appetite, and considerable thirst; sometimes a degree of voracity for food, whether solid or liquid.

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The accumulation in the colon really exists, and is with difficulty dislodged. Pyrosis often supervenes, with the peculiar drawing-in of the diaphragm to the spine.

"Within three or four months of a fatal termination a careful examination of the abdomen usually reveals an unusual fulness a little to the right of the pit of the stomach; it is hardly felt as a tumour, but as an undefined resisting mass, and it appears to rest upon the spine: pressure by the hand causes pain; and, the same as in cases of ulcerated carcinoma of the stomach, I have several times noticed that the patient exclaims with satisfaction that the precise seat of the pain has been touched, and he generally adds his conviction that the cause will be removed.

"At this time loss of flesh and strength increases, the appetite fails entirely, there are vomitings and retchings: the nights are restless, attended with pain. Hiccup is a very distressing symptom, and increases both in violence and in duration of the fit as the disease advances. The tongue shows a tendency to aphthæ, which also gradually increase. Local irritation on the skin, as erythema and erysipelas in the lower extremities, sometimes appear; and whilst they are present there appears some little remission of the other symptoms. Diarrhoea of severe character sets in at intervals: jaundice, with all the symptoms attendant upon it, often supervenes about this stage of the disease." P. 102.

In the closing scene, the prostration is sometimes extreme; the patient is exhausted with hectic fever; and vomiting of dark-coloured fluid, or even of blood, is generally present in a greater or less degree.

It is a melancholy feature of the disease which we have been considering, that in its early stage it is generally mistaken for mere functional derangement of the stomach, and treated accordingly;--by remedies too that often serve but to aggravate the existing lesion. We have already seen that one of the most constant symptoms, at the commencement of the disease, is the sensation of load in the bowels; a sensation which is somewhat relieved indeed by free alvine discharges, but only to return with as much distress as ever. There is, in many cases, a large accumulation of fæculent contents in the colon during the course of the malady-(a circumstance which may lead a physician to suspect a much wider extent of morbid deposit than really exists); but, even when these have been duly evacuated, the uneasiness in question is found to be scarcely lessened. In our author's opinion, it" is rather to be attributed to the presence of carcinomatous deposit, and its progressing adhesions, than to accumulation within the bowel, to which the patient always attributes it." We should, therefore, be on our guard not to have recourse to unnecessarily active medicines, in the vain hope of giving any material relief to symptoms which are inevitable. The use of any but the very gentlest aperients is still the more necessary, when there is reason to believe that the morbid process has involved any portion of the gastro-intestinal mucous surface.

This remark naturally leads us to the subject of the treatment of Carcinoma of the Stomach. The skill of the kind and wise physician consists rather in guarding his patient from injudicious, and perhaps hurtful, medication than in seeking to arrest, or even to materially mitigate, the fearful disease that he has to contend with. Our author writes with no less good feeling than sound judgment in reference to the sad duty which a medical man is called upon in such a case to fulfil, when he seeks to comfort where he dare not promise, to calm and tranquillize where he cannot encourage. His principal remarks on the therapeutic part of his subject is contained in this passage:

"As soon as the symptoms fairly indicate that the disease is in the larger curvature, or in the pylorus, as we have endeavoured to show they may do before ulceration commences, and long before positive evidence is given in the

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form of tumour, a course of active counter-irritants should be immediately adopted. Local depletion, either at the pit of the stomach or over the spine, may succeed in checking or retarding the irritation of the mucous coat, and blisters may be applied as near to the seat of pain as possible. It is necessary at the same time to discontinue all aperient medicines which tend to irritate the mucous membrane of the stomach, and to choose such as act upon the colon, since we must seek to obtain enlarged secretion from the mucous membrane of the bowels, both as a counter-irritant and as a measure of depletion. The occasional and moderate use of calomel, unmixed with any irritating purgative, or of hydrargyrum-cum-creta, is a most useful adjunct. There is evidence in several ways that counter-irritation has apparent power in this disease. The appearance of gout and erysipelas seem to stay the progress for a time. In Case No. 8, there is an instance of an external ulcerated tumour in the groin, which seemed to divert the course of the disease.

