accurately with what has been previously stated as the cause of functional luxation; and though there are not wanting grounds upon which this speculation has been based, as it respects the present species, we have now no time to adduce them.

That original luxation should occasionally show itself hereditarily will excite the surprise of none. Commencing, though frequently covertly, with the primal days of infancy, it maintains a steady and obstinate course, becoming rather more aggravated with advancing years, though in a few cases, all things considered, there is a surprising degree of agility. Dr. Maissiat, who communicated the details to Dupuytren, informs us that in one family where the disorder showed itself hereditarily, four individuals, who were related to each other, as aunts and nieces, were respectively of the ages of 70, 80, and 84. The niece had a daughter who suffered under an original luxation in her right femur; and this last individual had four children, two of whom had the same deformity, the one on both sides, the other only on the left side.

It might, at first sight, be apprehended that for a complaint, so serious as that on which we have been dwelling, no remedies would be of any avail; but in many cases, at all events, this is not the case. Not that we speak of cure, but of relief. Scrupulous attention must be paid to the general health, and double diligence bestowed on the infirm member, by the use of friction, champooing, and gentle traction, whereby its nervous and muscular energy may be augmented. And the palliative remedy, so far as the hip-joint, for example, is concerned, is the accurate and firm fitting of a kind of girdle to the pelvis, which is wadded and furnished with a groove for the head of the femur, so that its movements may be restrained, and much more assurance given to the step, and stability to the frame. What has been so successful in the hip-joint, could not fail in similar cases, with equal ingenuity, to be not less so in the others, and the patients' comfort thereby be much increased.

Thus, then, in reviewing the whole subject of this monograph, we find that the topics it embraces involved, even in our own time, in almost impenetrable confusion and obscurity, with the advance of the science, present entirely a new phase. Regarding congenital luxation as a genus, or natural group, we find that it very readily divides itself into the species of obstetric, spontaneous, functional, and original luxation, all having many points of resemblance, and yet each very distinct in its nature from its fellows. Viewed severally that nature is simple, and its treatment clear, and the diagnosis, to a careful and well-informed practitioner, can seldom remain long doubtful. We are far from asserting that the subject is even now exhausted. But sure we are that there is abundant ground for gratulation on account of the advances which have recently been made, including some of the brightest triumphs of modern surgery, gratifying alike to the admirer of his art, and the well-wisher of his kind.

ART. VII.

Mémoires de l'Académie Royale de Médecine. Tome XI.-Paris, 1845. Memoirs of the Royal Academy of Medicine of Paris. Vol. XI.-Paris, 1845. 4to, pp. 684.

Or the three éloges with which the present volume of Memoirs opens, there is one which will be read with deep interest, we mean that of which Esquirol forms the theme. Strong and enthusiastic as are the epithets which flow from the facile pen of M. Pariset, they do not give an exaggerated picture of the talents and the virtues of the man;-the simple events of his life, the respect with which his memory is honoured in his native land, the impulse he gave to the philosophical study of the terrible maladies with which his name is indissolubly connected, and the vast improvements he introduced in the actual practical comprehension of those maladies, his tried benevolence, charity and lovingness of character, all give warranty to the encomiums of that accomplished writer. It is good, it is gladdening to read all this,-and to know that eminence, distinction, and respect, such as Esquirol gained, may be achieved by a man who started originally in life with scarcely a sou in his pocket.

Of M. Double and M. Bourdois de la Motte, whose lives are likewise briefly narrated, the latter was very little known beyond his own immediate sphere; the former, too, had long ceased to mingle much in medical circles, though a member both of the Institute and Academy of Medicine. Although we retain unchanged the feeling which sometime since led us to decry the system of indiscriminate laudation adopted in France, in regard of defunct members of learned societies, still, we believe, that it is both wise and proper that some record should be kept of the lives of all the deceased members of our profession. For this reason, we perceive with considerable satisfaction, that the editor of the 'London Medical Directory,' has this year commenced the plan of briefly recording the ascertainable particulars of the lives of those whom the preceding twelve months may have consigned to the grave.

M. Frederic Dubois supplies an interesting essay on the recent progress of medicine and of surgery in France; this will be read with advantage, but does not bear condensation.

