberculosis. The outer walls are composed of non-striped muscle and fibrous
tissue. Scattered throughout this tissue are localized foci more or less characteristic of those noted in tuberculosis.
The areas b and c are very suggestive of tubercles.
 
The high-power picture of the area b is shown in Fig. 268; that of the area c, in Fig. 269.
 
 
 
"Personal History. — Typhoid at seventeen with good recovery; history otherwise negative; patient married two years and four months; one pregnancy, child
living and well; at no time night-sweats or protracted cough; no characteristic
temperature history; no other evidences of tuberculosis.
 
"Menstrual History. — Menstruation began at twelve; regular; duration five
days and free; no change in type since marriage or labor.
 
"Urination. — No increase in frequency, no nocturnal urination. Three diurnal
urinations; never any blood or burning or stinging.
 
"History of illness for which patient entered hospital. — This trouble began ten
 
* Eastman, Joseph Rilus: Amer. Jour, of Obstetrics, 1915, lxxii, 640.
 
 
 
TUBERCULOSIS OF THE PATENT URACHUS.
 
 
 
653
 
 
 
months before entrance. While working in the garden, pain was felt at a point in
the mid-line of the abdomen between the symphysis pubis and the umbilicus. At
this time patient noticed a lump at the point designated, the size of a small apple.
There was not much actual pain nor soreness. The mass did not increase in size
but the tenderness remained. This condition persisted for three months when a
pin-point opening appeared in the mid-line of the anterior abdominal wall, half-way
between the symphysis pubis and the umbilicus. This opening discharged a clear
watery fluid for about a week. Then a serous crust closed the opening. The
opening again discharged after about a week, continuing to do so for one week and
again the crust was formed. This process of closing and opening continued for
several months. The size of the tumor did not change. The tenderness still persisted. There had never been any disturbance of the bladder, intestines or uterus.
 
 
 
a
 
•1
 
 
 
b
 
 
 
x
 
 
 
 
 
 
 
 
 
 
d c
 
Fig. 26S. — An Area Suggesting a Tubercle.
This picture is a high-power magnification of the area b in Fig. 267. Its confines are indicated by x and x. Scattered throughout this area are spindle cells and round cells. At a and b are giant-cells. At c the cells are so arranged
as to suggest a small gland. At d is a large cell bearing a strong resemblance to a squamous cell.
 
 
 
The discharge had always been free from odor. She is positive that the discharge
never had a urinous odor.
 
"Status Prsesens. — The patient's general health was unimpaired. Urinalysis
and physical examination of the chest and abdomen were negative. There were
no evidences of pulmonary tuberculosis nor of tuberculosis elsewhere. Through
the discharging sinus below the umbilicus a small sound could be passed downward behind the symphysis pubis.
 
"Operation. — The fistulous tract, upon being dissected free, was found to pass
downward from the discharging orifice, coursing in front of the peritoneum, crossing
the space of Retzius and terminating in a thin cord attached to the anterior bladder
wall in the median line and near to the vesico-urethral junction. Upon being split
open the definite tube-like structure was found to be thin-walled, showing no evidence of inflammation or other pathological condition except near the external
discharging orifice, where an ulcerated mass about 2 cm. in width was situate upon
the dorsal wall of the tube.
 
"Cystoscopic Examination. — Bladder distended with 8 ounces of water for
 
 
 
654 THE UMBILICUS AND ITS DISEASES.
 
examination: vesical sphincter normal in outline; trigone normal; both ureteral
openings and the mucosa surrounding them were normal as to contractility and
rhythm. There were no ulcers, tubercles, or any other abnormalities upon the floor
of the bladder. The vesical roof was examined carefully and this portion of the
bladder was found to be absolutely devoid of any ulcer, tubercles, opening, or any
other abnormality of the vesical mucous membrane; and there was not the slightest
hint of any communication with the patent urachus.
 
"•Chemical and Microscopic Urinalysis. — After operation as before the urine
was normal.
 
••Clinical Course since Operation. — "Wound closed slowly; there have been no
 
 
 
 
 
 
 
 
 
 
Fig. 269. — A Tubercle from Dr. Eastman's Case of Tuberculosis of the Urachus.
 
This L= a high-power picture made by Mr. H. Schapiro from Fig. 267 at c.
 
The tubercle is oval in form and is fairly well differentiated from the surrounding stroma. The cells of the tubercle
are spindle-shaped, oval, round, or irregular. In the lower part of the tubercle is a large giant cell containing a large
number of nuclei arranged chiefly in its center. The grouping of the nuclei in this giant cell resembles to some extent
that usually found in foreign-body giant cells, but the picture as a whole is strongly suggestive of tuberculosis.
 
symptoms of any kind relating to the genitourinary organs; there is no evidence of
return of the disease."
 