"Simple astringents, as lime-water given in milk, and sedatives, may be usefully employed in this stage of structural disease, in the same way as if the secretions, intended to be corrected, were the result of mere disordered function. All stronger astringents should be carefully avoided. The opiates should be sparingly had recourse to, as there will be too much occasion for their aid in succeeding periods of severer trial; they may be usefully combined with alkalis, if indicated, and with hydro-cyanic acid. The diet should at once be changed, to avoid all irritating, stimulating food. The simple animal food which is so useful in common dyspepsia will be too irritating for this stage; beef and chicken tea would not be objectionable, but there is generally a distaste for them. Milk is the only animal food which is generally agreeable, and it is highly appropriate. Pure air, quiet, rest from great exertion, whether mental or bodily, but especially the latter, should be sought." P. 150.

The alterative most worthy, in his opinion, of a fair trial in the early stage of cancerous development is the Bichloride of Mercury, in minute doses conjoined with Sarsaparilla. The extract of Conium has been found one of the safest and most useful anodynes. The application of a Belladonna plaster to the epigastric region at the same time may assist its soothing action.

Dr. Alderson has a chapter on Hypertrophy of the Coats of the Stomach. The disease is limited to the pyloric extremity of the organ, and is almost always associated with-perhaps generally dependent upon a contracted state of the pyloric orifice. It appears to be generally attributable to chronic inflammation of the mucous coat in the first instance, this inflammation extending to the other coats of the stomach in consequence of the use of stimulating food and drinks. "This disease is preceded by morning sickness, and want of appetite; in the later stages the general symptoms are constant retching and sickness; great impatience for drink, which, of whatever quality, and in whatever quantity, is always immediately rejected. Dark-coloured fluid is also vomited in large quantity. Everything taken into the stomach gives pain, and causes not only its own rejection, but also copious vomiting of vitiated secretion from the mucous lining of the stomach. There are heats and chills, and the pulse is quick and the tongue furred. Pain is usually felt on pressure at the pit of the stomach, but not invariably; more so, probably, in cases which owe their origin to unsubdued chronic inflammation than to mere obstruction at the pylorus.

"Emaciation is not a symptom of the disease, and hence its absence negatively distinguishes the complaint from carcinoma." P. 132.

Two interesting cases are related. In both, the prominent and most distressing symptom was an almost incessant vomiting. We are tempted to give the report of the second case complete.

"Mr. H., aged 49, a traveller for a mercantile house in the wine and spirit trade. He had been an active man of business, and in the course of seeking

*

orders for his trade, had been led into convivial habits, which increased to an extreme degree. When I first saw him he was vomiting continually, always calling for liquids, toast and water, soda water, and even brandy and water; all of which were immediately rejected, together with a large quantity of mucous secretion, from the stomach. He was moaning, and restless, and seemed to find most relief by lying upon his stomach, rather on one side, and was very disinclined to be questioned, though anxious for relief. His pulse was small and quick, his tongue furred, and the urine high-coloured.

“On examination, the slightest pressure at the pit of the stomach caused him great pain. He said, there was situated all his misery, and unless something were done, and soon, to relieve it, he must die.

"All these symptoms had come on about a week before, and had continued increasing to the period of my seeing him. For a long time previous to their appearance he had suffered from morning sickness, want of appetite, occasional pain, and flatulence. He attributed his discomforts to his mode of life, and confessed that he usually sought to relieve them by additional stimulants. He was still a fine-looking, muscular man, not at all emaciated.

“General depletion was not ventured upon, as he had recently been the subject of delirium tremens; the most active local antiphlogistic measures were resorted to, but without giving relief. Nothing which was done seemed to have any control over the sickness, which was continued to the last. He only lived a few days.

"Examination of the body 24 hours after death.-On opening the body the parieties were well stored with fat.

