Vrolik of Amsterdam. The child was a male, and born in the eighth month— parents perfectly healthy. The skin of the infant, fissured in different parts, was hard and thickened generally: it was of a yellow colour, and covered with the epidermis; in the fissures it was softer, and somewhat of a bloody appearance. The head, which was almost round, presented very open sutures, and a very large anterior fontanelle. It was covered with thin, short, silky hair, and the scalp was intersected by numerous fissures, one of them running from the left superior eyelid over the os frontis, being twelve millimetres in breadth. Another was confined to the right superior eye-lid, and here also there was a very large fissure at the external angle of the eye-lids, which ran in a direction backwards. The forehead was inclined backwards; the ears were quite concealed by the skin, and only to be seen in their outline very imperfectly; the eye-brows were entirely absent; instead of closed eye-lids, there were two bloody tumors formed by the interior lining membrane of the eye-lids, or by the ectropia of the conjunctiva, behind which the eye-balls were deeply concealed in the orbits; there were but few cilia on the eye-lids, and the extroversion of the conjunctiva was less in the under than in the upper eye-lids. Between the two very distant eyes there was some indication of a nose, which was very large and flattened, and indeed only shewn to be such by the two nostrils. The mouth was largely opened, forming an ellipsis with the returned interior surface of the lips, and surrounding the alveolar parts of the two jaws and the tongue, which was much thickened; in the upper jaw the rudiments of the incisor teeth were very apparent: at each angle of the lips there were three cutaneous fissures; and in the same manner there was one on each side of the upper lip. Neck short and broad; breast and abdomen were almost of the same size, and very different from what they are under normal circumstances; the upper and lower extremities were so far natural, but the hands and feet were swollen, and covered with a fissured skin, and the fingers and toes resembled claws. The scrotum (containing no testes) and the penis were of a red colour, and appeared as if the chorion and epidermis were retracted from them; no perinæum was to be seen; the stretched skin did not allow of a depression behind the scrotum; the opening of the anus was placed on the same level with the nates; here, as well as on the thighs, there were a great many fissures, which, by some difference in their appearance, shewed that they had not all been formed at the same time. It was evident that some of these fissures were recent and unhealed; others were in the way of being cured; some were covered by a red cicatrix; and others were quite like the unfissured parts of the skin. Dr. Vrolik coincides in a great degree with Dr. Simpson regarding the etiology of this deformity, viz.: that the cutaneous fissures are merely a secondary and a mechanical result, and that the integumentary parts not possessing a proper degree of expansibility, and not increasing with the increasing dimensions of the growing fœtus, at last split and fissured under the stretching from within to which they are subjected. To the same mechanical cause are to be referred the ectropia of the eyelids, the form of the mouth, of the nose, and of the ears. The only part in which his explanation differs from that of Professor Simpson is, that the general form of the child must depend upon an arrest of development, and that both this and the degeneration of the integuments are the causes of this deformity. The other case of this disease occurred at Haddington, and bore an exact similitude to the one just described, except that in the Haddington case the disease was confined to the head and neck-in the latter case also the fissures were deeper and wider. In this case also the child was enormously large-it had been born at the full time. It appeared viable enough—it died, however, in a few days.

OBSERVATIONS ON THE VALUE OF THE CHEMICAL TESTS OF DIABETIC URINE. By W. T. GAIRDNER, Esq. Edinburgh. (London and Edinburgh Monthly Journal of Medical Science, July 1844.)

Dr. Golding Bird has described in the Medical Gazette the most notable of the tests which have been proposed for diabetic urine.

1st. Hunefield's test, founded on the power of sugar to deoxidate chromic acid-this is considered fallacious.

2nd. Runge's test, which consists in the development of a black colour by a drop of sulphuric acid.

3rd. Trommer's test-to be described presently.

4th. The fermentation test.-Diabetic urine treated with yeast, and left for a few hours in a warm place, becomes troubled, and covered with a frothy scum; at the same time it disengages carbonic acid gas, which being collected and measured, indicates the quantity of sugar, one cubic inch corresponding nearly to a grain of sugar.

