The presence of free hydrochloric acid in this fluid is no longer requisite for the carrying out of his theories, and singular to relate, that acid no longer exists there. In the second edition of the 'Animal Chemistry,' published four years since, we are informed that "the presence of free muriatic acid in the gastric juice, first observed by Prout, has been confirmed by all those chemists who have examined that fluid since;" but now (June, 1847),

"when we recollect that lactic and phosphoric acids, at temperatures in which hydrochloric, acetic, and barytic acids are volatilized, are almost fixed, we can explain how it happens that, in many cases, hydrochloric acid, in others, acetic or butyric acid, has been obtained by distilling the gastric juice. Acetates, butyrates, and even chloride of sodium are decomposed by lactic acid, as well as by acid phosphates in these circumstances, and the occurrence of the one or the other of the more volatile acids must vary with the amount of the lactic or phosphoric acid present in the gastric juice, and the amount also of their salts in the same fluid.” (p. 139.)

In the preceding pages we have given our readers an abstract of all the more important parts of this volume, which we deem the most valuable that has yet appeared from the pen of its illustrious author, in so far as concerns the application of animal chemistry to the actual practice of medicine.

We have alluded in one or two instances to the differences of opinion, on points of high importance, occurring in the present volume and in the last edition of the Animal Chemistry,' and we might have given more illustrations of a similar nature. We have done so with the view of showing that if, from the evidence afforded by his own writings, the first chemist of his age may fall into grievous errors, he should look with some degree of forbearance on those who have the misfortune to differ from him in points of comparatively minor importance. However, the points of controversy between himself and Mulder may be ultimately decided, his warmest admirers must ever regret the unaccommodating and hostile spirit he has exhibited. The following sentence from Mulder's defence* is strong we do not say that it is altogether true; but the very fact that such opinions are entertained by others ought to make the great professor more cautious and less dogmatical in the expression of his own. "Freedom of scientific opinion has never been understood by Liebig. For years past a tribunal has been established in Giessen, before which Liebig is at the same time accuser, witness, public prosecutor, advocate and judge."

ART. XIX.

Practical Observations on some of the Diseases of the Stomach and Alimentary Canal. By JAMES ALDERSON, M.D., F.R.S., late Senior Physician to the Hull Infirmary.-London, 1847. 8vo, pp. 208. With Ten coloured Plates.

THE author of this volume, after having long enjoyed an extensive practice in the country, has recently withdrawn from its harassing duties and taken up his abode in the metropolis. In the comparative leisure thus temporarily created he has set himself to review his past experience, Mulder's Reply to Liebig, p. 6.

XLVII-XXIV.

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and the present volume is the first-fruits of the scrutiny. In a modest preface he tells us that he claims "neither the character of a discoverer nor of a theorist, nor of a proposer of any particularly novel or scientific plan of treatment." He has written, he says, "in the belief, or at least the hope, that the result of extensive observation, classified and reasoned upon, would be found useful." He may rest assured that his professional brethren will give him all credit both for his motives and his exertions, and will receive his book in the honorable spirit in which it is presented to them.

The work is divided into two Parts-the first, containing observations on structural, the second on functional diseases of the alimentary canal. The structural diseases noticed are-carcinoma of the pharynx, œsophagus, stomach, pylorus; malignant disease of the colon; encephaloid disease of the liver; hypertrophy of the stomach; perforation of the stomach and ileum. The functional diseases are, different forms of dyspepsia, and disorder of the colon.

The work consists mainly of cases with remarks, many of which are well illustrated by engravings. To such of our readers as are familiar with the special works on cancer in general, and with the various illustrated treatises on morbid anatomy, the volume of Dr. Alderson will convey little or no new information: as an authentic record, however, of cases of severe diseases, traced to their termination and beyond, and subjected to rational and enlightened treatment, it will deserve the attention of practitioners as well as of systematic writers and pathologists.

In Chapter VII. entitled "Carcinoma of the stomach, external to it, and involving other organs," we have a very good account of a form of malignant disease which is of frequent occurrence and yet often misunderstood. It is sometimes confounded with enlargement of the liver or spleen, often with the "tubercular accretion" of Dr. Baron, and we have known it confounded with aneurism of the aorta. We extract the brief account given of the pathology of this disease, and also a part of the author's observations on the diagnosis, symptoms and treatment; and with these extracts we shall close this brief notice.