"The stomach was the seat of considerable change; the lining membrane was of a dull red colour; the opening into the duodenum was narrowed, but freely admitted the finger; the muscular and mucous coats were found hypertrophied. The muscular coat was firm, rather than hard like scirrhus; the mucous coat softer than natural, and thickened and injected." P. 138.

We must now take leave of Dr. Alderson. The perusal of his present volume has afforded us much gratification, and we trust that ere long we shall again have the pleasure of introducing him to the notice of our readers.

EXPERIMENTAL RESEARCHES ON THE POST-MORTEM CONTRACTILITY OF THE MUSCLES, WITH OBSERVATIONS ON THE REFLEX THEORY. By Bennet Dowler, M.D. New York, 1846.

It happens, from time to time, that some writer favours the world with speculations directly opposed to what are, by common consent, received as established laws and principles in science. On such productions people usually, and with good reason, look with some degree of suspicion; for, in order to make room for their reception, the labours of the most splended minds must first of all be set aside. The brochure before us belongs to the category just indicated. The author, not satisfied with criticising what are, to him, the errors of Haller, sweeps away the ground-work on which Bell based his splendid discoveries; and, having accomplished this feat to his own satisfaction, naturally enough asks whether, after all, there be any discovery in the doctrines of our distinguished countryman.

After such achievements, it is a small matter that our author demolishes without remorse, nay, with some indications of inward satisfaction, the whole theory of the reflex action, treating Dr. Marshall Hall with much less ceremony than is

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Dowler on the Reflex Theory.

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extended to his illustrious predecessor. Our readers will have formed great expectations of a work having such lofty objects; and may, if former experience has not cooled down such anticipations, be anxious to learn the character of these "Researches." For the sake of truth, and for the vindication of all sound physiology, we must place a very low value upon Dr. Dowler's investigations, whether regarded in the light in which it is wished that they should be viewed, namely, as original researches, or as invalidating the fundamental laws of innervation. We have no wish, however, to affirm, that these observations are devoid of interest; nor that, if published as illustrative of a somewhat obscure class of phenomena connected with muscular action, they would have been uninstructive; but, considered as the lever by which the magnificent superstructure of modern neurology is to be overturned, we hold them to be most vain and futile. On looking over the arguments and statements of Dr. Dowler, it becomes, moreover, immediately apparent, that his acquaintance with the anatomy and physiology of the present day is most defective; and one consequence is, that he brings forward as a novelty what is familiarly known to all careful observers on this side the Atlantic, namely, that muscular contractions, occasionally of a powerful character, so that the limbs are moved, may take place shortly after death. Another result of his imperfect knowledge is, that the author is ignorant of a large body of evidence, which has brought conviction to the professional mind of Europe, that the doctrine of the spinal action is a great truth, henceforth to be ranked as one of the fundamental principles of physiological science. Such indeed is the agreement upon this subject, that it would be useless to waste our own space and the time of our readers, by any lengthened refutation of the crude and fallacious reasoning with which we are informed our American brethren were first favoured in the New York Journal of Medicine. A few extracts will exhibit the physiological acumen and qualifications of a writer who has the ambitious aspirations we have just noticed.

"The reflex school maintains, not only that the integrity of the spinal cord is indispensable to transmission, but that the division of the anterior roots is a complete barrier to muscular motion. This doctrine is not based on the healthy, living body. It is not, with a few obscure and unimportant exceptions, deduced from morbid conditions, but from the last agony, and more than all, from the recently dead state of the inferior animals-a kind of proof by no means satisfactory.

"It should never be forgotten that experiments on the inferior animals, as frogs and turtles, are inconclusive in establishing the complicated physiology of man." P. 8.