5th. The microscopic test, which depends on the development in urine impregnated with sugar, of minute ovoid particles, the spores of a confervoid or fungoid vegetation which attends on the vinous fermentation in all saccharine fluids.

The fermentation test is not liable to any obvious source of fallacy, and it is one of peculiar excellence in this respect, that it furnishes us with a very accurate and simple means of estimating the amount of the sugar, if necessary.

Runge's test is best performed in the following manner; the urine should be evaporated on a white plate over a vapour bath, or carefully with very gentle heat, as it is difficult to avoid charring, if the proportion of sugar be considerable. A drop of the acid, diluted with six parts of water, should next be applied; and then by moving the plate two or three times backwards and forwards over the flame of a spirit lamp, the black hue is brought out in a spot with clearly defined edges, if there be any sugar present.

Trommer's test is described as follows:-" Add to the suspected urine, contained in a large test-tube, a few drops of a solution of sulphate of copper; a very inconsiderable troubling generally results, probably from the deposition of a little phosphate of copper. Sufficient liquor potasse should then be added to render the whole strongly alkaline: a greyish-green precipitate of hydrated oxide falls, which if sugar be present, wholly or partially re-dissolves in an excess of the solution of potash, forming a blue liquid, not unlike the blue ammoniuret of copper. On gently heating the mixture nearly to ebullition, the copper falls in the state of suboxide, forming a red and copious precipitate. If sugar is not present, the copper is deposited in the form of black oxide."—(See Dr. Bird's paper.) Mr. Gairdner repeated this test with healthy urine, as well as with diabetic urine, and found that, in two specimens of perfectly healthy urine, a precipitate was obtained by Trommer's process, which in colour and appearance was entirely different from the black oxide of copper. The precipitates in question were in rather smaller quantity than usual, flocculent, and of a light orange colour, and were surrounded by a fluid deeply tinged with orange. On adding sugar to a portion of one of those urines, and subjecting it again to the test, the precipitate which resulted differed in no perceptible degree from the former. The precipitate in the diabetic urine operated on (which was very strongly saccharine) differed from these in being much more abundant, and somewhat brighter in hue; but the colour was essentially the same in both, viz. deep yellowish-orange. The fallacious nature of the test is clearly indicated by these observations; other experiments have still further confirmed Mr. Gairdner in this idea, and incline him to the conclusion that it is not the sugar alone which is concerned in the changes in diabetic urine. The tendency of sulphate of copper to form peculiar compounds with organic principles of all kinds, and the extremely various results

when such compounds are submitted to Trommer's process, is another circumstance which tends to induce a suspicion of the fallaciousness of this test. Thus, a dilute solution of albumen (white of egg) gives a dark brown precipitate when treated by Trommer's process; a single drop or two of tincture of galls gives a red or purple precipitate in a brownish liquid; and a greatly diluted portion of skimmed milk gives a gold-coloured precipitate in a bright green liquid. Mr. Gairdner deems it probable that the precipitate thrown down from diabetic urine by Trommer's test is not uncombined protoxide of copper, but that both in this case and frequently in healthy urine, that precipitate is the result of a combination of the oxides of copper with various animal matters which occur in the urine.

REMARKS UPON THE EARLY CONDITION, AND PROBABLE Origin of DOUBLE MONSTERS. By ALLEN THOMSON, M.D. F.R.S.E. &c. &c. (London and Edinburgh Monthly Journal of Medical Science, July 1844.) In the preceding Number of the Journal we gave an analysis of the first part of Dr. A. Thomson's Paper on the subject of double malformation. We shall now present to our readers a few remarks from the same writer upon the theories which have been proposed to explain their origin. Three speculative views have been taken of this subject. 1. The double monster has been supposed to have proceeded from two distinct germs, which have become united in the course of development; 2. It has been held to have originated in a single germ, which has become double or has been subdivided; and 3. The germ has been regarded as abnormally compound from the first, implying that the organs and parts com posing the double monster are at once produced from the germ, without either separation or coalition of its parts, other than belong to the natural process of development. This last view appears to be more in accordance with our knowledge of embryology than either of the two before mentioned.