I wrote Dr. Eastman asking if he could send me sections of the urachus. This
he promptly did. An examination of them shows the following:
 
The central portion of the specimen consists of granular tissue containing a few
cells. It looks very much like caseous tissue (Fig. 267a). External to this is a
tissue made up of young connective-tissue cells and fairly large round cells with
small round nuclei, and beneath this a zone containing a few giant cells. The
outer wall apparently consists of non-striped muscle and connective tissue infiltrated with small round cells. In this are round or oval areas containing aggregations of epithelioid cells with giant cells scattered here and there throughout them
[Figs. 208 and 269;. External to this zone is the surrounding adipose tissue. The
entire picture strongly indicates tuberculosis of the urachus.
 
Dr. Benjamin O. McCleary and Dr. George L. Stickney have each independently demonstrated tubercle bacilli in the sections; consequently this is a definite
of tuberculosis of the urachus.

Revision as of 11:59, 26 October 2018

Embryology - 28 Apr 2024    Facebook link Pinterest link Twitter link  Expand to Translate  
Google Translate - select your language from the list shown below (this will open a new external page)

العربية | català | 中文 | 中國傳統的 | français | Deutsche | עִברִית | हिंदी | bahasa Indonesia | italiano | 日本語 | 한국어 | မြန်မာ | Pilipino | Polskie | português | ਪੰਜਾਬੀ ਦੇ | Română | русский | Español | Swahili | Svensk | ไทย | Türkçe | اردو | ייִדיש | Tiếng Việt    These external translations are automated and may not be accurate. (More? About Translations)

Cullen TS. Embryology, anatomy, and diseases of the umbilicus together with diseases of the urachus. (1916) W. B. Saunders Company, Philadelphia And London.

Online Editor 
Mark Hill.jpg
This historic 1916 textbook by Cullen describes the umbilical region.



Modern Notes: placenta

Placenta Links: placenta | Lecture - Placenta | Lecture Movie | Practical - Placenta | implantation | placental villi | trophoblast | maternal decidua | uterus | endocrine placenta | placental cord | placental membranes | placenta abnormalities | ectopic pregnancy | Stage 13 | Stage 22 | placenta histology | placenta vascular | blood vessel | cord stem cells | 2013 Meeting Presentation | Placenta Terms | Category:Placenta
Historic Embryology - Placenta 
1883 Embryonic Membranes | 1907 Development Atlas | 1909 | 1910 Textbook | 1917 Textbook | 1921 Textbook | 1921 Foetal Membranes |1921 human | 1921 Pig implantation | 1922 Single placental artery | 1923 Placenta Review | 1939 umbilical cord | 1943 human and monkey | 1944 chorionic villus and decidua parietalis | 1946 placenta ageing | 1960 first trimester placenta | 1960 monkey | 1972 Placental circulation | Historic Disclaimer


Historic Disclaimer - information about historic embryology pages 
Mark Hill.jpg
Pages where the terms "Historic" (textbooks, papers, people, recommendations) appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms, interpretations and recommendations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)

Embryology, Anatomy, and Diseases of the Umbilicus together with Diseases of the Urachus

By

Thomas Stephen Cullen

Associate Professor of Gynecology in the Johns Hopkins University

Assistant Visiting Gynecologist to the Johns Hopkins Hospital

Illustrated By

Max Brodel


W. B. Saunders Company, Philadelphia And London, 1916


This book is affectionately dedicated to my Mother Mary Cullen

Daughter of the late Rev. Thomas and Mary Greene

Born on July 12, 1841, at Polminick, near

Penzance, Cornwall, England

Preface

During the summer of 1904 I saw a case of cancer of the umbilicus with Dr. Jacob L. Winner. Up to that time I had thought that hernia was practically the only lesion to be noted in this locality. The patient did well for a time, but later large intra-abdominal tumors could be felt and finally he died. Xo autopsy was obtained. Histologic examination of the umbilical growth showed that it was an adenocarcinoma.


I was at a loss to explain the presence of glands in this position, and a cursory examination of the text-books failed to elucidate the matter. I could not rid myself of the desire to find out definitely just how an adenocarcinoma could exist in the umbilicus, and several years later, when other and more pressing problems had been completed, I carefully searched the literature for cases of cancer of the umbilicus and was amazed to find the records of many instances.

In the majority of the cases the umbilical growth was secondary to a cancer of the stomach, gall-bladder, intestine, or ovary. Cases of primary adenocarcinoma and of squamous-cell carcinoma of the umbilicus occur, but they are very rare.