:

"Deposit of carcinomatous matter may take place beneath, or on the free surface, of the serous membrane covering the stomach, and the neighbouring viscera (as the duodenum, the head of the pancreas, the omenta, the mesocolon, &c.) the deposit varies in consistence from the hardness of scirrhus to the softness of pulp. It is difficult, if not impossible, to assign a position to the earlier deposit: as it increases, however, lymph is effused, and adhesions are formed, by which contiguous parts are glued together; the viscera become bound to the spine, and to each other, by these adhesions, and, as a consequence, the healthy performance of their various functions is interfered with. The adhesions often present a dark smoky hue, and jelly-like appearance, and are easily torn through; the proximity of organs, rather than the similarity of function, seems to be the cause of their being involved. The order in which the parts are severally included in the diseased mass may be inferred from the succession of the symptoms which will be hereafter detailed; this order, as well as the number of organs finally included, varies in different cases. In some cases the disease proceeds until portions of the stomach, the duodenum, the pancreas, the colon, and even the liver, are all involved in one diseased mass, forming an undefined tumour. In the later stages of the disease ulceration finds its way into the duodenum, the stomach, or the colon. The ulceration has a peculiar character, differing from that which results when the primary seat of the deposit is in the submucous cellular tissue; the disorganising process is, perhaps, more properly expressed by erosion, which takes

place through the coats, where either hard or soft material of carcinoma is deposited.

“When the extension of the disease is to the duodenum, and perforation of the coats takes place, the orifice of the gall-ducts becomes involved, and jaundice supervenes; the caliber of the intestine becomes narrowed, and the stomach in consequence obtains a habit of unusual distension.

"The pancreas is ascertained generally by post-mortem examination to be included in the disease; and from its proximity it is to be inferred that it is simultaneously affected with the duodenum: there is no train of symptoms, however, with which I am acquainted to give certain notice of this organ being involved.

"When the extension of the disease is towards the stomach, similar erosion of the coats takes place as in the duodenum, and is followed by the same set of symptoms as have been enumerated as denoting ulceration of the mucous coat.

"When the extension is to the colon, the centre of the arch, from proximity, is the part attacked; the bowel at that point becomes narrowed, and there is a mechanical obstruction to the passage of the antecedent contents; the contractile power of the muscular coat is at the same time interfered with by the adhesions: the capacity of the whole tube to this point enlarges, and the bowel remains habitually distended, just as the stomach does by pyloric or duodenal interference. This state of the colon gives rise to the accumulation which will be noticed as a prominent symptom; diarrhoea or dysentery follow from the effects of ulceration through the mucous lining of the colon.

"The liver is secondarily affected by the deposit of encephaloid tubera, and in some cases subsequently becomes adherent to the diseased mass; the gall-bladder is usually distended with bile, and contains gall-stones. Secondary deposit also sometimes takes place in the lungs, though very rarely, but it does not proceed to a state to cause any very prominent pulmonic symptoms." (pp. 96-9.)

"Amongst the earlier symptoms of this disease, unsatisfactory relief from the bowels is the most prominent. It is experienced for a year or more before the more urgent symptoms set in, and is accompanied at intervals by nausea, retch. ings, and headache. Pain is also suffered, but not to any great extent, and it is referred by the patient to an unremoved accumulation in the bowels; it is described as situated at the pit of the stomach, or rather lower. The patient subsequently begins to lose flesh, the features shrink, the complexion becomes opaque, sallow, and exsanguineous; the eye looks sunken, and the strength begins to fail: great anxiety about his health now possesses the patient, who is often prone to seek various opinions, until he finds a voice ready to flatter him with the delusive promise of a cure." (p. 100.)

"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." (p. 101.)

"It is obvious that, according to the organs included in the disease, their different functions will be interfered with. Amongst the most constant symptoms of the first stage of the complaint is the sensation of load in the bowels. Relief is only obtained by several daily evacuations, and the uneasy sensations again daily return. This partial relief may arise from the actual removal of a lodgment of feculent matter in the arch of the colon, or by the aperient acting as an antiphlogistic measure, by causing increased secretion from the mucous coat: but I am inclined to think, from the fact that the uneasy sensations recur again so soon

after copious action of the bowels, that the uneasiness is rather to be attributed to the presence of the carcinomatous deposit, and its progressing adhesions, than to accumulation within the bowel, to which the patient always attributes it.

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In every stage of the complaint the evacuations will give evidence of there having been accumulation in the colon, which will seem to call for the repetition of purgatives; but as the difficulty to be overcome is, after all, merely a symptom, it is necessary to be cautious in subjecting the patient to a severe discipline which could only be warranted on the supposition that the endurance would be rewarded by permanent benefit." (pp. 111-3.)

"At an early period of the disease the deposit is evidently confined to a small space; the future ramifications have yet to be determined; and the symptoms obviously vary according to the progress of the encroachment: thus hepatic symptoms become more prominent as the disease proceeds towards the duodenum and pylorus. Mechanical opposition to the food from the stomach begins, and vomiting comes on. The vomiting is not of the same kind as that in cases of ulceration of the mucous lining; it is full and free, as in scirrhous pylorus: the stomach becomes habitually distended, and admits of a large accumulation of contents, which are sometimes retained for a period of twenty-four hours or more, and then rejected all at once, without any accompanying nausea. The stomach, being comparatively in a sound state, craves for food immediately after it has got rid of the contents, and hence the voracious appetite which is sometimes expe rienced. The eagerness for food is also to be attributed to a sense of relief obtained by a full state of the organ which replaces the neighbouring viscera in their easiest relative position: in such a case, it is impossible to deny the patient the solid food which he desires." (pp. 115-6.)

