that it can only happen in the earliest period of the embryonic life, or at least before the term of its completion." The author has given a fuller explanation, but in the same sense, in the following words:

"The peculiarity of these malformations, and their essential difference from ordinary morbid changes, are explained by the following considerations :— immediately after birth almost all the organs exist in a condition which, with slight modifications of form, they retain throughout life. All organs, indeed, grow until they are perfectly developed; but this growth is, for the most part, merely a simple augmentation of bulk. A few organs only, as the sexual apparatus and the thymus gland, undergo at a later period comparatively important modifications, either developing themselves more highly, or, on the other hand, disappearing. Indeed, in adults, the changes of the body are, in the normal state, almost solely confined to renewal of material (metamorphosis of tissues), whilst the form of the organs, with very trivial modifications, remains unaltered. The case is different with the embryo and foetus. Here, as the laws of development teach us, the various parts and organs of the body are gradually developed from the simple stroma of the ovum. During foetal life we have, therefore, not merely nutrition, as afterwards, but also development; and whilst, after birth, pathological influences only affect existing structures, or, at most, give rise to the introduction of heterogeneous matters, previous to birth, morbid influences extend their operation even to the development, so that pathological structures are generated, which differ considerably from those occurring after birth." P. 481.

The preceding remarks apply, it must be remembered, only to derangements of form. There are certain other congenital defects which are dependent upon abnormal nutrition, and which, consequently, do not essentially differ from similar disturbances after birth; such as encysted tumours and other morbid products. The more limited instances of abnormal position and excess of parts, belong to distinct classes.

The following classification, adopted by Dr. Vogel, is convenient for studying this department of pathological anatomy, if such it can be called.

"1st Class. Malformations, in which certain parts of the normal body are entirely absent, or are too small.-Monstra deficientia.

"2nd Class. Malformations produced by fusion or coalescence of organs. Coalitio partium-Symphysis.

"3rd Class. Malformations, in which parts in the normal state united-as for instance, in the mesial line of the body-are separated from each other-Clefts, fissures.

"4th Class. Malformations, in which normal openings are occluded—Atresia. "5th Class. Malformations of excess, or in which certain parts have attained a disproportionate size-Monstra abundantia.

"6th Class. Malformations, in which one or many parts have an abnormal position-Situs mutatus.

"7th Class. Malformations of the sexual organs-Hermaphroditism." P.487. To these, the author also appends "diseases of the fœtus, and abnormal states of its envelopes."

In a subject so comprehensive and at the same time so full of details as the one under consideration, it is impossible to do more than to offer a few observations relating to some of the most important and interesting points. One of the latter is connected with the causes and mode of origin of twin and triplet monsters, whose bodies are more or less extensively adherent or fused, as it were, together. According to some authorities they arise by a coalescence of two separate germs, which to us appears the more

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probable explanation; or, they depend, according to others, on a furcation of a single germ. The author, without attempting to decide positively on either of these views, inclines to the latter; and adduces the following as the chief arguments in its favour.

"1. The organs that are united are always similar organs: head with head, thorax with thorax, &c.; a fact that can only be explained in a very forced manner by the assumption of a coalescence of two germs.

"2. There is a complete transition from the cases where two almost perfect individuals are attached at only a circumscribed spot of the body, to those where one individual bears only some trivial supernumerary parts, or other malformation, as, for example, fissure of the skull; in short, to cases whose origin no one would ascribe to a coalescence of two germs.

"3. Finally, it is totally incomprehensible, how, in the case of two separated germs or ova, of which each must have its own membranes, a union of two embryos can take place; and it is just as little to be comprehended how, in such a union, often more than the halves of the two systems can be so intimately fused together, as we sometimes find to be the case. These are the principal reasons which lead me to agree in the opinion, that all twin and triplet monsters, with the exception of the cases of fœtus in fœtu, proceed from a simple germ, or ovum." P. 509.

The doctrine we have advocated, to the effect that the larger number of malformations are the result of certain disturbances in the formative process, usually termed "arrest of development," receives the most striking elucidation from congenital defects connected with the termination of the alimentary canal and genital organs. The clue to this part of the inquiry is to be found in three leading facts:

1. That the posterior extremity of the intestinal passage presents in the early stage of its development a cul-de-sac.

2. That there is subsequently, but still at an early epoch, in both sexes a cloaca, or common connexion of the genito-urinary organs and the intestinal canal.