It is difficult to conceive, with the evidence possessed upon the points here referred to, how this passage could have been penned : the only possible explanation is the one above suggested. What, it may be asked, are the phenomena displayed in the anencephalous infant that survives its birth? It breathes, it cries, it sucks, it discharges the excreta of the body. How, we would ask of the author, are these complex, associated muscular movements performed? Do they involve any nervous agency?—if so, what is the part implicated? Brain there is none; and we may presume that, even Dr. Dowler would not attribute either to the nerves or to the great sympathetic, the power of originating and combining in functional action, muscles so numerous and remote as those engaged in the functions named. What other conclusion remains, but that the spinal cord is the necessary and active centre. As to the objections raised against vivisections, they do not apply to the case before us. If it can be shown that, in a decapitated turtle or frog, or in a rabbit with a portion of the spinal cord removed, impressions made on the skin produce definite, and as it has been clearly proved, functional muscular actions; if it can be shown that the same results are, proportionally to the parts excited, induced by irritating the posterior roots of the nerves, whilst they are arrested by the division of the anterior roots, and are totally prevented

by the destruction of the cord; admitting these phenomena, can any one acquainted with the unity of the organic laws, that one great truth which has been evolved from the profound researches of Cuvier, of Owen, and of every successful cultivator of this branch of science, can any one, we ask, entertain a doubt that, the conditions being the same, the consequences would also be the same in man, with a spinal centre constructed upon essentially similar principles to that of reptiles and mammals? If such kind of evidence be rejected, physiology must return to its very infancy; for, with a few exceptions, little or nothing can be learnt, strange as it may sound to some ears, of human physiology from observations exclusively restricted to man. The difficulty of drawing safe deductions from experiments made on animals, relates to the phenomena of sensation, not of motion, which, as a general rule, can be certainly and successfully interpreted. In further illustration of his argument the author invokes the supposed fact that "an earth-worm may be cut into several pieces, and that each portion becomes a perfect animal." No one acquainted with the structure of this annelide and with the laws of development, could imagine such a departure from the principles of formation; but, for the information of Dr. Dowler, we may state that, by numerous experiments made some years ago, we ascertained that no portion of the earth-worm severed from the head, however large, survived beyond a limited period, dependent upon the length of the segment: the part so detached dies ring by ring.

It would, however, be useless to dwell longer on the errors with which the work abounds, in reference to the received opinions of physiologists; we there fore proceed to notice briefly the author's own researches, into the mysteries of which we are thus somewhat facetiously initiated. "During an attempt to produce contusions on the recently dead body, I happened to select a spot over the middle of the biceps; a blow there (the arm having been extended on the floor) caused the subject to slap his hand against his face with much force. I was almost as much surprised as was a black man that I hired to aid me in a private dissection in St. John the Baptist street, in 1842, of the body of a gentleman of much travel, who died of remittent fever. Previous to this dissection, which was two hours after death, I struck the arm with the inferior edge of my extended hand. The subject contracted his arm, carrying his hand to his breast. My aid looked to the door, which had been closed beforehand, and begged to be let out without delay."

This post-mortem muscular contractility Dr. Dowler regards not only as a thing, till seen by him, unknown; but likewise as an important point of departure in the analysis of some of the most interesting problems in physiology. Many other similar instances, out of a very large number, are related; being principally cases of death from yellow fever, that occurred at New Orleans. One or two of these we extract :

"Mr. S., aged 45. Dead two hours; legs becoming rigid; struck the flexors of the arm with the inferior edge of my hand; the cadaver raised his arm with a regular slow movement, placing his hand upon his breast: as soon as the muscles relaxed, he carried his arm back, extending the same. The experiment was repeated three or four times, when the arm fell back exhausted. The blows were now made with a piece of wood. The biceps gathered up into a lump, at the place where the blow was given, but failed to move the fore-arm." P. 19. The following and other cases show that calorification may take place after death:

"J. K., a Philadelphian, aged 25. In fifteen minutes after death presented the contractile phenomena in its most intense form, but which declined wholly in one hour, the body being everywhere flexible. In half an hour after rigidity set in. This body, which before death had been remarkably cold, had a temperature after death as high as 109°, and which did not refrigerate below 104° in three hours after."