mon. By pressing the stomach from before backwards, its parietes could be brought into contact, and a part of the fluid contained in the viscus forced to escape by its cardiac opening, and thus fill the lower end of the oesophagus. The parietes of the organ were thickened and indurated, and it was impossible to distinguish the tunics one from another. The greatest thickening was at the curvatures and the pylorus, which was contracted, but not altogether obstructed. The only part which remained healthy, was the cardiac orifice and a small district around it.

Speaking of this observation, M. Bourdon reasons thus; here is a woman who makes violent muscular exertions to vomit, where consequently the stomach must be compressed by the abdominal muscles, and yet no vomiting took place, a proof that the action of the abdominal muscles is insufficient to produce vomiting, as M. Magendie asserts. We have already given the refutation of this argument, and proceed to make an abstract of the cases which M. Piedagnel opposes to it.

L. J. Delaitre, aged 32, entered the hospital Sainte Antoine, September 17, 1820. He had suffered from pain in the epigastrium for three months; during the same time he had bitter risings in the morning, attempts to vomit, and vomiting of sour matters of a very disagreeable smell. At the time of his admission the vomiting took place immediately after the ingestion of food, but only when it was of the animal kind, and in particular when it was fatty: vegetables were retained. He had no appetite, his mouth was foul, often bitter. The vomiting continued constantly, and the patient died October 14th.

On OPENING THE BODY the stomach was found to be pushed upwards and to the left side. It was divided into two distinct portions, the pyloric and the splenic. It was completely empty. Its sides were from three lines to an inch in thickness; they were cancerous, hard, lardaceous. This disorganization commenced some lines below the cardia, and extended to the pylorus inclusive. There were two apertures in the stomach, the one on its upper, the other on its under surface. The last of these was occupied by the left extremity of the pancreas, which had undergone the same changes as the stomach itself, and projected into its cavity. The opening on the upper surface was closed by the liver to which its edges closely adhered.

The second and third of M. Piedagnel's cases are of a similar nature to the one above described. In the third the patient perished at the moment of evacuating by stool, and by vomiting a large quantity of dark blood. In this, as in the former instance; a schirrous thickening of all its parietes was met with. His

sixth case is quoted from the Observationes Medica of La Riviere, for the purpose of proving that a healthy stomach is incapable of producing vomiting, if it be removed from the influence of the diaphragm and abdominal muscles. In this instance a young man of Montpelier, aged 24, had by the advice of an empiric, taken a dose of antimony, which produced violent attempts to vomit, but without effect. These efforts continued to torment him, reduced him to the last extremity in seven or eight hours, and ultimately destroyed him in the evening. On opening the body, the stomach was found in the right side of the chest, full of various matters. This situation was judged to be congenital, from the circumstance that the lung on the same side was wanting, and on the left had but one lobe. This young man had no difficulty of breathing.

After such facts, says M. Piedagnel, what are we to think of the conclusions drawn from a single case of cancer of the stomach, unaccompanied by vomiting? Is it not evident that some particular circumstances must have hindered it? perhaps the contractions of the diaphragm and abdominal muscles were not sufficiently powerful to compress the stomach, or to overcome the resistance of the oesophagus.

In fact, do we not every day see individuals weakened by diseases, who make repeated attempts to vomit, without succeeding? Do we not observe the same facts, even in strong subjects, suffering from diseases of the brain, and others? Do we not meet with individuals who have never been able to vomit, and in whom emetics cause serious accidents by the attempts at vomiting, consequent on their operation? This is also sometimes the case with dogs. In the last place, there are individuals affected with cancer of the stomach, who vomit during several years, and yet cease to vomit as the disease advances; after death the opening of the pylorus is found enlarged. M. Magendie communicated a remarkable fact of this nature to the author, in which the opening of the pylorus was found to be more than an inch in diameter in every direction, and the patient had ceased to vomit for three months preceding his death. This case, with some others in the possession of the author, has induced him to make some reflections on the nature of the vomiting in scirrhous affections of the stomach, and has convinced him that the nature and seat of the disease, are sufficient to explain the different appearances of that symptom.

When the cancer is situated in the pylorus, its form is such, that the opening is large and allows of a ready communication with the duodenum; here there is no vomiting, or if it does take -place it is scanty, although the attempts be violent, for every

thing passes into the duodenum. It may be at first difficult to conceive that the contents of the stomach when compressed by the abdominal muscles, should have any tendency to escape by the intestines, which seem to be equally compressed; but when this contraction takes place for the purpose of producing vomiting, the lower part of the abdominal parietes first contracts; is then relaxed, and becomes slightly prominent, whilst the upper part is in its turn contracted, and continues so, until the expulsion is compleated. By such mechanism, the organs of the lower part of the abdomen suffer a slighter degree of compression than those which are higher (placed. The following experiment will serve to support this idea. If a ligature be placed on the cardiac opening of the stomach of a dog, and an emetic introduced into the veins, the animal attempts to vomit, but as the ligature hinders the contents of the stomach from escaping at its superior aperture, they pass very readily through the pylorus and the whole intestinal canal: In one dog, after a single effort, the coloured fluid introduced into the stomach, had diffused itself through all the intestines, even to the anus.

