Embryology, anatomy, and diseases of the umbilicus together with diseases of the urachus / by Thomas Stephen Cullen.

  • Cullen, Thomas Stephen, 1868-1953.
Date:
1916
Catalogue details

Licence: Public Domain Mark

Credit: Embryology, anatomy, and diseases of the umbilicus together with diseases of the urachus / by Thomas Stephen Cullen. Source: Wellcome Collection.

    17/714
    The classification of the material, and the interpreting of the diagnoses in the light of our present knowledge of pathology, offered no easy task. I have tried to fit each case into its proper place, but it is always difficult to interpret accurately the findings of others, especially when the original specimens are not at hand. At the beginning of each chapter a synopsis of the subject is given, and then the cases are cited more or less in detail. This method has naturally led to some repe- tition. A study of the individual cases is, however, of value in itself, and the gather- ing of them together will save subsequent investigators much time and will serve as a foundation on which they may build. Doubtless some important cases have been overlooked and others have not been recorded. Recently, when dis- cussing the subject with several of my colleagues, Hugh Young told me he had re- ported some urachal cases in the Johns Hopkins Hospital Reports, Volume XIII. They were referred to in a paper dealing with vesical diverticula, and had naturally been indexed under ‘“‘bladder,’’ so that they did not appear in the literature on the urachus. Both John Finney and Joseph Bloodgood told me of interesting urachal conditions that they had encountered. These cases have not yet been recorded. I have endeavored to give every author due credit and have also tried in each instance to render clear the source from which the information has been obtained. I wish to thank especially all editors and authors from whose publications illustra- tions have been copied. If any omissions be noted, I take this opportunity of apolo- gizing for -the oversight. The reader will rightly criticise descriptions of a tumor as being the size of a pea, a cherry, an olive-stone, a hazelnut, a walnut, an orange, etc. In this criticism I fully concur, but as the objects just mentioned vary considerably in size in differ- ent countries, and as these names occurred in the original articles, there was nothing for me to do but to give the exact translation. The strange incongruities involved in such a loose method of describing the size of a tumor will serve, however, to emphasize the advisability of giving definite measurements in the description of our own specimens. . ; Wherever the analysis of a given group of cases has clearly indicated a definite line of treatment, I have given it in brief. The anatomy of the umbilical region, as viewed from both its outer and its inner surfaces, has been carefully described. I found, however, that there was a con- siderable difference of opinion as to what constituted a normal umbilicus. In order to gather data on the subject, Mr. Brédel and I made observations in the various wards of the Johns Hopkins Hospital, the results of which are shown in Plates I, II, I1J, 1V, and VI. There is no doubt that the outer surface of the umbilicus is subject to wide variations both in size and inform. I wish to express my thanks to my chief, Dr. Howard A. Kelly, to Dr. William 8. Halsted, to Dr. John Howland, to Dr. Theodore Janeway, and to Dr. J. Whitridge Williams, for their kindness in extending the courtesy of their wards to us. No book on the umbilicus would be complete without a thorough considera- tion of the embryology of this region, and more particularly because many of the lesions are due to a partial or complete lack of closure of the omphalomesenteric duct or of the urachus. I asked Mr. Brédel if he would not make a few drawings graphically illustrating the gradual development of the umbilical region. After gaining a clear insight into the various abnormalities found in this region, he be-