Academy of Natural Sciences of Philadelphia might with great propriety be selected as the recipient of all such craniological statistics, and the Proceedings of the Academy distributed to 200 associations and individuals in Europe, and to 210 in America, would then become the channel through which these statistics might be very generally made known. In Canada, the Canadian Institute, and its literary and scientific organ, the Canadian Journal, might be selected for a similar purpose. In Great Britain, the London Ethnological Society might be enlisted in carrying out the objects under consideration by this or some other similar plan. French Ethnology being represented at present by the Societé de Géographie de Paris, as I am informed by its learned secretary, M. Alfred Maury, in a letter dated June 24, 1858, it appears to me that this Society, through its Bulletin, might coöperate very successfully in the furtherance of this plan with the craniologists of Scandinavia, Holland, Germany, Russia, Southern Europe, etc.

"The editors of scientific, medical, and literary magazines, journals, reviews, etc., have it in their power greatly to promote craniographic science by inserting in their pages from time to time, and thus disseminating the information obtained in the manner indicated above. This statement particularly applies to medical journals, inasmuch as most of those cultivating craniography are physicians, not a few of whom are in the active public or private practice of their profession."

A PAPER ON THE MANAGEMENT OF THE SHOULDERS, IN EXAMINATIONS OF THE CHEST; including a New Physical Sign. Read before the New York Academy of Medicine. By JOHN W. CORSON, M. D., etc. New York: H. Baillière, 290 Broadway.

A very useful, practical manual for students in physical exploration, the various positions of the shoulders being so managed as to facilitate the auscultatory diagnosis, by tightening and attenuating the muscles, and removing the scapulæ from parts usually covered by those bones.

We cannot, however, refrain from giving the opinion that some things in the book are not so new as the author imagines. Thus his fifth position, which he considers "worth more than all the rest," we have not only seen practiced, but frequently put in practice ourselves, though we are free to acknowledge that we are unable to cite any directions for it in any text-book with which we are acquainted. We give his account of it from the "Summary" at the end of the pamphlet:

"As worth more than all the rest, we commend the 'fifth position,' for by natural machinery it wrenches the shoulders forward out of their beds, and widely severs them in the rear. In thin persons, it often thus

stretches out their intervening muscles till like stout broadcloth, and thus quite uncovers the inner and upper part of the lungs behind. To accomplish this, the patient crosses arms in front, with the stronger outside, grasps with the opposite hands the two shoulder joints, pulls both strongly, and holds fast, to keep them tense. The physician aids to fix the shoulder blades widely apart at the back by firmly pushing. Even in health, as any one can prove, the soft breathing murmur at the former place of the scapula can be thus nearly doubled. In tubercles it here opens a new field for palpation, and especially for percussion. It intensifies harsh respiration, or fatty crackling.' In pneumonia, it exaggerates the clear, barrel-like echo of bronchophony,' and in pleurisy, that line between wind and water, the trembling egophony.' It brings out a delicate new sign, we have discovered, in bronchitis. It is a kind of prolonged liquid breathing, as if through a layer of wet sponge, heard before or after mucous râles, which we venture to name moist respiration."

The new physical sign may be learned from the following:

6

"Another new and really useful physical sign we have to communicate is the comparative stiffness of the shoulder over the lung most diseased, in strong breathing, seen and felt from behind. For this we may use the 'sixth position.' Facing the back of patient, a yard distant, near a window or white wall, you tell him to drop his arms, let them hang easily by the sides, as if dead,' and then breathe deeply for a few moments, like a man a little out of breath.' You now take aim,' like a rifleman, across the tops of the shoulders, and then shut your eyes and feel them gently swell. Drawing nearer, you notice that the inferior angles' of the scapula move gently in breathing like the fins of a fish. You can both see and feel this movement. This stiffness of the shoulder in breathing may be decided, or slight, local, or general. When most at the top, we term it, for convenience, 'acromial,' and when most at the lower extremity, or inferior angle, we call it angular.' Curiously enough, these last features seem to depend on the higher or lower location of the disease which thus, as it were, paralyzes the parts nearest. An elegant way of testing angular stiffness,' even in a lady fully clad, is to place your two index fingers on the lower points of her shoulder blades, and watch and feel their movement as she sighs. The causes of this stiffness are supposed to be loss of upward expansion in the lung, tenderness, pleuritic adhesions, and weight of morbid deposits. A table of eighteen cases is added, illustrative of this sign. It was least in recent attacks; varied most in phthisis; was slightest in pneumonia, and greatest in chronic pleurisy."

Dr. Corson is very earnest in enforcing the necessity of an early diag nosis in tuberculous disease, with a view to its prompt and sedulous hygienic treatment-fresh air and exercise being the prominent items thereof. We cordially commend the work as one of evident practical utility. D. F. W.

