attending to the following circumstances, which he enumerates: (a) "the absence of all symptoms during life which indicated softening, or the morbid processes that give rise to it; (b) sudden death, from natural or other causes, during the digestive act, while the stomach is filled with chyme, without previous illness; (c) limitation of the softening to the mucous membranes, and especially to the projecting folds, so as to form streaks; (d) and at the same time, its extension beyond the ordinary boundaries of morbid softening-its development being most remarkable at those points at which there is a stagnation of the greatest quantity of the gastric contents;" this latter circumstance determines the seat of post-mortem softening to be the part which is most depending. An experiment performed by M. Cameron, illustrates very well the influence of impaired vitality in promoting the softening of the gastric tissues. A fluid obtained from the stomachs of two children, who died from gelatiniform softening, was introduced into the stomach of a living rabbit, and produced no injurious effect; the viscus being found quite healthy when the animal was killed. Another rabbit was treated in the same way, having previously had its pneumogastric nerves divided, the mucous membrane of the stomach was found in a state of softening. If the nerves only were divided, no softening took place. This experiment seems confirmative of the opinion of Dr. Copland, noticed above.

Fatty tumors, originating in the submucous tissue, and increasing in size, may either press inwards towards the cavity of the stomach, or outwards, towards the peritoneal sac. In either situation they may be sessile or pedunculated. Fibroid nodules sometimes form in the areolar submucous tissue, "chiefly in the vicinity of the cardiac orifice, and the lesser curvature.' Erectile tissue may be developed at the free extremity of polypoid growths, or may occupy a larger surface of a sessile tumor. Tubercle is very rarely seen in the stomach, and only occurs in cases "where intestinal tuberculosis has advanced to an extreme degree.' Cancerous disease of the stomach is frequently met with; this organ ranks next to the uterus in the list of mortality from this cause. Primary cancer exists in the majority of cases. Dr. Walshe speaks of secondary "as almost unknown," except where it invades the organ from extension of adjacent growths. It is not uncommon to find a solitary growth in the stomach, no other part being implicated, as in a case we have recently examined. "The pylorus," says Rokitansky, "indifferently at all parts of its circumference, is known to be the chief seat of primary fibrous and areolar cancer of the stomach. From this point the degeneration extends chiefly along the lesser curvature over the pyloric half of the stomach; in many, though severe cases, it affects the entire stomach, attacking the fundus last, which, however, generally remains partially free. The parietes of the stomach may attain an inch in thickness, being rigid and generally tuberculated on their inner surface; the cavity of the stomach will at the same time be diminished in size." Dr. Walshe states that cancer of the orifices may extend to the duodenum or the oesophagus. Rokitansky affirms "that cancer of the pylorus is accurately bounded by the pyloric ring, and never extends to the duodenum," whereas, cancer at the cardia invariably involves a portion of the œsophagus. We certainly think that scirrhous disease

of the pylorus does not extend much beyond its original site, at least along the intestine, although it may propagate itself to the head of the pancreas, or the adjacent lymphatic glands. Commonly, as Rokitansky describes it, the scirrhous pylorus is bound down by the degeneration of the tissues lying behind it; but, in other cases, it remains movable, and may be felt as a distinct tumor having descended more or less over to the lower part of the abdomen. The pylorus, the cardiac orifice, the greater, and, lastly, the lesser curvature are liable, according to the order in which we have placed them, to be the seat of cancer. Fibrous cancer undoubtedly is the most common, i. e. scirrhus, or, as we are inclined to think, a combination of scirrhus with colloid. Medullary cancer ranks next, according to Rokitansky, and areolar or colloid last.

He notices the frequent primary combination, and the yet more frequent secondary, of scirrhus with encephaloid, or of both with colloid. The following description was taken from an exceedingly well-marked specime of scirrhus pylori, in which the walls of the passage were so thickened as to be nearly an inch in diameter. The cut surface presented a whity grayish tissue, contrasting well with the injected mucous membrane, and exhibiting a distinct striation vertical to the axis of the canal. A section under the microscope showed grayish-white bands, separated here and there by transparent gelatinous matter. The bands consisted of homogeneous, faintly-mottled substance, occasionally divisible into fibres closely resembling those of organic muscle, and, like them, exhibiting elongated nuclei when treated with acetic acid. Towards the mucous membrane this close stroma was replaced by a loose fibroid tissue, forming circular loculi of various sizes, which were filled with very various forms of cell-growth. Among them granule-cells were often apparent, but the main mass consisted of nuclei and low developments of them. Some large mother-cells were seen, containing several well-formed nuclei and granulous matter: in the interspaces between the fibrous bands these mother-cells had attained a gigantic size, and appeared to constitute the loculi; one of them was distinctly bifurcated at its narrow end, and the branches were of some length. Dr. Bennett, v. p. 43 of his work, doubts the cell character of these conglomerate

masses, chiefly from the absence of a cell-wall. We are, however, inclined still to believe that the loculi, in this instance, and in colloid generally, resulted from the development of an endogenous growth within parent cells. In this case, we consider that there was a combination of colloid with scirrhus, the former being constituted by the celloid substance. In Dr. Bennett's xxi. Observation, the alteration which had taken place in "the walls of the stomach was wholly of a fibrous character.' No cancer-cells were detected, only elongated and fusiform nuclei; but they were numerous in the enlarged mesenteric and lumbar glands. This latter circumstance is, we think, decisive of the truly cancerous nature of the morbid change in the stomach. Such a case may then be regarded as one of pure scirrhus, upon which encephaloid growths are sometimes secondarily developed, appearing as fungus or cock's-comb-like bleeding excrescences. Encephaloid, however, either in the form of knotted tumors, or degeneration of the submucous tissue, or infiltration of new-formed erectile tissue, sometimes occurs primarily.

