The Philadelphia Polyclinic, 
Vol. VI, June 19, 1897, No. 25. 
[Reprinted from 
PERSISTENCE OF THE UMBILICAL CORD. 
W. A. NEWMAN BORLAND, A.M., M.D. 
Within the past ten months the attention 
of the writer has been called in two instances 
to a curious condition of the umbilical cord, 
or rather of the stump of the cord, mention of 
which he has been unable to find in any of 
the standard text-books on obstetrics. This 
condition consists in a failure of occurrence 
of the usual phenomena attendant upon the 
separation of the cord ; in other words, the 
normal line of demarkation does not form, 
or it is only present in part, and instead of 
the process of disintegration and separation 
being accomplished within the usual limit of 
from four to six days, the cord persists 
indefinitely, or until removed by some surg- 
ical procedure. An examination of the 
section of cord after this secondary amputa- 
tion reveals a great excess of fibrous connec- 
tive tissue with total obliteration of the 
vessels and an apparent fibrous degeneration 
of all the structures. If proper antiseptic 
precautions be observed prior to the second- 
ary amputation the infants do not seem to 
suffer in the least from this unusual state of 
affairs. 
Assistant Demonstrator of Obstetrics in the University of Pennsylvania, etc. 
and serum—around the part. The change in 
question, as has already been suggested, seems 
rather to be a process of fibroid degeneration 
without any tendency whatever to mummifi- 
cation. A close examination of the amniotic 
covering of the stump shows no attempt at 
ulceration at any point from the site of the 
ligature to the navel-ring; the distal one- 
third or one-half inch of the cord may, how- 
ever, be somewhat mummified, but otherwise 
the cord presents no abnormal features. In 
the two cases personally encountered by the 
writer, separation had not occurred at the 
ninth and sixteenth days, respectively, and he 
was informed by one of the delegates to the 
recent convention of the American Medical 
Association, to whom he had made mention of 
the matter, that a similar case had occurred, a 
few months since, in his own practice, in which 
the cord had persisted for eight weeks, at the 
expiration of which time he had, at the re- 
quest of the family, amputated close to the 
navel-ring. The tissue at this time, he said, 
was almost cartilaginous in density, and there 
was not the slightest sign of beginning sepa- 
ration, nor had the child suffered in the least 
from this unusual persistence of its umbilical 
appendage. 
The condition is quite distinct from that 
known as umb'lical fungus, which is a true 
granulation-t lor forming after the sponta- 
neous sens’- m of the cord, and which is 
probabh an excess of moisture—blood 
Owing to the fact that a mere Assuring 
had occurred on the under surface of the cord, close to the abdominal wall, in the first of the 
writer’s cases, thorough antisepsis of which 
had not been observed, the child presented, 
on the eighth day, the signs of septic infection 
with convulsions,persistent and high elevation 
of temperature, and a rapidly-developing om- 
phalitis, which resulted fatally on the fol- 
lowing day, a few hours after amputation of 
the cord had been accomplished. The labor 
in this instance had been somewhat pro- 
longed, the child presenting in the third 
position of the vertex (R O P), and rotation 
and delivery being prevented by a marked 
uterine inertia; an easy forceps-delivery was 
accomplished, followed by a smart post-par- 
tum hemorrhage; there was no tear; the 
cord encircled the neck once. 
of the vessels or other structures could be de- 
tected. A slight oozing of serum persisted 
after the amputation for two days, and then 
ceased. 
Upon looking more closely into the proba- 
ble etiology of this rare condition, it would 
seem quite rational to suppose that some inti- 
mate relationship must exist between the 
changes in the cord and the dry method of 
umbilical antisepsis that is practised by the 
majority of the present-day obstetricians. 
Talcum powder, lycopodium, salicylic acid 
and starch, boric acid, acetanilid—all have 
been and are constantly being employed, and 
it stands to reason that, if this process be 
carried out with the usual degree of thorough- 
ness that the well-trained antiseptic surgeon 
would insist upon, the tendency would be 
rather to a preservation of the- umbilical tis- 
sues than to their proper disintegration and 
separation. This is merely offered as a sug- 
gestion as to the probable causation of the 
persistence, although it does not explain why 
the condition does not result in every in- 
stance so treated. 
The second case was the child of a primi- 
para, who had passed through a remarkably 
easy labor lasting but three hours and forty- 
six minutes. The baby menstruated on the 
fourth day, the flow lasting for three days. 
At the time of separation of the cord, on the 
sixteenth day, the tissue was thoroughly or- 
ganized, so much so, in fact, that no trace