During this study I encountered a wealth of material dealing with the omphalomesenteric duct. We have long been familiar with Meckel's diverticulum, but two facts, that the omphalomesenteric duct may be patent throughout its entire extent at birth, and that remnants of the outer end of the duct may give rise to the small umbilical polyps sometimes noted after the cord drops off, have not been commonly appreciated.

The literature is rich in records of devastating infections that prevailed before the era of asepsis. These occurred generally in hospitals, and most often when an epidemic of puerperal sepsis was rampant among the mothers. The descriptions of some of them are intensely graphic, and from the detailed reports of the individual cases one can obtain a wonderful picture of the terminal infections occurring in these infants.

I found a somewhat extensive literature on dermoids of the umbilicus, but on analyzing the cases was obliged to conclude that the majority of these growths represented nothing more than inflammations due to irritation exerted by an umbilical concretion. It was the presence of caseous material and the admixture of wool from the patient's clothing that had led to the erroneous diagnosis.

I found records of cases of Paget's disease, diphtheria, and syphilis of the umbilicus. There is also an extensive literature on the escape of intra- and extraabdominal fluid, usually pus, through the umbilicus, and many cases of umbilical fistula are recorded.

Many umbilical tumors have been reported, some benign, others malignant. I was especially interested in one group of cases. These tumors were small; they always occurred in women; they tended to swell at the menstrual period, and some urachus have been collected, the cases classified, and the appropriate methods of treatment outlined. I trust that this work may help the general practitioner, the pediatrician, and the surgeon to treat more satisfactorily lesions of this heretofore relatively unknown region, unknown, although up to the daj r of birth it is on the main highway between the mother and the child.

Thomas S. Cullen.

The Johns Hopkins Hospital, May, 1916.


Contents

Umbilicus (1916): 1 Umbilical Region Embryology | 2 Umbilical Region Anatomy | 3 Umbilical New-born Infections | 4 Umbilical Hemorrhage | 5 Umbilicus Granuloma | 6 Omphalomesenteric Duct Remnants | 7 Umbilicus Abnormalities | 8 Meckel's Diverticulum | 9 Intestinal Cysts | 10 Patent Omphalomesenteric Duct 1 | 11 Patent Omphalomesenteric Duct 2 | 12 Bowel Prolapsus at Patent Omphalomesenteric Duct | 13 Abdominal Wall Cysts by Omphalomesenteric Duct Remnants | 14 Omphalomesenteric Vessels Persistence | 15 Umbilical Inflammatory Changes | 16 Subumbilical Space Abscess | 17 Umbilicus Paget's Disease | 18 Umbilicus Infections | 19 Umbilicus Abnormalities 2 | 20 Umbilicus Fecal Fistula | 21 Umbilicus Round Worms | 22 Umbilicus Foreign Substance Escape | 23 Umbilical Tumors | 24 Umbilicus Adenomyoma | 25 Umbilicus Carcinoma | 26 Umbilicus Sarcoma | 27 Umbilical Hernia | 28 The Urachus | 29 Congenital Patent Urachus | 30 Urachus Remnants | 31 Urachal Remnants Producing Tumors | 32 Large Urachal Cysts | 33 Anterior Abdominal Wall Abscesses | 34 Urachal Cavities | 35 Umbilicus Acquired Urinary Fistula | 36 Urachal Concretions and Urinary Calculi | 37 Urachus Malignant Changes | 38 Urachus Bleeding into the Bladder | 39 Patent Urachus Tuberculosis | Figures
  1. Embryology of the Umbilical Region
  2. Anatomy of the Umbilical Region
  3. Umbilical Infections in the New-born
  4. Umbilical Hemorrhage
  5. Granulation Tissue or Granuloma of the Umbilicus
  6. Remnants of the Omphalomesenteric Duct
  7. Congenital Polyps; Fistul.e or Cystic Dilatations at the Umbilicus; with a Mucosa More or Less Similar to that of the Pyloric Region of the Stomach, and Secreting an Irritating Fluid Bearing a Marked Resemblance to Gastric Juice. Persistence of the Outer Portion of the Omphalomesenteric Duct
  8. Meckel's Diverticulum
  9. Intestinal Cysts
  10. A Patent Omphalomesenteric Duct
  11. The Patent Omphalomesenteric Duct (continued)
  12. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct
  13. Cysts in the Abdominal Wall Due to Remnants of the Omphalomesenteric Duct
  14. Persistence of the Omphalomesenteric Vessels
  15. Umbilical Concretions Associated with Inflammatory Changes in the Abdominal Wall
  16. Abscess in the Subumbilical Space
  17. Paget's Disease of the Umbilicus
  18. Diphtheria of the Umbilicus . Syphilis of the Umbilicus; Tuberculosis of the Umbilicus; Atrophic Tuberculid commencing at the Umbilicus
  19. The Escape of Retroperitoneal and Abdominal Fluid from the Umbilicus; the Opening of an Appendix Abscess at the Umbilicus. Abscess of the Liver Opening at the Umbilicus; Peritonitis with the Escape of Pus from the Umbilicus; the Piecemeal Removal of a Suppurating Ovarian Cyst through the Umbilicus
  20. Fecal Fistula at the Umbilicus
  21. The Escape of Round Worms from the Umbilicus
  22. The Escape of Various Foreign Substances from the Umbilicus
  23. Umbilical Tumors
  24. Adenomyoma of the Umbilicus
  25. Carcinoma of the Umbilicus
  26. Sarcoma of the Umbilicus
  27. Umbilical Hernia
  28. The Urachus
  29. Congenital Patent Urachus
  30. Remnants of the Urachus
  31. Urachal Remnants Producing Tumors between the Umbilicus and Symphysis
  32. Large Urachal Cysts
  33. Abscesses in the Anterior Abdominal Wall between the Umbilicus and Symphysis Due to Infection of Urachal Remains or of Urachal Cysts
  34. Urachal Cavities between the Symphysis and Umbilicus Communicating with the Bladder or Umbilicus or with Both
  35. Acquired Urinary Fistula at the Umbilicus
  36. Urachal Concretions and Urinary Calculi Associated with Urachal Remains
  37. Malignant Changes in the Urachus
  38. Bleeding from the Urachus into the Bladder
  39. Tuberculosis of the Patent Urachus