CONGENITAL ECTROPHY OF THE URINARY BLADDER AND ITS COMPLICATIONS successfully treated by a New Plastic Operation. By DANIEL AYRES, M. D., LL. D., Surgeon to the Long Island College Hospital,

etc.

This interesting report originally appeared in the American Medical Gazette for February, 1859. The malformation treated is one of the most distressing known, and has been spoken of by all writers as incurable. Dr. Ayres can, therefore, boast of an entirely original operation. The mode of operation was to dissect a flap from the abdominal parietes, out of which an anterior wall was formed for the bladder, while the separated nymphæ were forcibly approximated, and an opening left below which supplied an artificial urethra and meatus. The various steps of the operation, the difficulties encountered, and the ingenuity with which they were overcome, can only be fully comprehended by carefully perusing the pamphlet; and such perusal will, we think, show that Dr. Ayres has achieved a triumph in surgery only second in value to the operations of Drs. Sims and Bozeman for vesico-vaginal fistula; and indeed, if less useful than these, it is only because the lesion cured is less common.

D. F. W.

SOME important reviews are excluded by a press of other matter.

Editorial Department.

REMARKABLE INSTANCE IN TERATOLOGY.

FOR Some time an interesting case of united twins has been exhibited in this and several of the neighboring States. Vague and inaccurate descriptions of it in newspapers have led to inquiry on the part of medical journals at a distance. With the purpose of giving a satisfactory answer to these inquiries, we were led to apply for a private inspection, which was very courteously acceded to by the proprietor, Col. Vestal.

It may be premised that this child (or children) has been exhibited in several of the Southern States under the somewhat incorrect appellation of "Christine Milly, or the Two-headed Girl." As now described, we think our scientific readers will recognize it as a very remarkable but quite credible case of twins united and partially blended.

On first inspection, the twins present the appearance of two wellformed mulatto children, of about seven or eight years old, united back to back at the lumbar region, but a further examination shows several remarkable characteristics of the common pelvis. It is probable that a post mortem examination alone could entirely elucidate the complex structure either of the pelvic viscera or even its bony skeleton.

As far as can be understood without dissection, each child has a complete dorsal and lumbar vertebral column, these two meeting in a common sacrum, from which, as from an apophysis, the common pelvis may be considered as developed. This common pelvis is so situated that its antero-posterior diameter lies not in the direction of the antero-posterior median plane of either of the two children, but at right angles to it; so that, calling the child to the right of this central pelvis A, and that to the left of it B, the right leg of A and the left of B are on the posterior or sacral aspect of the common pelvis, and the left leg of A and right leg of B on its anterior or pubic aspect. Or perhaps we shall be more intelligible if we trace the whole circle of the pelvis, commencing at the

sacrum as a centre. Proceeding from this towards the right, we find an os ileum belonging to child A, with the regularly formed pelvic bones forming the acetabulum for A's right leg; then apparently a rudimentary os pubis peculiar to A; then the acetabulum of A's left leg; then a pubis common to both children, and opposite the common sacrum; then the acetabulum of B's right leg, a pubis peculiar to B; then B's left acetabulum; then an os ileum for B uniting with the common sacrum. Proceeding now to the pelvic orifices, in front of the common sacrum, at the customary distance from the extremity of the coccyx, is a common anus of the ordinary form, and again separated from this by an ordinary perineal space is a common vulva. This lies transversely, and not in the antero-posterior direction, considering it in reference to the common pelvis; but, on the other hand, if we refer it to the two individuals, it may be considered as occupying its ordinary antero-posterior direction, and may be considered as two vulvæ, the pubic extremity of each being complete, but the perineal extremity obliterated in each so that the two openings are blended in one. Pursuing our examination now from behind forwards, immediately behind the common pubis is a depression as if the rudiment of another vulva, and anterior to that the common os pubis.

We trust this description, necessarily complicated, will be found intelligible. Perhaps it will make it plainer to say that each individual child turns her back upon the median antero-posterior plane of the common pelvis, to the sacrum of which the vertebral column of each is articulated.

As bearing upon transcendental anatomy and embryogeny, we deem this case of unusual interest. Assuming the pelvo-crural arch and the genital system as two successive circles developed from the spinal axis, and represented respectively by the lumbar and sacral plexus of nerves, we find the former partially and the latter wholly blended, the individuality of all the rest of the body being complete in both.

As we have said before, several questions arise insoluble before death: as the nature of the connection of the two intestinal canals with the common rectum, and the two uteri, or possibly the bicornute uterus, with the common vagina. Any of our scientific friends who may have the opportunity will be much interested in inspecting this remarkable phenomenon: the general law of structure perfectly fulfilled, modified but not cancelled by the singular circumstances under which it acts; persistency of principle under a total subversion of ordinary conditions.

We forgot to remark that in the child to the right of the common pelvis, the heart is on the right side of the thorax. D. F. W.