and downwards; in other words, that the length of the round ligament and its position is such as to allow, without rupture, the head of the femur to leave the socket entirely in the directions of forward and downward, especially towards the obturator foramen; at one point it may be found to have quitted the cotyloid cavity to the extent of three-quarters of an inch, without inflicting any injury upon the ligament itself. But if the bone thus hanging attached merely to the os innominatum by the round ligament be now carried forwards towards the horizontal ramus of the pubes and its body, and the shaft of the femur be at the same time kept extended in the usual position it hangs in the body, then it will be found that the round ligament will restore the head of the bone so pushed upwards, or upwards and outwards, to its proper place in the acetabulum.

Lastly, a long narrow bistoury being introduced through the capsular ligament, and the round ligament divided, with as little injury as possible to the capsular ligament, it was found that this ligament, the capsular, checked the motions of the femur, just as effectually as when the round ligament was left intact,explaining thus the very curious fact, although I have not myself observed it, that the round ligament may be congenitally absent, and the motions of the joint, with all the checks to these motions, be found as perfect as if no such deficiency existed.

In conclusion, there remain but a few more points, which I think it necessary to advert to here. They refer to some facts not so immediately connected with the subject of the preceding memoir, as to induce me to introduce them in the body of the memoir.

1. It is by no means improbable that the round ligament of the femur may vary in length in different persons, and that a congenital comparative shortness of this ligament may contribute to the production of the deformity of “in-toes." The measurements of the ligament in a tolerably well-formed female were as follows: 1. posterior and outer surface, 14 inch; 2. anterior and inner surface, 1 inch; 3. upper margin, 14 inch; 4. lower margin, 14th inch; breadth at the acetabulum, gths of an inch; breadth at the femur, 4ths; thickness at the femur, ts; thickness at the acetabulum somewhat less. On the other hand, it is quite certain that the round ligament of the femur may be congenitally lax, or of a more than usual length in some persons; which laxity may either be confined to itself, or form a part of a general laxity of all the ligaments and fibro-cartilaginous structures throughout the body. One case of this kind I perfectly remember occurred in my practical rooms, Old Surgeon's Hall, a few years ago. A tall and seemingly stout-made woman was brought into the rooms for dissection, and time being allowed by a delayed in

terment for a careful examination, the hip-joints were found so loose that rotation, and, indeed, all the usual motions, could be performed to an extraordinary extent. During rotation, the hip-joints had precisely the appearance of partially dislocated limbs; in fact, the head of the femur looked as if it had partially left the socket. Similar remarks applied to all the joints of the body, and further dissection showed that the inter-spinal fibro-cartilages partook of the same laxity. The spine, curved like the letter S, presented a series of lateral curvatures, so exactly compensating each other, that the perpendicularity of the spine had, notwithstanding these curves, been perfectly preserved. To this very remarkable case, I hope afterwards to return in a memoir on curvatures of the spine and their

causes.

A case of congenital absence of the round ligament, permitting of dislocation of the head of the femur, has been recorded by M. Dupuytren; but in other similar cases of original or congenital luxation, the round ligament was not absent, but very much elongated, flattened superiorly, and, as it were, worn at certain points by the pressure and friction of the head of the femur. Very lately, Mr Stanley brought before the Medico-Chirurgical Society, some very interesting cases of luxation of the ileo-femoral joint, produced by other causes than external violence, and yet not connected with scrofulous ulceration of the hip-joint. A brief report of the cases, and of the discussion thereon, will be found in the Lancet and Medical Gazette for February of the present year. In one case only did an opportunity occur for dissecting the joint, when it was found that the capsular and round ligaments were merely elongated, but that neither of them had given way. I have also been informed by my friend, Mr Dick, of the Veterinary College here, that it is not very unusual to find the round ligament of the femur absent in the horse. He attributes its absence in these cases to rupture from sudden violence short of dislocation; besides the absence of the ligament, other changes go on in the joint subsequent, as he considers, and in some measure, the result of the original accident, viz. atrophy of the cartilages of incrustation, and the conversion of a part, at least, of the abraded surfaces into the ivory structure; in short, the very changes I described as occurring in the case which formed the commencement of this memoir.

Lastly, it is worthy of remark, that the fibres composing the round ligament are of unequal lengths, and that in most positions of the femur, the ligament itself is constantly twisted; indeed, it can only be unfolded by a dislocation of the femur downwards, and a subsequent rotation, in so peculiar a direction, as can never happen in the living body.

ART. VII-Report of a Committee of the Royal College of Physicians of Edinburgh, appointed to consider the best mode of framing Public Registers of Deaths. (Approved by the Royal College, February 17th 1841.)

THE proper mode of framing public registers of deaths was pretty fully considered by a Committee of the British Association, which was appointed at the meeting held in this city, in 1834, and reported to the subsequent meeting of the Association in Dublin, in 1835. At that time, the "Act for Registering Births, Deaths, and Marriages in England," was only in contemplation, and it was expected that a similar Act for Scotland would be introduced into Parliament. The English Bill became law in 1837, but the Scottish Bill, in consequence, as is said, of the opposition made to it by the Parish-Clerks throughout the country, has been hitherto postponed. It seems hardly possible, however, that the numerous benefits which our sister-country derives from an effective system of registration, should not, within a reasonable time, be extended to Scotland; and it may be hoped that the recent decided expression of opinion by the Statistical Section of the British Association, respecting the importance of the measure, will contribute to this end.

It is obviously of importance, therefore, that the attention of the Profession in Scotland should be again directed to the subject of the registration of Deaths, and to the advantages, as regards not only the interests of the public, but the progress of medical science, which may be expected to result from a well-regulated system of Registration; and this more particularly, as the plan of keeping such Registers, introduced by the English Bill, (which is considerably different from that previously recommended by the Edinburgh Committee,) and the Statistical Nosology recommended by the RegistrarGeneral, for the use of Practitioners, in filling up the returns of the causes of death, appear to your Committee liable to serious objec tions.