List of Illustrations

1. Sagittal Section Showing a Very Early Stage in the Formation of the Umbilicus and allantois 2

2. A More Advanced Stage in the Formation of the Umbilical Region 2

3. A Composite Picture Showing the Formation of the Umbilicus in an Embryo 3

4. A Diagrammatic Representation of a Human Embryo, about 3.5 mm. Long, Show ing the Effect of the Expanding Amnion upon the Yolk-sac and Body-stalk ... 4

5. Sagittal View of a Human Embryo 5 mm. in Length 5

6. Anterior View and Transverse Section of a Human Embryo 7 mm. Long, Showing

the Umbilical Region 6

7. Sagittal Section of the Umbilical Region in an Embryo 7 mm. in Length 7

8. Sagittal View of the Umbilical Region of a Human Embryo 10 mm. in Length 8

9. Graphic Reconstruction of the Umbilical Cord of a Human Embryo 12.5 mm. in

Length 9

10. Anterior View of the Umbilical Cord of a Human Embryo 18 mm. in Length 10

11. Sagittal Section of the Umbilical Region in a Human Embryo 23 mm. in Length .. 11

12. A Graphic Reconstruction of the Umbilical Region of a Human Embryo 3 cm.

Long 12

13. Sagittal Section of the Umbilical Region in a Human Embryo 4.5 cm. in Length .. 13

14. A Graphic Reconstruction of the Umbilical Region of a Human Embryo 4.5 cm.

in Length as Viewed from within the Abdomen 14

15. Sagittal View of a Graphic Reconstruction of the Umbilical Region of a Human

Embryo 5.2 cm. in Length 15

16. Intra-abdominal View of the Umbilical Region of a Human Embryo 6.5 cm. in

Length 17

17. Intra-abdominal View of the Umbilical Region in a Human Embryo 7.5 cm. Long . . 18

18. Intra-abdominal View of the Umbilical Region in a Human Embryo 9 cm. in

Length 18

19. Intra-abdominal View of the Umbilical Region in a Human Embryo 10 cm. in

Length 19

20. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. Long . . 19

21. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. in

Length 20

22. Intra-abdominal View of the Umbilical Region in a Human Embryo 12 cm. in

Length 21

23. Cross-section of the Umbilical Cord at the Umbilicus in a Human Embryo 12 cm.

in Length 22

24. Internal View of the Umbilical Region in a Human Embryo 15 cm. Long 23

25. A Composite Representation of Abnormal Umbilical Structures, Based on the

Work of Keibel, Lowy, and Others 24

26. A Composite Representation of Abnormal Umbilical Structures, Based on the

Work of Keibel, Lowy, and Others 24

27. A Composite Representation of Abnormal Umbilical Structures, Based on the

Work of Keibel, Lowy, and Others 24

28. The Umbilical Region in a Fetus about Five Months Old Viewed from the Left . . 25

29. Side and Posterior Views of the Umbilical Region in a Fetus of Six to Seven

Months 25

30. Three Diagrams of the Umbilical Ring and Its Significance in the Development

of Ventral Hernia 27

XV


XVI LIST OF ILLUSTRATIONS

Fig. Page

31. The Appearance of the Yolk-sac (Umbilical Vesicle) in a Pregnancy, with the

Embryo 5.5 cm. Long 28

32. The Umbilical Region, the Cord, and the Placenta at Term 29

33. A Diagrammatic Representation of the Umbilical Region of a Fetus at Term .... 32

34. Normal Umbilicus according to Catteau 35

35. A Type of Umbilical Region in the Adult, Viewed from Within 44

36. A Frequent Type of the Umbilical Region in the Adult, Viewed from Within .... 44

37. The Umbilical Region of an Adult, Viewed from Within 45

38. Classic Type of Umbilicus 47

39. Disposition of the Vascular Cords (Usual Type) 48

40. Vascular Cords of the Anastomosing Type, Noted 7 Times in 50 Cases 48