The various forms of double mal-formation, considered with a reference to the theory of their origin, may be distinguished into two sets; in one of which the united embryos, or, if they are not complete, the parts composing them, have arrived at a nearly equal degree of development; in the other, an imperfectly formed body, or a part of one, is either attached to or inclosed in a more perfect embryo. This last set includes the various forms of Parasitical and Inclosed Double Malformations. The following arguments are among the more convincing that may be adduced in support of the view that double monsters are of original formation, and not the result of any secondary or accidental separation or combination of germs.

1. The different varieties of double monsters form together a complete series of gradation, from the smallest to the greatest degree of the double condition; and in this series, as in those of simple mal-formations, the forms are by no means infinitely varied, but analogous deviations of structure are constantly returning; so as to give no countenance to the idea, that any variation of external circumstances could determine either the manner or the degree of combination existing between the two component individuals.

2. In this combination of the two individuals, or of some of their parts, the most remarkable symmetry is preserved: for there is not any appearance of the junction of parts fortuitously brought into juxta-position; but, on the contrary, an invariable union of only similar or corresponding parts in the two bodies. For the most part that union is to an equal extent in the two individuals; and in the majority of those cases wherein the duplicity is a mere redundance, this superadded part is not single or unilateral, but rather median and common.

3. We observe in twin conceptions the ova frequently pressed closely together, without any tendency to the union of the fœtuses. These circumstances render

it improbable that mere accident can have contributed to any great degree to bring about the union of the parts of the two embryos.

Still, however, though it appears necessary that the compound parts of a double monster should be at once formed and developed as such from the monstrous germ in which they originate, it is obvious that the process of double development must differ in some important respects from that in a single embryo, It is interesting to observe here that while the development of the parts on the external or remote sides of the two united embryoes may be quite or nearly natural, that of the uniting parts must generally be of an anomalous kind.

In the separate parts of double monsters, their development is independent, and may be natural,—in the united portions it is compound and abnormal.

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Another subject of interest connected with the history of double monsters, is the relation between the symmetrical arrangement of the organs in the two united individuals, and the position of the embryos in the ovum at an early period. It is a remarkable fact that those internal organs of the body, such as the heart and liver, stomach, pancreas, colon, &c. which are non-symmetrical, are generally reversed in the body of one of the individuals composing a double monster. Von Baer offers the following theoretical explanation of the cause of its oc

currence.

The embryo of the bird during the first thirty-six hours of its formation, lies with its abdominal surface downwards, and its dorsum upwards, and its parts are nearly in a symmetrical position; but in the course of the third day of incubation in the egg of the common fowl, a change of position occurs, by which first the head, then the thoracic part of the body, and still later the abdominal and caudale portions, come to be laid with the left side of the embryo towards the subjacent surface of the membranes of the yolk; so that in opening a fowl's egg, the small end being directed away from the observer, the cephalic extremity of the embryo will generally be found directed transversely across the yolk, laid in part on its left side, and with its head towards the left hand of the observer. Von Baer had remarked, in very rare instances in the bird's egg, more frequently in the ovum of the pig, the embryo lying with its right side applied to the yolk; and he has very ingeniously supposed that inversion, partial or general, in the position of the non-symmetrical organs, may be connected with this mal-position of the embryo at an early period.