When, on the other hand, the scirrhus is of such a kind as compleatly to close the pyloric opening, vomiting is very frequent, and in such cases death takes place much sooner; and appears to be occasioned as much by defective nutrition, as by the nature of the disease; whilst in the former instances, nutritious substances readily passing into the intestines, chyle may still be formed; the progress of the disease is much more slow, and appears to be the sole cause of death. When the cancer is situated at the cardia, if that opening is enlarged by the consequences of the disease, vomiting is very easy, and very abundant. Such was the case in seven observations in the possession of M. Piedagnel, with only one exception, in which the patient had only some slight vomiting at the commencement of the disease, when its nature was doubtful. It is hard to say what would be the consequence, if the cancer should considerably diminish the size of the cardiac opening, but it is probable that there would be little or no vomiting. The only observation of this kind M. Piedagnel has met with, was a coachman at the Hospital Sainte Antoine, in 1819, who laboured under all the symptoms of cancer of the stomach. There was one particularly in the vomiting, that this evacuation was tolerably free in the beginning, while the straining was slight; but all at once it would stop, the attempts then becoming much more violent, though unsuccessful.

The patient died, and on opening the body, a circular cancer was found at the cardia, together with a contraction of that

opening on its right side a round, reddish body, sprung from the mucous membrane, and had a great tendency to introduce itself into the œsophagus, and thus to close the lower extremity of that canal. M. Piedagnel regrets that the forces, passed after the attempts at vomiting, had not been examined; for, as he says, the preceding observations render it probable, that they consisted of undigested food, which had passed rapidly through the alimentary canal.

Before concluding his Memoir, M. Piedagnel relates a curious case, mentioned in the thesis of M. Lallemand, Professor of the School of Medicine at Montpelier, and which served to confirm this able observer, in the idea that the stomach performs an active part in vomiting. It is as follows:-A patient,who had been for a long time confined to a spare diet, in consequence of indigestion, took all at once a large quantity of food; a sensation of weight at the stomach soon followed, with nausea, and a wish to vomit, but the attempts to effect this, though violent were fruitless. All at once, in the midst of extreme anguish, she experienced a severe pain in the abdomen, accompanied with a feeling of laceration; she uttered some loud cries, and fell without sense; her body was covered with a cold sweat, and the attempts to vomit ceased; she died in the night. On opening the body, the cavity of the peritoneum was found full of food, still distinguishable, half digested, and of a sour smell. The middle and anterior part of the stomach was obliquely torn, from its lesser towards its greater curvature to the extent of five inches. The edges of this opening thin and irregular, presented no traces of previous disease. The three membranes of the stomach were not torn to the same extent, nor exactly in the same direction. The laceration of the peritoneum was most extensive, and that of the mucous membrane less so. The pylorus presented a circular contraction, depending on a schirrous thickening, an inch and a half in size; the rest of the stomach was perfectly healthy: the cardiac opening was pervious, and not in the least affected.

So

"I am far," says M. Piedagnel, "from concluding with Professor Lallemand, that this case proves that the stomach contracts convulsively for the purpose of rejecting its contents. far, indeed, on the contrary, that I think it confirms the new theory of vomiting. I see nothing in the case but an enormously distended stomach, extending into the lower part of the abdomen, and strongly compressed by the abdominal muscles; but as its contents could not pass through the contracted pylorus, as the cardia also refused to allow of their passage, and as the contractions still continued, the organ gave way; and at

what part? At its anterior part, which was least compressed because it descended lowest, and, because as has been shown above, the force was less powerful than at the upper part."

M. Magendie adds a note on this point, to mention that in horses, in which vomiting is very difficult, the stomach is sometimes found to be torn in the attempt to reject its contents. The rupture constantly occurs along the great curvature, it is here also that a horse's stomach bursts, when filled with air, and forcibly compressed. M. Dupuy, Professor at Alford, has lately made some interesting researches on the subject.

M. Piedagnel terminates his Memoir by drawing the following conclusions from his observations and experiments:-1. That the stomach possesses no contraction capable of producing vomiting. 2. That in vomiting the stomach acts only by contracting gradually and slowly, after the evacuation of its contents. 3. That vomiting is produced by the abdominal muscles and diaphragm. 4. That the force exerted by these muscles in vomiting is not equally diffused over all the abdominal viscera. 5. That the state of the pylorus and cardia causes some modifications in vomiting, when a cancer of the stomach exists,

ON SCARPA'S TEMPORARY LIGATURE IN ANEURISM, WITH CASES BY GIUNTINI, UCCELLI, and MenegaZZI.

THE unsuccessful result which attended one of the cases published by Mr. Travers, in the ninth volume of the MedicoChirurgical Transactions, in which the temporary ligature of the femoral artery was employed for the cure of a popliteal aneurism, and the opinion expressed by that gentleman of the hazard attendant on this practice, besides the inconsiderable advantages to be expected from it, even in the most fortunate event, seem to have left an impression upon the minds of English surgeons, very unfavourable to the employment of this operation. Mr. Roberts indeed has since published a case, in which the ligature was employed with a happy result: with this exception, we are not aware that the operation has been repeated in this country.

On the Continent, but more particularly in Italy, it has met with many advocates, and among them Scarpa, whose name cannot fail to have a great authority on any subject connected