41. Vascular Cord Type, Noted 5 Times in 50 Cases 49

42. Vascular Cords, Noted 5 Times in 50 Cases, Completely Filling the Umbilical

Ring 49

43. Vascular Cords, Noted 3 Times in 50 Cases 49

44. Vascular Cords, Noted in 2 out of 50 Cases 50

45. Umbilical Fascia. Peritoneum in Place 52

46. Umbilical Fascia and Umbilical Mesentery 52

47. Reduplication of the Linea Alba. Peritoneum Removed 52

48. Atrophy of the Umbilical Fascia, Posterior View 53

49. Formation of a Mesentery. Peritoneum in Place 53

50. Mesentery of the Urachus and of the Umbilical Arteries 53

51. Adipose Fringes. From a Well-developed Young Woman. Peritoneum in Place 54

52. Adipose Fringes in a Stout Subject. Peritoneum in Place 54

53. Peritoneal Diverticula. Peritoneum in Place 55

54. Peri-umbilical Fossettes. Peritoneum in Place 55

55. Ovarian Pedicle Passing from Uterus out through a Hernial Ring in the Ab dominal Wall 57

56. Extra-abdominal Multilocular Fibrocystoma of the Ovary 5S

57. An Extra- abdominal Multilocular Fibrocystoma 59

58. Superficial Lymphatics of the Umbilical Region 64

59. The Deep Umbilical Lymphatics as Seen from the Peritoneal Side 65

60. The Umbilical Vessels about the Time of Birth 72

61. The Umbilical Vessels in the Adult 72

62. 63. Method of Treating the Umbilical Stump at Birth 98

64. Nature's Method of Checking Bleeding from the Umbilical Arteries 107

65. An Umbilical Granulation 117

66. The Gradual Atrophy of the Omphalomesenteric Duct 121

67. An Umbilical Polyp Connected with Meckel's Diverticulum by a Fibrous Cord . . 121

68. An Umbilical Polyp Attached to the Small Bowel by a Fibrous Cord 121

69. An Umbilical Polyp on the Prominent Part of an Umbilical Hernia : . . 123

70. A Polypoid Outgrowth from the Umbilicus 129

71. Tubular Glands from the Umbilical Polyp Shown in Fig. 70 129

72. A Diverticular Tumor at the Umbilicus 132

73. A Glandular Tumor from the Umbilicus 132

74. A Glandular Growth at the Umbilicus 133

75. Section in the Long Axis of a Small Umbilical Growth 134

76. Adenoma of the Umbilicus 135

77. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord. 138

78. Ax Umbilical Polyp Attached to a Meckel's Diverticulum by a Fibrous Cord . . . 138

79. An Umbilical Polyp 139

80. A Small Intestinal Polyp Almost Fillingthb Umbilical Depression 139

81. An Umbilical Polyp 140

82. Portion of an Intestinal Polyp Partially Filling the Umbilical Depression .... 141

83. Transverse Section op a Pseudopyloric Congenital Fistula at the Umbilicus . . . . 149


LIST OF ILLUSTRATIONS XV11

Fia. Fage

84. High-power Picture op a Fistulous Tract at the Umbilicus, Showing Glands Re sembling those of the Pylorus 150

85. An Umbilical Fistula Lined with Mucosa Resembling that of the Stomach 150

86. Appearance of the Umbilical Depression in von Rosthorn's Case 152

87. Gastric Mucosa at the Umbilicus 153

88. Appearance of the Umbilicus After Removal of the Stomach Mucosa Seen in

Fig. 87 154

89. Persistence of the Outer End of the Omphalomesenteric Duct 156

90. Atrophy of the Inner End of the Omphalomesenteric Duct 156

91. A Long Umbilical Polyp as a Remnant of the Omphalomesenteric Duct 156

92. Meckel's Diverticulum 159

93. A Meckel's Diverticulum Attached to the Abdominal Wall at the Umbilicus. . 160

94. An Abnormally Large Meckel's Diverticulum 161

95. A Meckel's Diverticulum with a Lobulated Extremity 161

96. A Meckel's Diverticulum with Hernial Protrusions from Its Surface 162

97. A Short Meckel's Diverticulum Springing from the Mesenteric Attachment . . 163