3. That there are in the two sexes corresponding organs-such as the testes and the ovaria―the penis and the clitoris-the scrotum and the labia majora; and that, in the early development of these parts, they are remarkably similar to each other, so that, till the commencement of the sixth week after conception, the sex cannot be distinguished. It has even been lately affirmed that there is in the male a representative of the uterus, consisting of a median sinus in the prostatic portion of the urethra.

A careful examination of specimens contained in anatomical museums, enlightened by a thorough acquaintance with embryology, will enable the observer to comprehend the true nature of these malformations. Thus, the imperforate anus or the deficiency of the lower extremity of the rectum is evidently dependent on the persistence of the cul-de-sac of the primordial alimentary canal. The specimens in which the rectum communicates, in the male with the urethra and in the female with the vagina, or in either sex with the urinary bladder, is owing to the original cloacal formation remaining, instead of disappearing, as in the normal process, at about the 10th or 11th week, when the canalis uro-genitalis becomes separated from the rectum and anus.

The cases in which the greatest difficulties have arisen, and relating to

which the most false notions have prevailed even among medical practitioners, are those that are said to be examples of hermaphroditism.

In former times no doubts seem to have been entertained as to the possibility of the essential organs of generation, by which are meant the testis and the ovarium, co-existing in the same individual. That this was the opinion of Hunter is made evident by his account of the Free Martin, or defective cow-calf. In his introductory observations he says, " as the distinction of male and female parts is natural to most animals; as the union of them in the same animal is also natural to many; and as the separation of them is only a circumstance making no essential difference in the structure of the parts themselves, it becomes no great effort or uncommon play in Nature, sometimes to unite them in those animals in which they are naturally separated; a circumstance we really find takes place in many animals of those orders in which such an union is unnatural." He subsequently expresses his belief that this unnatural hermaphroditism" now and then occurs in every tribe of animals having distinct sexes." Similar views have been prevalent up to a much later period; but it is apparent that, until each successive step in the evolution of the sexual organs in the embryo had been determined, it was not possible justly to interpret the character of the malformations under consideration. The researches of Baer, J. Müller, Rathke, Valentin, and other observers of the present day, which have thrown so much light upon the history of development, have at the same time removed the principal difficulties involved in hermaphroditical conformations, and have necessitated a review de novo of the whole question. One of the highest authorities in this branch of anatomical science, Professor Bischoff, and to whose masterly sketch we have already alluded, speaking of the cases formerly recorded, in which male organs were affirmed to exist on one side of the body, and female organs on the other; or in which male and female organs were supposed to be present on both sides in the same individual, judiciously observes, "there are so many probable explanations derived from the history of development as to how these appearances may have originated, partly owing to an arrest of formation, and, partly owing to modifications of individual types of development, that I cannot arrive at an unqualified decision." He afterwards expresses himself more definitely:" if my view of the so-called hermaphroditical formations be correct, then, strictly speaking, there are none such in the higher animal forms and man; that is, there is no contemporaneous presence of testes and ovaria in one and the same individual : there are, respect being had to these essential organs, only male and female individuals."

We have already said that the complex and peculiar formations connected with the inferior part of the intestinal canal (representing the future rectum), and in an especial manner the complex productions and metamorphoses of the allantois within the body, and of the uro-genital canal, bear intimately upon the question under consideration. It is essential to know, for example, that in the early state of the embryo, the clitoris and the penis have a perfect resemblance to each other; that each possesses a particular groove; that there are in the male cutaneous folds corresponding to the labia majora of the female; that these folds are at first separated by a fissure; and that subsequently they unite to form the

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scrotum, the prominent suture or raphé indicating their line of junction. The existence, in both sexes, of the peculiar glands called Corpora Wolffiana and the destination of their excretory ducts, are also points of importance; nor should the prostate and Cowper's glands, developed apparently in the female as well as the male, be overlooked. Taking these facts as a guide, it becomes apparent that by far the larger number of the so-called cases of hermaphroditical malformations can at once be referred to certain modifications either of the male or female organs; and doubtless all of them would be thus interpreted, if they were thoroughly investigated. The author is evidently inclined to this opinion, speaking in most doubtful terms of the existence of true hermaphroditism. The most ordinary forms of false hermaphroditism are, in the female, the disproportionate size of the clitoris, so that it may be mistaken for the penis; especially if, which sometimes happens, there is an opening or an inferior channel connected with the clitoris, somewhat resembling the male urethra.