With two observations, contained in the letter on Statistical Nosology, prefixed to the Table of Diseases drawn up by Mr Farr, and both of which are contained in the Remarks on the Registration of Deaths, that were laid before the British Association by the Sub-Committee formed at Edinburgh in 1834, all must concur.

The first of these relates to the importance of retaining the old division of diseases into Plagues and Sporadic Diseases, or, in other words, into 1st, those diseases which are confined to limited districts and limited periods,-which are either endemic or epidemic; and 2d, those which proceed from causes acting pretty uniformly on every large mass of mankind, and which are found accordingly, although influenced by climate and season, to prevail more or less, and to produce a larger or smaller annual mortality in all coun

tries.

This distinction at once recommends itself to the common sense of

mankind, and perhaps the most correct scientific account we can give of it is by saying, that one class of diseases is the result of Specific Poisons, of various sorts, introduced into the animal economy, and the other of Morbid Actions, excited by causes which are very generally applied, and are not necessarily deleterious in their effects. But the allocation of individual diseases, in one or other of these great divisions, is attended with difficulty, and the plan adopted in the English Table is in several respects unsatisfactory.

The second of the two observations referred to, is that, in Sporadic Diseases, it is generally easier to distinguish the region, or even the organ, primarily and chiefly affected, than to ascertain the precise nature of the disease. The importance of this observation appears to your Committee not to have been sufficiently appreciated in forming the Registration lists of diseases for England; and to suggest the only distinction that ought to be observed between a Statistical Nosology, and a Nosology for the use of Schools of Medicine.

To these we would add only one other preliminary observation, which is the foundation of the criticism to be offered on the Tables of the Causes of Death drawn up by Mr Farr, and used in the Returns under the English Registration Bill, viz.-That in constructing such returns, it is better to acknowledge ignorance, than to run the risk of proclaiming error,-better to rest satisfied with a smaller amount of information, of which we can be absolutely certain, than to attempt to procure a larger amount, at the risk of the facts being so much blended with opinions, as to make numerical statements a possible source of misapprehension and erroneous doctrine.

It is to be observed, that certain articles of information in regard to all the deaths that occur in a district, may be accurately and uniformly given in the Registers, and be of much importance in various medical inquiries (because enabling us to construct Tables illustrating with certainty the influence of various causes on health,) altogether independently of any medical opinions as to the causes of death; viz. the age, the sex, the precise date of death, the occupation of the deceased person, or that of the head of the family to which he belonged, the precise locality of his residence, the part of the body chiefly affected by the fatal disease, and, in a general way, the duration of his disease. The Report of the Edinburgh Sub-Committee laid some stress on the importance of all Registers containing details on the two last of these heads; and suggested, that all the deaths should be ranked as depending on acute or chronic diseases, according as the patient should have been known to be ill, and disabled for his ordinary occupations for less or more than six weeks before death. We regret to perceive no evidence that effectual provision is made in the Registers kept under the Act now in force in England for any of the last mentioned points being uniformly and regularly ascertained.

In proceeding farther, it must always be kept in mind, first, That to a very large proportion of the deaths registered, no report of the cause of death, by a medical man, will be annexed; and, secondly, That such a report, when given, unless much care be taken, may

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very often be founded in a great measure on opinion, not on ascertained facts. But, conformably with the principles above laid down, it is desirable that all the cases of sporadic diseases should be entered according to the seat of what was regarded as the chief affection, as acute or chronic disease of the head, of the chest, of the stomach or bowels, (including affections of the liver and other chylopoietic viscera,) of the urinary organs, of the genital organs, of the bones or joints, or of external parts. This may be done, as was observed by the Committee of the Association, without any report by ́a medical man; but it will of course be done with more accuracy by medical practitioners. Farther, it would be desirable that the accurate specification of the organ, or the more precise name of the disease, should be given, only when furnished by a medical practitioner, and should be stated in a separate column; and that practitioners should be requested to specify the name, only in those cases in which they can announce it with confidence and precision. Thus we might have, e. g. 100 cases of death reported as resulting from diseases of the chest, 40 of these marked as acute cases, and of these 40, perhaps only 10 would be named; but the names given, being in conformity to instructions, as simple as possible, issued to all medical men, and to none others, would be understood alike by all, and therefore be deserving of confidence.

Thus we should have in every register of deaths, two distinct columns-the one to be filled up in all cases, the other only in some cases, from which, of course, two lists may be at any time made up, the first illustrating many important points relative to disease, although containing no nosological name; the second affording as good security as the state of medical science and medical instruction permits, that the names of diseases given in it are given uniformly, and applied similarly in all parts of the country. Each of these columns would be subdivided in the way to be afterwards mentioned.

The construction of the List of Diseases, to be recommended, by authority, to all practitioners, is the subject of greatest difficulty connected with the registration of deaths, and that in which the plan adopted in England seems liable to the greatest objection. But we regard it as a fundamental principle, that practitioners should be strongly advised rather to content themselves with stating the seat of the disease causing death, and its course as acute or chronic, than to affix a name to it, without possessing certain evidence, from examination of the body or other unequivocal indications, of the name they affix being the right one.

The importance of this caution appears from the Tables published in England. We do not refer to the whole list of diseases, about 180 in number, given under the name of Statistical Nosology, which seems very deficient in simplicity, (comprising, for example, six distinct names for varieties of the Continued Fever of this country,) but would refer particularly to the Abstract of the causes of death in the registers contained in page 120 of the First Report. The names there given are certainly a great improvement on the ancient Bills of Mortality, but we think it easy to show that the objections justly