98. An Accessory Pancreas in the Tip of Meckel's Diverticulum 163

99. A Meckel's Diverticulum Completely Tying off a Loop of Small Bowel 164

100. A Diverticulum Tying Off a Loop of Small Bowel 165

101. Strangulation of a Meckel's Diverticulum Causing Volvulus of the Ileum. . . . 166

102. Fatal Intestinal Obstruction Due to the Passage of the Bowel through a

Hole in the Mesentery of a Meckel's Diverticulum .170

103. Inversion of a Meckel's Diverticulum into the Lumen of the Bowel 171

104. A Well-developed Loop of Small Bowel in a Dermoid Cyst of the Ovary 175

105. An Intestinal Cyst 176

106. An Intestinal Cyst Attached to the Umbilicus by a Pedicle but not Connected

with the Bowel 176

107. Volvulus of Meckel's Diverticulum 177

108. An Intestinal Cyst Developing from Meckel's Diverticulum 178

109. Intestinal Cysts in the Abdominal Cavity 182

1 10. An Intramesenteric Cyst 183

111. A Patent Omphalomesenteric Duct 190

112. A Patent Omphalomesenteric Duct with a Polypoid Formation at the Umbilicus . 190

113. A Very Short Omphalomesenteric Duct 190

114. A Patent Omphalomesenteric Duct with a Polyp- like Formation at the Umbil icus 190

1 15. A Patent Omphalomesenteric Duct 192

116. A Patent Omphalomesenteric Duct 193

1 17. A Patent Omphalomesenteric Duct 197

118. A Patent Omphalomesenteric Duct 197

119. A Patent Omphalomesenteric Duct 202

120. A Patent Omphalomesenteric Duct 205

121. A Patent Omphalomesenteric Duct 206

122. Part of a Patent Omphalomesenteric Duct 206

123. Intestinal Mucosa Covering the Cutaneous or Umbilical End of a Patent Om phalomesenteric Duct 207

124. An Umbilical Polyp and a Fibrous Nodule at the Umbilicus. There was Origin ally a Patent Omphalomesenteric Duct 209

125. Longitudinal Section through the Entire Center of a Partially Closed Om phalomesenteric Duct 209

126. A Patent Omphalomesenteric Duct 211

127. A Patent Omphalomesenteric Duct Opening at the Base of the Umbilical Cord . . 216

128. A Patent Omphalomesenteric Duct 216

129. A Patent Omphalomesenteric Duct as Seen from the Abdominal Cavity 216

130. Inversion of the Bowel through a Patent Omphalomesenteric Duct Opening on the Side of the Umbilical Cord 219

131. A Patent Omphalomesenteric Duct of Large Diameter 224

132. Commencing Prolapsus of Small Bowel through a Patent Omphalomesenteric Duct 224

133. Partial Prolapsus of the Small Bowel through the Omphalomesenteric Duct . . . 224

134. Prolapsus of the Small Bowel through the Patent Omphalomesenteric Duct .... 224

135. Complete Prolapsus of the Bowel through the Patent Omphalomesenteric Duct 225

136. Prolapsus of the Small Bowel through the Patent Omphalomesenteric Duct, and an Umbilical Hernia between the Loops of Prolapsed Bowel 225

137. Prolapse of the Small Bowel through an Open Omphalomesenteric Duct 227

138. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct 228

139. Prolapsus of the Bowel through a Patent Omphalomesenteric Duct, with Sec ondary Complications 229

140. Prolapsus and Inversion of the Intestine through a Patent Omphalomesenteric Duct 230

141. Prolapsus of the Bowel through the Patent Omphalomesenteric Duct 232

142. A Small Cyst of the Umbilicus Due to a Remnant of the Omphalomesenteric Duct 238

143. Small Cyst of the Abdominal Wall Due to a Remnant of the Omphalomesenteric Duct 238

144. A Small Intestinal Cyst Lying between the Peritoneum and the Recti 240

145. An Omphalomesenteric Duct Originating from the Concave Side of the Bowel and Attached to the Umbilicus by a Fibrous Cord 243