ART. XX.

Ueber die Gesetze nach welchen die Mischung von Flüssigkeiten und ihr Eindringen in permeable Substanzen erfolgt, mit besonderer Rücksicht auf die Vorgänge im menschlichen und thierischen Organismus. Von JULIUS VOGEL.-Göttingen, 1846.

On the Laws regarding the Mixing of Fluids and their penetration into permeable substances, with special reference to the processes in the Human and Animal Organism. By JULIUS VOGEL.-8vo, pp. 42.

THIS is an excellent attempt to explain many of the obscure points in the process of secretion, by a reference to purely physical laws. It must be obvious to the most casual observer that many phenomena in the human body exclusively depend on the permeation of fluids through organic partitions, whilst in many others it plays a more or less important part. Hence the obvious necessity for a careful investigation of the law regulating the commixture of fluids through membranous partitions, such as occur in the human body.

"The food of which we partake passes first through the mouth, the fauces, and the oesophagus: all these parts are covered by a thick epithelium, which does not readily yield a passage to fluids. In the stomach, however, whose walls permit fluids to pass more readily through them, an energetic reaction takes place between its fluid contents and the blood in the gastric vessels, and a similar process is continued throughout the whole of the intestinal canal. The contents of the stomach are generally much more aqueous than the blood; the various kinds of drink and most articles of fluid food are naturally so, while the saliva and gastric juice reduce solid food to that condition. As is usually the case, where a concentrated fluid comes in contact with one that is more aqueous, there can be no doubt that here also a larger quantity of the thinner fluid passes through the membranous partition

to the concentrated fluid, than conversely. Thus by degrees a larger portion of the contents of the stomach and intestinal canal passes into the blood than is conversely yielded by the blood to the fluid of the digestive canal, as has been directly proved by the experiments of Poiseuille. We are still deficient in exact researches respecting the substances that pass from the blood-vessels to the contents of the intestinal canal; but they are probably salts with a small quantity of extractive matters and some protein-compounds, which latter are there converted into mucus. What is usually denominated gastric and intestinal mucus is doubtless the equivalent yielded in the act of digestion by the blood to the contents of the stomach and intestinal canal; but it must be understood that gastric and intestinal mucus may also be secreted by the blood, in the manner we shall subsequently consider under the head of secretions, without that fluid receiving anything in return. It is, however, arranged in a most wonderful manner, that nearly the whole contents of the stomach and intestinal canal may gradually penetrate into the interior of the organism without any appreciable quantity of matter passing as an equivalent from the blood to the intestinal canal. In the first place the acid character of the gastric juice seems to be of great importance. The experiments of Dutrochet show us that acid fluids, especially in their mixture with another fluid through an animal membrane, yield more than they receive; and thus the acid character of the contents of the stomach seems to be precisely the means by which resorption is promoted in a simple physical manner. It would, however, be highly desirable to institute a series of carefully conducted experiments on the influence which the acidity of the gastric juice thus apparently exercises on the resorption of the chyme." (pp. 25-6.)

Vogel then proceeds to illustrate the law, that "the more two fluids separated by an animal membrane differ from one another in the degree of their concentration, the more proportionally will the concentrated abstract from the thinner fluid." This law explains how it is that the passage of nutriment into the circulation is essentially facilitated by the liquidity of the contents of the intestinal canal, induced by the admixture of fluids much more aqueous than the blood, namely, the bile and pancreatic fluid, and further by the drink for which a desire is usually experienced after meal-times.

"The bile contains in itself much more water than the blood, containing on an average about 10 per cent. of solid constituents, while the blood contains more than 20 per cent. The bile, however, becomes yet more aqueous in the intestinal canal owing to a portion of its solid constituents (the bilate of soda) being decomposed by the acid of the chyme, and separated in part in a modified (insoluble) condition, as dyslysin, &c. It contributes therefore essentially to the dilution of the chyme, facilitating its resorption. The pancreatic fluid acts in a like manner, for although we know but little of its composition, it is at all events much more aqueous than the blood, its solid constituents being about 8 per cent. Another means acting with the same object is the circulation of the blood, the consequence of which is, that the portion of blood become more dilute by the absorption of aqueous constituents from the chyme is being constantly removed and replaced by more concentrated blood." (p. 26.)

The object of the lacteals is, according to our author, to abstract the chyle that is too concentrated to be taken up in the above manner, and to take up fatty matter.

"Fat does not mix with water, and as it can either not at all or only with difficulty pass through membranes moistened by watery solutions, it cannot penetrate in more than a very small quantity from the chyme into the blood-vessels. Fat may, however, penetrate from the intestinal canal into the lacteals as has been shown by experiments made on the chyle of animals, killed soon after partaking of fatty food. The penetration of fat through the intestinal walls into the chyle-vessels, is no doubt effected in the same way that oil penetrates through a filter moistened with water; thus in some parts of the filter the particles of oil