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In addition to ordinary and honorary members, provision is made for the admission of corresponding members; and it is hoped that many in almost every part of the world, and such especially as retain a grateful recollection of the advantages they derived from their alma mater, will not be backward in supplying interesting communications.

Communications may be transmitted to the president of the society, or to either of the secretaries, according to the following addresses : Dr. W. P. ALISON, 44 Heriot-Row, Edinburgh.

Dr. ROBT. HAMILTON, 3 Northumberland-Street, Edinburgh.

A physician, a graduate of the University of Edinburgh, and Member of the Royal College of Surgeons in London, residing in a populous country town, has a vacancy in his family for a young gentleman who may have finished his apprenticeship, and intends taking his degree in one of the Universities. He will have ample opportunity of practice in a Public Institution, and recourse to a good medical library. It will be required of him to devote a certain portion of each day to his professional studies, on which he will have to undergo regular examinations. He will be treated as one of the family. Terms, 150 guineas per annum.

For further particulars apply to Dr. Johnson, No. 58, Spring Gardens.

MEDICAL PUPIL.

A physician attached to several public institutions is desirous of accommodating a respectable house pupil. The terms and peculiar advantages of the residence here proposed may be known by reference to Dr. James Johnson.

INTELLIGENCE.

The London Medical and Physical Journal is now conducted by Dr. A. B. Granville-vice, Dr. W. Hutchinson.

The LONDON MEDICAL REPOSITORY is henceforth to be conducted by Dr. Copland-vice, Drs. Uwins, Palmer, and Gray.

We are sorry that we have been forced to postpone, till our next number, the important reviews of Sir Astley Cooper's, and Mr. Wilson's Lectures-James on Inflammation-last volume of the Medico-Chirurgical Transactions-Transactions of the PhysicoMedical Society of New-York-Stevenson on Gutta Serena-Reid on Hypochondriasis-Chatelet and Martinet on Arachnitis-and the interesting review of the new Italian doctrines and practices. The above shall have precedency in our next number.

THE

Medico-Chirurgical Review,

AND

JOURNAL OF MEDICAL SCIENCE.

(Analytical Series.)

"Nec Aranearum textus ideò melior, quia ex se fila tingunt; nec noster vilior, quia ex alienis lubamus, ut apes."

VOL. II]

MARCH 1, 1822.

I.

[No. 8.

ARACHNOID INFLAMMATION, CEREBRAL
AND SPINAL.

Recherches sur l'Inflammation de l'Arachnoide, Cerebrale, et
Spinale; ou Histoire Theorique et Pratique de l'Arachnitis.
Ouvrage fait conjointement par PARENT-DUCHATELET,
M. D. Medecin en Chef de la 4 Legion de la Garde
Nationale, &c. et L. MARTINET, M. D. &c. &c. One
large volume, 8vo. pp. 612. Paris, 1821.

quid nobis certius ipsis

Sensibus esse potest, quo vera ac falsa notemus.-LUCRET.

THAT there cannot be a more important subject of investigation than that which occupies the volume before us, must be admitted by every one. The brain, as the organ which unites our moral and physical natures, exercises unbounded sway over our mental and corporeal faculties and functions; while its slightest deviations from health involve derangements of numerous other organs and structures in the living machine. These peculiarities of the sensorium, its appendages, and its coverings, render an investigation of their disorders so extremely difficult and perplexing, that nothing but the most ardent, unwearied, and systematic course of clinical observation and pathological research can be at all expected to throw light on the obscurity of the subject. Such clinical records and necrologic examinations have not been systematically pursued in this country; for the writings of Dr. Abercrombie and a few others are confessedly sketches, or contributions towards a more regular work on the important class of diseases now under consideration. It is a rare Vol. II. No. 8.

4 X

thing, in this country, to see two men uniting to watch and record the phenomena of disease at the bed-side, and minutely examine, after death, the corresponding traces of disorganization. Such a process, especially when carried on in a great public hospital, under the eye of the medical officers and visiters, acquires an authenticity of inestimable value, and which places it beyond the humiliating sarcasm of Cullen, who observes" that there are more false facts than false theories in medicine."

If Routinism and Apathy should raise their voices-and doubtless they will-against the arduous, or, in their apprehension, fruitless attempt to discriminate the diseases of structures so contiguous as the membranes and substance of the brain, we must not, on that account, be turned from the path of investigation which Reason, as well as experience of the past, points out as the only one likely to lead us from darkness to light-from doubt to certainty, or at least probability-from empyricism to science. Let it be remembered also, that as it is by minutely studying every part, we can hope to become intimately acquainted with the whole; so a rigid and careful examination of the disorders affecting each particular tissue enveloping the cerebral mass, must, of necessity, improve our general knowledge of encephalic disease, even when we are unable to determine the precise seat of lesion in the living body. On this account we must entreat the patient attention of our readers to the following analysis, which we trust and hope will amply repay the perusal. The extent of the article must be imputed to the size of the volume, the importance of the subject, and the improbability of any translation of the original into our language taking place.

ten.