146. A Remnant of an Omphalomesenteric Duct Causing Fatal Intestinal Obstruction 245

147. A Small Umbilical Concretion 249

148. Acute Inflammation of the Umbilicus Due to an Accumulation of Sebaceous Material 249

149. Cholesteatoma from the Umbilicus in Case 1 251

150. Cholesteatoma from Case 2 251

151. A Connective-tissue Projection Really Representing a Small Fibroma in the Floor of the Umbilicus 252

152. Enlargement of Fig. 151 252

153. Subumbilical Phlegmon 262

154. The Subumbilical Space 264

155. Paget's Disease of the Umbilicus 270

156. Paget's Disease of the U/mbilicus 270

157. Paget's Disease of the Umbilicus 271

158. Paget's Disease of the Umbilicus 274

159. The Appearance in a Case of Paget's Disease of the Umbilicus After Treatment with Radium 275

160. Syphilis of the Umbilicus 284

161. Atrophic Tuberculid Starting at the Umbilicus 286

162. Leakage from an Abdominal Aneurysm Producing a Temporary Abdominal Tumor; Subsequent Escape of the Blood into the Right Renal Pocket 288

163. The Manner in Which a Periprostatic Abscess may Occasionally Rupture at the Umbilicus 289

164. Escape of Pleural Fluid from the Umbilicus 289

165. The Opening of a Broad Ligament Abscess at the Umbilicus 290

166. Abdominal Pregnancy with Spontaneous Escape of Liquor Amnii from the Umbilicus 348

167. Small Papilloma in the Umbilical Depression 365

168. A Shall Umbilical Tumor Containing Glands and Stroma Identical with Those of the Uterine Mucosa 376

169. Glands from a Small U\iisiLirALTuMOR 377

170. Typical Uterine Mucosa in a Small Umbilical Tumor. An Enlargement of Area B in Fig. 168 378

171. Glands in a Small Umbilical Tumor 379

172. Dilated Glands in a Small Umbilical Tumor 380

173. Dichotomous Branching of Glands in a Small Umbilical Tumor 381

174. Uterine Glands in an Umbilical Tumor 381

175. Gland Hypertrophy in a Small Umbilical Tumor 382

176. A Tumor of the Umbilicus Composed Partly of Hypertrophic Sweat-glands 383

177. Uterine Mucosa in an Umbilical Tumor 384

178. A Small Umbilical Tumor Containing Numerous Glands 388

179. Glands in a Small Umbilical Tumor 389

180. An Adenomyoma in the Abdominal Wall Near the Anterior Iliac Spine 394

181. A Small Umbilical Tumor Containing Glands Similar to Those of the Body of the Uterus 396

182. Adenomyoma of the Umbilicus 397

183. A Group of Sweat-glands in an Umbilical Tumor 398

184. Appearance of the Carcinomatous Umbilicus After Removal 424

185. Carcinoma of the Umbilicus Secondary to Carcinoma of the Ovaries 432

186. A Malignant Growth of the Umbilicus, Apparently a Carcinoma Secondary to Some Abdominal Growth 439

187. Adenocarcinoma of the Umbilicus Secondary to an Intra-abdominal Growth .... 440

188. Adenocarcinoma of the Umbilicus 441

189. A Section Showing Carcinoma of the Right Inguinal Glands 442

190. Secondary Carcinoma of the Umbilicus 443

191. Telangiectatic Myxosarcoma of the Umbilicus 450

192. Appearance of the Umbilicus After Removal of the Tumor Shown in Fig. 191. . 450

193. Myxosarcoma of the Umbilicus 451

194. Telangiectatic Myxosarcoma Projecting from the Right Side of the Umbilicus . . 452

195. A Telangiectatic Myxosarcoma 452

196. A Case of Congenital Umbilical Hernia 460

197. An Amniotic Hernia 462

198. Several Loops of Bowel Which Lay Outside the Umbilicus and were Nipped Off During Fetal Life. The Child Lived a Short Time After Birth 464

199. A Serous Umbilical Hernia 469

200. Freeing the Umbilical Hernial Sac from the Abdomen 472

201. Closure of the Hernial Opening at the Umbilicus 473

202. Closure of the Hernial Opening at the Umbilicus 474

203. An Umbilical Hernia Associated with Marked Prolapsus of the Abdominal Wall 475

204. An Umbilical Hernia and a Markedly Pendulous Abdomen in a Patient Weighing 464 Pounds 476

205. The Abdominal Scar After the Removal of a Very Large Area of Fat 477

206. An Umbilical Cyst 478

207. Exstrophy of the Bladder Opening at or Near the Umbilicus 482

208. Exstrophy of the Bladder. A side View of the Case Depicted in Fig. 207, Showing the Relative Distance from the Symphysis to the Opening in the Abdominal Wall : 483