"If, at the same time, as is frequently the case, there is constriction of the vagina, considerable development of the hymen, tumefaction of the labia pudendi, approximation of the total habitus to the male sex by deep voice, traces of beard, and slightly developed mammæ; such individuals may be easily mistaken for men." P. 521.

The most common form of “false hermaphroditism in the male sex, arises from the urethra being fissured beneath and atrophied (hypospadias), while, at the same time, also, the scrotum and even the perineum are cleft, so that the fissure resembles the female vulva; the resemblance being increased by the circumstance, that, like the latter, it is lined with a soft, red, mucous membrane. "Generally, also, in such cases, the testicles have not descended (cryptorchismus), which adds to the deception, so that such individuals have been frequently taken for girls until the period of puberty, when they have suddenly changed into men.' P. 522.

There are some other malformations in the male which have led to a similar error; as where fissure and eversion of the urinary bladder have been mistaken for a vagina; especially if, at the same time, he penis is atrophied and cleft upon its upper side-(epispadius.) In rarer cases, the approximation of the male genitals to the female habitus, is produced by the penis being attached to the scrotum by adhesions; it is thus drawn downwards, and appears to have vanished; the deception is further favoured when the testicles do not descend.

In dismissing this subject, it will not be superfluous to call attention to the fact, that a large number of these so-called cases of hermaphroditism have been examined only during life, and therefore most inefficiently; that the accounts of them have for the most part been drawn up by persons unacquainted with developmental anatomy; and that, even when the parts have been inspected post-mortem, instead of having been submitted to a rigid scrutiny, the most superficial investigation has satisfied the inquirer, so that such an obvious proceeding, for example, as the application of the microscope to determine whether a doubtful organ was a testis or an ovarium, has not been adopted.

We must here conclude our remarks of Dr. Vogel's Treatise, and although, as already stated, we think there is less of originality than might justly have been expected from a writer who stands so high as a pathologist; and fewer of those philosophic generalizations, which the character

of the work would seem to demand, we can strongly recommend the volume now translated to the favourable notice of our readers. In the course of this article, we have not alluded to the English editor, Dr. Day, because, as that gentleman states, the additions he has made are unimportant. We cannot, however, conclude without bearing our testimony to the very efficient manner in which Dr. Day has executed his task; the whole volume indeed, owing to the omission of all German expressions, reads like an original work. The numerous plates, selected principally from the author's "Icones Histologiæ Pathologica," form a very important addition to the text, illustrations being an almost indispensable accompaniment of descriptions relating to minute anatomy.

I, DICTIONARY OF PRACTICAL MEDICINE. By James Copland, M.D., F.R.S., &c. &c. Parts X. & XI. Article, PESTILENCE. London, Longman & Co. 1846-7.

II. A TREATISE ON THE PLAGUE; MORE ESPECIALLY On the POLICE MANAGEMENT OF THAT DISEASE, ILLUSTRATED BY THE PLAN OF OPERATIONS SUCCESSFULLY CARRIED INTO EFFECT IN the late PLAGUE OF CORFU. WITH HINTS ON QUARANTINE. By A. White, M.D., Deputy Inspector-General of Hospitals, &c. Octavo, pp. 342. London, Churchill, 1846. THERE is no subject in the whole range of Medical Science of such wide and momentous interest, alike to the physician and to the public at large, as the history of Pestilential Diseases-including their probable mode of origin; the various circumstances of climate, season, locality, &c., which seem either to promote or to check their development; the causes of the changes or phases which they occasionally exhibit; the laws of their propagation and diffusion; their influence upon population; the effect of quarantine and other restrictive measures upon their progress; the operation of medicinal and hygienic treatment upon individual cases, and also upon the general mortality in a community; as well as various other questions of minor note that must suggest themselves in so comprehensive an enquiry. By the term "Pestilence," has generally been understood any malignant and rapidly fatal Epidemic, or extensively diffused distemper. It has been used, therefore, not so much to designate any particular disease or set of diseases, as to denote the general feature or character of their prevailing within a short period over a large extent of space, and of their proving, at the same time, highly destructive. Dr. Copland however employs the word in a more limited, and in a somewhat peculiar, sense. "Under the head pestilence," says he, "I comprise certain maladies which have appeared as wide-spreading and devastating epidemics, but which have surpassed all other epidemics in their rapid extension, in their fatality, and in the duration of their prevalence." He goes on to remark that these "certain maladies," although usually prevailing epidemically, may occur