the temples, the neck, or the chest. His general treatment, indeed, of the whole class of diseases consists in cooling the head by refrigerents and topical blood letting; and he seems to have little relish for the blue-pill practice. Our readers will find it adviseable, perhaps, to hold a middle course: Medio tutissimi ibunt.

ON VOMITING AND EMETICS, BY M.M. PIEDAGNEL AND MAGENDIE.*

EXPERIMENT is the most direct road to improvement; and experimental physiology, as it often leads to practical results of the highest utility, deserves more attention from the profession than, we fear, it usually obtains. It was this which raised so high the name of Hunter-and it is this which, at present, is the chief basis of the fame of several living ornaments of the profession. On the Continent, researches of this kind have been lately pursued with much ardour; and we promise always to avail ourselves of whatever, in such researches, is novel and useful. We begin with a subject of much interest.

The manner in which vomiting is effected, has for some years past been a favourite subject of controversy in the French school of physiology. Memoirs, and counter-memoirs have appeared almost without end, and experiments have been multiplied in support of the different modes which have been suggested of accounting for this phenomenon. M. Magendie has been one of the principal performers in this dispute, and appears to have been as successful in this instance as in most of his experimental investigations into the laws of the animal economy. While we allow him the credit to which he is fairly entitled, as being the first among his countrymen to discover and point out the true efficient causes of this function, it cannot but be a matter of surprise, and indeed of regret, as regards the unnecessary performance of painful experiments on animals, that he should have been unacquainted (as we suppose he must) with the results of the labours of English physiologists on the same subjects; we allude more particularly to the experiments and observations

Memoire sur le vomissement, par M. Piedagnel, Eléve interne aux Lospitaux civils de Paris. (Journal de Physiologic Experimentale, par M. Magendie, Juillet, 1821.)

published by Dr. Haighton in the Memoirs of the London Medical Society, so long back as the year 1788. We will not do M. Magendie the injustice to imagine for a moment, that he would have promulgated his own explanation of the facts as original, had he been aware of the existence of experiments and conclusions so nearly resembling his. We shall now return to the point from which our anxiety to establish the just claims of our countryman had induced us to digress.

It may not be altogether useless, before we proceed to the consideration of M. Piedagnel's Memoir, to mention that the disputed point is, whether the stomach itself does or does not contribute to the evacuation of its contents. M. Magendie and his followers, among whom is M. Piedagnel, are of opinion, that in vomiting the stomach is perfectly passive, and that the performance of this function is to be attributed to the combined action of the diaphragm and abdominal muscles. On the other band, Haller, with most of the older physiologists, M.M. Maingault and Bourdon, while they admit the powerful agency of the diaphragm and abdominal muscles, attribute to the stomach itself a considerable share of the contraction which produces the evacuation of its contents. The latter gentleman (M. Bourdon, like M. Piedagnel, a house pupil of the hospitals of Paris) in a Memoir lately published, adduced some arguments in support of the opinion he entertained, and which he conceived fatal to the theory of M. Magendie, from the circumstance of having observed a case of cancer in the stomach, in the course of which no vomiting had occurred. To our minds, it needs but little consideration to discover how inadequate a single, unsupported case, which had at most the weight of negative evidence only, was to form the ground of a decision on a disputed point. But unimportant as it really was, it still formed an objection to the unreserved adoption of M. Magendie's theory; and it became necessary for the support of this, that it should receive a satisfactory refutation. Such is the task which M. Piedagnel has undertaken, and we do not hesitate to say, that he has performed it in a manner that is honourable to his own abilities, and likely to set the point at rest for the future.

As the long agitated question of the contraction or non-contraction of the stomach in vomiting had been renewed, he first proceeded to inquire into the condition of the organ at the moment of the occurrence of that phenomenon. M. Magendie, in his Memoir on Vomiting, had established the fact, that if the stomach of an animal be exposed at the time of vomiting, this organ, during the first efforts, so far from contracting, is seen to become distended in the air; if the organ be drawn out of the

abdomen, the animal makes the last effort, (which, in the natural state, is followed by the expulsion of the contents of the stomach,) and yet no vomiting occurs; if the stomach then returned into the abdomen, its contents are at once rejected. These occurrences are uniform, but several authors have stated that they have seen the stomach contract during the time of vomiting. What, then, it may be asked, is the nature of this contraction?

The stomach, according to M. Piedagnel, is susceptible of three kinds of contraction. The first is that which takes place when having been distended, it contracts itself in proportion as its contents are evacuated. This is weak, slow, and gradual, and is only rendered perceptible by the diminution of the size of the organ. The second is that which it possesses in common with the rest of the intestinal canal; it is the peristaltic motion. This movement, which is most observable at the conclusion of digestion, is much more marked in the pyloric than the cardiac part of the stomach; it occurs sometimes from below upwards, at others, from above downwards: it is commonly very inconsiderable, and very slow. Once only, M. Piedagnel saw it so strong in a dog, that he waited to see if the animal would vomit; as this was not the case, after some time, he killed the animal, and found that the contraction continued after death; it was even so far increased, that the parietes of the stomach seemed to be in contact, and the right extremity of the organ was reduced to the size of a finger.