I. Memoir on urethroplasty, by M. Ségalas. Under this title M. Ségalas describes the modifications which he has introduced in the mode of applying plastic surgery to cure of openings in the urethra. In a letter, which this surgeon addressed to M. Dieffenbach in 1840, he endeavoured to show that the frequent failure of urethro-plastic operations depended upon the great difficulty experienced in preventing the contact of the urine with the parts which the operator proposes to unite; and that hence the first condition of success was the establishment of a temporary channel for the discharge of the urine through the perineum, by means of a gum-elastic bougie retained in the wound. In the present publication, he more particularly seeks to give additional support to his views by the narration of another (his second) successful case.

To detail all the circumstances of the operation would occupy more space than we can afford; but a few particulars will suffice to make the general nature of M. Ségalas' proceeding comprehensible. The patient,

a working shoemaker, aged about 30, had lost a considerable portion of the spongy part of the urethra at the age of six years, the missing part having sloughed away in consequence of the owner having playfully tied up the penis with a string. The entire thickness of the urethra, for about an inch in length, was wanting, when the operation was undertaken; the urine and semen of course passed by the posterior opening. The portion of urethra lying in front of the hiatus described, was tracted, but perfectly pervious. The man's general heath was excellent.

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The operator commenced (21st July 1841) by placing a small gum-elastic bougie in the urethra. Finding that this instrument caused no particular inconvenience to the patient, though allowed to remain in situ for a few days, M. Ségalas, at the expiration of these, incised the prepuce at its upper part, in order to give all possible freedom to the structures to be brought in contact, a preliminary step, the more important as the patient was affected with phymosis. Six days after this little operation (which produced not the slightest constitutional disturbance), M. Ségalas opened the membranous part of the urethra through the perineum, passed a gum-elastic sound through into the bladder, and then by means of an oesophagus-tube, transforming this sound into a siphon, caused the urine to pass away continuously through the perineum. Sixteen days after (the wound in the latter place having ceased to give the least pain, the patient being in good health, and not annoyed by erections), the closing step of this complicated operation was performed as follows:

"I made two semi-elliptical incisions in a transverse direction on the inferior surface of the penis, in front of and below the hiatus caused by the loss of substance: these incisions met each other on each side of the lateral aspect of the corpus cavernosum. I then carefully denuded the entire surface circumscribed by these two incisions, and bringing together the two lips of the wound thus formed, I united them by means of six points of twisted suture, one on the median line, three to the right, and two to the left. My intention had been to make a third point of suture on the latter side; but an observation made by one of the persons present, that the swelling might cause too great an amount of compression between the parts united, prevented me from doing this, and I left a much wider space between the two needles in question, than between those of the opposite side "

M. Ségalas attaches much importance to this omission, tracing to it the difficulty subsequently encountered in closing a small fistulous opening in the site, where he had proposed, but omitted, to place an additional needle. A minute opening still existed in the month of February following, which was finally closed after repeated failures by cauterization, by a point of twisted suture. The cure continued perfect, when the patient was last seen in July 1844. Three engravings exhibit the progress of events in connexion with the operation. Nothing is said of the effects of the cicatrices on erection of the penis, -a matter of no small importance.

II. An Essay on the two diseases known under the name of meningeal apoplexy, by Dr. R. Prus. These two diseases are hemorrhage between the arachnoid and pia mater: and hemorrhage into the cavity of the

serous membrane. Both varieties are illustrated by a certain number of cases (not remarkable for closeness of description in any respect); and the relation of these is followed by a general account of the affections.

A. To commence with the first, whether blood effused into the subarachnoid tissue has made its way there in consequence of exhalation or rupture of a vessel, it may be found in clots or liquid, may be spread in a layer on the outer surface of the convolutions or penetrate into the anfractuosities, and even pass through the substance of the pia mater. The most extensive effusions occur at the base of the skull, and are most frequently due to rupture of an artery. A peculiarity in these effusions is that, although the progress of the symptoms render it unquestionable, that escape of blood may have, and sometimes must have, taken place on two or more successive occasions, no differences exist in different parts of the extravasated blood significant of a difference of age: the solution of the difficulty suggested by the author, namely, that the want of such appearance depends on the short duration of the disease, is not altogether satisfactory, as indeed he himself admits. The formation of pseudo-membrane round the effused blood is slow to occur in this situation: a case related by Morgagni, shows that no trace of its development may be discoverable even eight days after the hemorrhage has occurred. The author conjectures that the deficiency of false membrane may depend on the flux and reflux of the cephalo-rachidian fluid; but to the movement of this fluid, he conceives, the disappearance of blood effused in this situation (when not in sufficient quantity to cause death) is possibly altogether due. Coagula contained within the ventricles become invested with pseudo-membrane.