It may be necessary to state, in limine, that almost all the observations contained in this work were made in the HOTEL DIEU, under the eye of Dr. Recamier, and at the HOSPICE DES ENFANS, under the inspection of Drs. Jadelot and NysThe cases were carefully noted at the bed-side, and the histories can be verified by the hospital registers. The work itself has been submitted at the INSTITUTE, to the Royal Academy of Sciences, and a very detailed and very favourable report thereon has been drawn up by Portal, Dumeril, Pelletan, Hallè, and Baron Cuvier, concluding with the following sentence :--

"Le travail dont nous venons de donner l'analyse, nous parait pouvoir contribuer à perfectionner la connaissance et le diagnostic, souvent bien difficiles, d'une maladie très-importante à bien caractèriser, et par conséquent à assurer le succès de son traitement.

The approbation of such a distinguished body as the IN

STITUTE, is a certain passport to public attention; and, without farther preface, we shall proceed to an analysis of the work.

Our authors observe that the diseases to which the cerebral envelopes (dura mater, arachnoid, and pia mater) are subject, may be conveniently classed under the following heads: 1. Congestions. 2 Exhalations, serous or sanguineous. 3. Hæmorrhages. 4. Inflammations. 5. Organic affections, or changes of structure. Where the cerebral pulp itself is affected, "exhalations" must be omitted, and two other heads added-" commotion," and "nervous affections." The present inquiry of our author's is limited to the 4th head, viz. inflammation, and that of the middle envelope, or tunica arachnoides. Their reasons for this preference are, the obscurity in which arachnitis has hitherto been involved-the frequency and danger of the disease-the difficulty of the diagnosis-and, above all, the light which it throws on other cerebral affections.

1. The first chapter presents a neat, but very succinct sketch of the anatomy and physiology of the arachnoid,* cerebral and spinal. Our readers are aware that it is a delicate transparent membrane, closely in contact with the pia mater, and reflected, according to Bichat and other French. anatomists, over the internal surface of the dura mater. Since Bichat's time, it is considered as passing in, to form a lining for all the ventricles of the cerebrum and cerebellum. It is constantly lubricated by a fine rosy exhalation, and is decidedly a serous membrane, performing the same functions in the head as the membrane investing the heart, lungs, and abdominal viscera, perform in their respective situations. In a healthy state it is insensible to touch or torture; but, when inflamed, it acquires a high degree of morbid sensibility -a change to which we must attribute the headach, more or less violent, but invariably attendant on arachnitis, forming its special character, and, in this respect, meriting the most profound attention of the practitioner. In its pathological as well as physical character, it harmonizes with the other serous membranes of the body. It is inflamed by the same causes which inflame them-and, like them, frequently throws out aqueous collections, or forms adhesions where the surfaces were before free. Finally, like the pleura and peritoneum, its mode of suppuration is by an effusion of whitish or sero-albuminous fluid, sometimes forming layers of false membrane, &c.

*For the sake of brevity, we shall use "Arachnoid" as a substantive throughout this article. It is so used by our authors.

II. The second chapter is on the important subjects of etiology and history of cerebral arachnitis.* Among the primary, most common, and most frequent causes of the disease, are percussions of the head,† insolation, organic lesions of the brain itself, apoplectic disposition, depressing passions of a moral nature. Among the secondary causes, in point of frequency or importance, are metastases of different kinds, suppression of habitual discharges, the use of strong drinks, and the common causes of other internal phlegmasiæ, as of pleuritis, gastritis, &c.

Our authors' attach great importance to those percussions or commotions, which, though far too slight to produce fracture of the cranium, are yet capable of injuring the tender structure of the arachnoid. It is curious that this cause determines the suppurative process in the arachnoid more frequently than any other cause. With the exception of two cases, the suppurative process was established in every instance where arachnitis resulted from external violence. To insolation, our authors were able to distinctly trace only two cases, probably because their patients were inhabitants of a great city, and little exposed to the direct rays of the sun. Doubtless in the country-and especially in warm countries -this cause is a very frequent one.

Our authors exhibit tabular views of the causes, sexes, ages, duration, periods, &c. of which we can take but a cursory notice. Thus of 116 cases of arachnitis, 21 were from percussion, two from insolation, two from tubercles of the brain, ten from depressing passions, six from metastasis, one from hydrophobia, three from apoplectic tendency, seventeen from indirect causes, 54 from unknown causes. Of these 116 cases, 78 were suppurated, and 38 not suppurated. In respect to sex, there were 88 cases of arachnitis in males to 28 in females. By the table of ages it appears that 29 were

*That layer reflected over the cerebrum, as distinguished from that lining the dura mater. REV.

We this day (26th Oct. 1821) saw a very interesting dissection by Mr. Brodie, of a woman who died of well-marked arachnitis at St. George's Hos pital. This was caused also by percussion, and Mr. Brodie pronounced it arachnitis, from the symptoms, and before dissection. There was much coma, and the arachnoid covering the base of the brain was thickened, quite opaque, and in some places suppurated. There was scarcely any other lesion of the contents of the cranium besides the inflammation and suppuration of the arachnoid. REV.

Our readers will remember the sentiments of Dr. Golis on this subject. See No. 7. p. 473.

Our authors watched a far greater number than this, but have not thought it necessary to detail more than the above number. REV.

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