The third species of contraction which the stomach presents, is also very slow. It is in fact not a vital contraction, but a chemical phenomenon; it occurs when sublimate mineral acids, &c. are placed in this organ or upon its surface; the part in contact with these substances mortifies, and a contraction occurs, the effects of which are visible for the space of an incl round the eschar; towards which the other parts of the stomach are drawn. Such are the only kinds of contraction which M.. Piedagnel, by the utmost attention, has been able to observe, and none of these appear to him capable of producing vomiting.

Having settled this point, the next thing was to inquire whether vomiting could take place without the stomach, and M. Magendie's experiment naturally presents itself, which consists in putting a pig's bladder in the place of a dog's stomach, and then making the animal vomit. This experiment, it must be allowed, is very conclusive, but M. Bourdon had started an objection to it from the circumstance, that the factitious stomach is not always completely emptied. He asserted, that a third of the

liquid remained in the bladder, and concluded from this fact, that, in natural vomiting, the stomach, by its own contraction, expelled a third part of its contents. M. Piedagnel, on the other hand, after having indulged in a little criticism on the attempt at precision, in this estimate, of the separate action of each organ, affirms, that in some cases, the false stomach is completely emptied, and that by means of some precautions this result may be certainly attained. Reflecting on what takes place in the experiment of the bladder, he conceived that the occasional retention of a part of the liquid during vomiting, might depend on the position of the bag, with respect to the tube through which its contents should escape, a mechanical obstacle being thus presented to its evacuation. This idea was farther confirmed by an experiment which M. Magendie communicated to the author, and made publicly this year, in the course of his lectures on experimental physiology.

The stomach of a living dog was removed, and that of a dead one substituted for it. The last was then filled with a coloured fluid, and placed in the abdomen; the wound in the belly was closed, and the dog made to vomit by means of an emetic injected into the veins. The vomiting was several times repeated, the animal was then killed, and, when opened, the stomach was found completely empty.

From this experiment, M. Piedagnel concluded that his opinion, as to the cause of the obstacle to the rejection of the whole of the contents of the bladder was correct, and that by giving it another shape he could at pleasure secure its total evacuation by vomiting. For this purpose, he made, on a stout dog, two incisions in the linea alba, one at its upper part, the other a little above the pubes. By means of a bougie, introduced through the upper opening, he placed a piece of the colon of a large dog, in the abdomen of the subject of the experiment, one end passing out at the upper; the other at the lower extremity. The stomach was then removed, and the upper end of the intestine fixed to the oesophagus, by means of a wooden canula; the upper opening was then sewed up, a part of coloured fluid injected into the intestine, by the extremity corresponding to the pubes, and a ligature made on that extremity. In this experiment there was a sort of stomach, extending from the oesophagus to the pubes, and which could not change its position, from being fixed at the latter point. The animal was made to vomit by the introduction of an emetic into the veins; the vomiting was several times repeated, and when the subject of the experiment was opened, the false stomach was found completely empty.

From what we have just said it will be seen, that the experiment from which M. Bourdon draws his inferences, is far from being favourable to the theory he adopts. M. Piedagnel proceeds to inquire whether his pathological facts are of more value. He quotes from M. Bourdon's Memoir, the observation of a case of cancer of the stomach, in which no vomiting took place, and contrasts it with several others, in which vomiting was present to the last, although the stomach had long been incapable of contraction. Besides the importance which these discussions attach to the cases in question, they are deserving of some attention as regards the practice of medicine, inasmuch as they show how little weight the presence or absence of this symptom has, as a diagnostic sign of the disease.

With this view we shall present our readers with a concise account of the most important circumstances connected with them. In the instance related by M. Bourdon, the patient was a female, aged fifty-six, who presented herself at La Charité. Her disease was principally remarkable for a state of languor and emaciation; so great, that from this circumstance and the tinge of her countenance, Dr. Lerminier suspected the existence of a cancer, though unable to discover the seat of the presumed disease.

Her appetite was variable; digestion slow; diarrhoea alternated with constipation; the belly was not painful and presented no sensible swelling. There was no vomiting, but the patient suffered from nausea, particularly after meals. Sometimes she experienced all the anxiety which precedes and accompanies vomiting; deglutition was performed, and the jaws acted in the same way as a person who is going to vomit; several times indeed attempts at vomiting took place; on such occasions respiration was suspended, the abdominal muscles were hard and coutracted, but still no vomiting took place. These unsuccess-ful attempts caused the patient a degree of anxiety scarcely to be expressed. Coughing often succeeded these efforts to vomit, and had the effect of removing the nausea. It is unnecessary to follow the history of all the symptoms and circumstances of the case; it is enough to mention, that the patient ultimately perished with symptoms of an affection of the chest; that her appetite continued good to the last day, and that she never vomited from the time of her entrance into the hospital to that of her death.

The examination of the body shewed, that together with other lesions which it is unnecessary to mention here, the stomach was a little more contracted then it ordinarily is; its parietes beore their section appeared thicker and more resisng than com

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