Hemiplegia is a very rare effect of the description of hemorrhage under consideration. Of twelve cases of rupture of arteries, two only were attended with this symptom; and in no instance was rupture of the veins or sinuses productive of paralysis. This peculiarity may very probably depend, as M. Prus observes, either, 1st, upon the fact that the sub-arachnoid tissue being naturally destined to receive the cephalo-rachidian fluid, is capable of giving lodgement to an undue quantity of blood without ill effects; or 2dly, that the effused blood being spread over a large surface by that fluid, exercises no special pressure upon any point in particular of the cerebral surface. In a certain class of cases, however, where a very large quantity of blood is thrown out, such marked compression of the brain arises, that sudden and complete annihilation of power generally takes place, and in consequence no local paralysis can be particularly traced.

In the cases observed by M. Prus the only invariable symptom was coma, preceded several times by general discomfort and prostration. Cephalalgia, and redness and heat of the integuments of the face, are rather to be considered in the light of premonitory symptoms, than evidences of the actual occurrence of hemorrhage. Slight delirium was noticed in one case; the intellectual faculties are scarcely ever perverted, but for the most part weakened.

The course of the disease, commonly continuous, is in some instances intermittent, -obviously a consequence of successive hemorrhages taking place. Death occurs more rapidly in certain cases of sub-arachnoid hemorrhage than of any form of effusion of blood into the cerebral structure itself; the prognosis, too, seems absolutely without hope, as death

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was the invariable result, either immediately or within the space days, in the cases brought together by the author. No appearance of cysts has yet been discovered in the sub-arachnoid cavity.

B. Effusion of blood into the cavity of the arachnoid, always occurs by exhalation, and not in consequence of rupture of vessels. The blood does not stain the cephalo-rachidian fluid,-seeing that it does not come into contact with it; and, when it has been extravasated some five days or so, is invariably invested with a pseudo-membrane. Differences in the characters of different parts of the coagula, significant of differences in the periods of effusion of the blood, have frequently been noticed. Intraarachnoid coagula, generally adhere closely and firmly to the external lamina of the serous membrane; traces of absorption through the agency of cysts have sometimes been discovered.

It will be observed, that all these anatomical conditions are different from those noticed in sub-arachnoid hemorrhages; and a corresponding difference in symptoms may be traced. Paralysis, at least of movement, is common, having occurred in six of eight cases related by M. Prus; paralysis of sensation is less usual. In three of these eight cases sudden loss of consciousness occurred. Somnolence and coma occur almost invariably towards the close of cases of both these forms of hemorrhage; but in the intra-arachnoid form, cephalalgia, dryness of the tongue, fever, and delirium, are almost always observed, and these symptoms are doubtless the effects of inflammation of the arachnoid, itself due to congestion either preceding the hemorrhage or caused by the irritative action of the effused blood. Delirium commonly occurs about the fourth day in cases of intra-arachnoid hemorrhage, the precise period at which the investiture of the clot with pseudo-membrane becomes apparent.

M. Prus contrasts the symptomatic characters of meningeal, with those of cerebral hemorrhage, somewhat in the following wise. Sudden loss of consciousness existed in three (or rather but two only, as in one of the three death was immediate) out of fourteen cases of meningeal apoplexy; it is unnecessary to state how different the proportion of cases would be in cerebral hemorrhage.

The paralysis of movement occurring in intra-arachnoid hemorrhage, is not generally as complete as in effusion into the cerebral substance,— and is but rarely, and then temporarily only, accompanied with paralysis of sensation. Again, paralysis of movement, resulting from meningeal apoplexy, may completely disappear,-a most rare result in old subjects, where the symptom is produced by cerebral hemorrhage. Deviation of the mouth, so common in the latter species of effusion, is extremely rarely met with in cases of meningeal apoplexy; in the single case in which M. Prus observed the symptom, the patient had previously had hemorrhage of the brain itself. In fine, somnolence and coma constitute, from their intensity and continuance, one of the principal characters of meningeal apoplexy.

The duration of the sub-arachnoid apoplexy does not, according to the experience of M. Prus, exceed eight days; it is always fatal. The duration of intra-arachnoid hemorrhage may extend to a month and upwards; and recovery may take place, as shown by the discovery of cysts in the cavity of the serous sac.