The union between the two embryos composing a double monster may be either visceral or cerebro-spinal. The latter mode of union, when simple, is of comparatively rare occurrence-it in general is by more or less of the visceral parietes, that the two individuals are conjoined. The best known instances of cerebro-spinal union are those in which a part of the cerebrospinal axis (upper or lower) is common to the embryos, and the remainder double. In such cases, however, there is also invariably visceral union to a considerable extent. A much rarer form of cerebro-spinal union occurs in those examples in which there is no visceral fusion, there being two complete or nearly complete embryos, conjoined either by the vertices of their heads, or by the opposite extremities of the vertebral column. In cases of lateral union of two embryos by the visceral parietes, there is generally more or less of the fusion of corresponding parts of the two embryos between them, such fusion being attributable to the simultaneous and compound development of the united parts. But there are instances of an intimate union of this kind occurring on both sides of the body in those double monsters in which the embryos are opposed to each other, more or less directly, face to face. We may here refer to the very remarkable symmetrical union of the parietes of the body or head, presented in the various forms of the Janus-like double monsters. We shall return to this interesting Paper at a future period.

CHRONIC EMPYEMA-PARACENTESIS, &c.

Dr Wells, of Columbia, relates an interesting case which occurred in the person of a medical gentleman, about 33 years of age, when he came under his care in the beginning of June, 1836. About 12 months previously he had an intense pleurisy of the left side, which gave way to active treatment, leaving a pain and sense of weight in that side, with slow fever, quick pulse, dyspnoea, and inability to lie on the right side. In four or five weeks these symptoms partially subsided, and his appetite returned; but dyspnoea and palpitation remained. Fluctuation became evident in the left cavity of the pleura, and the ribs of that side were bulged out.

June, 1836.—The heart was found beating in the right side of the chest-no respiratory murmur in the opposite side, which was one-third larger than the right-intercostal spaces very wide-hectic fever-pulse small and rapid-face bloated, with various other symptoms indicative of the nature of the case. On the 7th June paracentesis thoracis was performed, and between two and three quarts of thin inodorous pus were discharged, with much relief, but with such faintness that the further issue of fluid was stopped. In the evening two quarts more of the fluid were drawn off-faintness was produced-and another interruption occurred. In the middle of next day, June 8th, the tube was introduced, and about two quarts of fluid were drawn off, when the stream was interrupted, the thoracic parietes not being capable of farther compression. 9th. Complained of oppression, and about a quart of fluid was abstracted, with relief. 10th. Another quart drawn off. A quantity of air was this time sucked in, and produced inconvenience. 11th. Febrile excitement-embarrassed respiration. Drew off a quart of intolerably fætid matter. 12th. Less fever-similar dis charge from the chest. 13th. Discharge the same-debility increasing. A quarter of a pint of weak solution of chloride of soda was injected into the chest, and the greater part of it soon afterwards withdrawn. 14th. Did not experience any inconvenience from the injection, but seemed relieved by it. The irritation and fever subsiding-fluid withdrawn this day less fætid. The injection repeated, and most of it suffered to return, after a few minutes.

"It is unnecessary farther to detail the daily treatment in this case. It was found impracticable to prevent more or less air passing into the chest, at each operation, and as little or no inconvenience resulted from it, under the counteracting influence of the injection, it was no longer regarded. The free extremity of the elastic tube was bent downwards below the level of that within the cavity, giving to the instrument the properties of a syphon, and the whole of the secreted fluid daily evacuated, and the solution of chloride of soda injected, gradually increasing its strength and its quantity, until it corresponded with the quantity of matter drawn off at each operation. From this time to the 20th of July, when he left Columbia, the same course was followed up. The discharge soon lost its fetor, and gradually decreased in quantity from the time we commenced the use of the injection, so that on his departure it amounted to about three gills in the twenty-four hours.

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During this period, a little over a month, his recovery was uninterrupted by any untoward symptoms; the state of his digestive organs was carefully watched, under the influence of an alterative, tonic course; and as his appetite and powers of digestion improved, he was allowed a more liberal diet. For the last ten days he remained here he was able to take a short walk daily, and with much more ease to himself than when he came; the prominence of the left side of the thorax, and upper part of the abdomen, had subsided; the heart had made some progress towards the left; but no respiratory murmur was yet perceptible on that side. His appetite was good; sleep much improved; and when he left me for