209. Exstrophy of the Bladder 483

210. Escape of Urine from the Umbilicus When the Inner Urethral Orifice Is Blocked by a Membrane 488

211. A Patent Urachus with a Mushroom-like Projection at the Umbilicus 489

212. A Patent Urachus with a Penile Projection at the Umbilicus 489

213. The Appearance of the Umbilicus in a Case in Which both a Patent Omphalomesenteric Duct and a Patent Urachus Existed 493

214. Cross-section of the Patent Omphalomesenteric Duct and of the Patent Urachus in the Same Child 493

215. A Picture of the Child Three Weeks After Removal of a Patent Omphalomesenteric Duct and a Patulous Urachus 494

216. A Patent Urachus 497

217. A Urachus Open from Bladder to Umbilicus 498

218. An Open Urachus 499

219. Escape of Urine from the Umbilicus Due to a Patent Urachus 502

220. A Patent Urachus with a Penile Projection at the Umbilicus 505

221. A Ring-shaped Vesical Calculus with a Fine Hair in Its Axis 507

222. A Partially Patent Urachus 515

223. A Patent Urachus 517

224. A Portion of a Urachus Seven Times Enlarged, with Numerous Large and Small Dilatations 518

225. Portion of a Urachus Ten Times Enlarged 518

226. Cysts of the Urachus Arranged Like a String of Pearls .- 520

227. Spindle-Shaped Dilatations of the Urachus 520

228. A Small Cyst of the Urachus 532

229. A Patent Urachus 534

230. A Multilocular Cyst of the Urachus 535

231. Section of a Patent Urachus .' 536

232. Transverse Section of a Patent Urachus 537

233. A Small Cyst of the Urachus 538

234. A Diffuse Neuroma of the Bladder 542

235. Cut Surface of the Bladder Showing a Diffuse Neuroma of Its Walls 543

236. A Diffuse Neuroma Forming a Mantle Around the Cavity of the Bladder 544

237. Diagram Showing the Arrested Development of the Genital Tract and the Relation of the Malformed Parts to the Cyst of the Urachus 551

238. Section of the Segment of Urachus Which Passed between the Bladder and the Cyst- wall, as Seen under a Low Power 552

239. The Abdominal Contour in a Case of Very Large Urachal Cyst 558

240. A Urachal Cyst Turned Inside Out and Showing Papillary Masses, Particularly in the Lower Part of the Picture 559

241. Infected Urachal Remains 568

242. An Infected Urachus Opening between the Umbilicus and Bladder 570

243. Urachal Cyst 576

244. A Dilated Urachus Communicating with the Bladder 579

245. Large Accumulation of Urine in a Partially Patent Urachus 579

246. An Infected Urachus Opening at the Umbilicus 580

247. A Patent Urachus Dilated in Its Middle Portion 580

248. Accumulation of a Large Quantity of Urine in a Urachal Pouch 581

249. Fetal Bones Removed from an Old Extra-uterine Pregnancy Sac 584

250. A Phosphatic Deposit on the End of a Long Bone 585

251. A Dilated Urachus Communicating with the Bladder 598

252. Urachal Cyst 599

253. Urachal Cyst 603

254. Urachal Cyst 603

255. A Patent Urachus Containing a Vesical Calculus 625

256. Carcinoma of the Patent Urachus 632

257. A Multilocular and Malignant Cyst of the Urachus 637

258. Giant-cells in the Wall of an Adenocarcinomatous Cyst of the Urachus 638

259. Giant-cells in the Wall of an Adenocarcinoma of the Urachus 639

260. Giant-cells in the Wall of an Adenocarcinomatous Cyst of the Urachus. . .640-641

261. Adenocarcinoma of the Urachus 642

262. A Papillary-like Area i.\ an Adkxocarcinomatous Cystofthe Urachus 643

263. Metastasis from Adenocarcinoma of the Urachus 644

264. An Umbilical Cyst 645

265. \\ aj.i of an Umbilical Cyst 645

266. Giant-cells in the Wall of an Umbilical Cyst 646

267. Tuberculosis of the Urachus 652

268. An Area Suggesting a Tubercle 653

269. A Tubercle from Dr. Eastman's Case of Tuberculosis of the Urachus 654


List of Plates

I. Drawings of Normal Umbilici 40

II. Drawings of Normal Umbilici 41

III. Drawings of Normal Umbilici 42

IV. Drawings of Normal Umbilici 43

V. Cancer of the Umbilicus Apparently Secondary to a Tumor of the Ovary. .434-435

VI. Umbilical Hernia 466-467

VII. Exstrophy of the Bladder 484-485

Retrieved from ‘https://embryology.med.unsw.edu.au/embryology/index.php?title=Book_-_Umbilicus_(1916)&oldid=361073’
Powered by MediaWiki