Colloid cancer, affecting the stomach, behaves much as it does elsewhere; it originates, as the other species generally do, in the submucous tissue, and, as in a case excellently described by Dr. Walshe, may cause atrophy and destruction of the mucous membrane, over a more or less considerable space. We agree with this observer, that colloid may also be developed in the mucous membrane itself; for we have seen, in examining the mid-region of the stomach affected with scirrhus pylori, two large oval cysts, or cells, lined by a vesicular epithelium, and full of a clear fluid in the substance of the mucous tissue. It seems not improbable that these would have developed into a colloid growth, especially as the scirrhous formation contained loculi, somewhat similar to those described in the former observation. The mucous membrane, covering the cancerous growth, may undergo various changes. "It sometimes degenerates into an areolar cancerous tissue, which discharges large quantities of gelatinous mucous fluid; or it is converted into erettile tissue as a fungoid growth, which becomes the seat of encephaloid infiltration, suppurates, and partially exposes the submucous scirrhous celJular tissue; or, lastly, it most frequently becomes the seat of a sloeblack softening, with hemorrhage," or it is quite destroyed, and the sloughing process attacks even the denuded scirrhus itself. In a specimen we recently examined of scirrhus pylori, where the mass, limited to the pyloric region, was exposed on its inner surface, forming a sloughy ulceration with elevated, thickened margins, a fatty transformation had very evidently commenced. It was most apparent in the contents of the loculi, which, in some parts, consisted of well-formed nuclei and granulous matter, but, in many others, only of an amorphogranulous substance, imbedding much oily matter. It is conceivable that the further progress of this change might have effected a cure. In this case it was very distinct; and it is worthy of remark, that, while the muscular coat had undergone very considerable hypertrophy, it was in no degree affected by the cancerous disease. This, though encircling the pyloric outlet, had not caused any actual obstruction to the passage, nor was the stomach distended in any very considerable degree. The

cause, therefore, of the hypertrophy of the muscular coat does not seem sufficiently explained.

A case is recorded by Andral, in which enormous dilatation of the stomach had taken place, although the pyloric orifice was free, and even larger than natural. He accounts for this by the non-existence of muscular fibres in this instance in the vicinity of the pylorus. Admitting this explanation, we are inclined to think that the very alteration of the natural condition of the outlet, its being reduced to a passive and rigid orifice, may necessitate a greater exertion of the muscular fibres, which, if it fails to take place, and thus induces a conservative hypertrophy, dilatation must result. Dr. Walshe, after mentioning the more usual occurrence of dilatation ensuing when the pyloric opening is obstructed, and contraction when the cardiac is, the size remaining unchanged when the body of the organ alone is affected, notices as "less intelligible" the fact to which we have just referred. He also remarks that, "as a general truth, the mucous membrane exhibits a notable power of resistance to the encroachment of the disease." This, we think, is true, at least as far as naked-eye investigation can ascertain; but in one case, where the mucous membrane appeared tolerably healthy, we found the tubular secreting structure in process of disorganization, not, however, from the extension of the cancerous disease.

It is necessary to be on one's guard against confounding scirrhous cancer with simple induration and hypertrophy of the coats of the stomach. Rokitansky enumerates as distinguishing signs the preponderating increase of substance in the submucous cellular tissue, and its want of uniformity, the accompanying cartilaginous hardness and closeness of texture, the fusion with the mucous and muscular coats, and particularly the alteration in the muscular tissue itself. We think the microscope, in practised hands, would generally clear up all doubt. When loculi of cell-substance are mingled with the fibrous tissue, there can be little hesitation in regarding the growth as cancerous. If the structure is purely fibrous, attention must be directed to the limitation of the disease, and to the existence of the infiltrating, softening, and contaminating properties of cancer. Ulceration, usually the result of secondary gastric cancer, may cause perforation of the stomach and fatal peritonitis; it more frequently happens, however, that effusion is prevented by the formation of adhesions between the threatened part and contiguous viscera. The liver and pancreas may thus become the seat of further cancerous invasion and destruction, or the ulcer may eat its way into the transverse colon, and thus cause an unnatural communication between its cavity and that of the stomach. A dark fluid, resembling coffee-grounds, is often found in the cancerous stomach after death, as well as vomited during life. In one case, where we examined it, we found it to consist of very numerous blood-globules, together with black granules and grains (probably altered hæmatin), and a very large quantity of amorphous, with some oily matter. It is to be remembered that vomited matter of this kind is not peculiar to cancerous disease; the same may be brought up when there is simple exhalation of blood from the mucous membrane, common ulceration, or follicular ulceration, or

even softening. The only circumstances necessary for its production are hemorrhage and the acid secretion of the stomach.

Besides blood, there may be several other matters abnormally present in the stomach. Unhealthy mucus in large quantities, purulent and other exudations, bile, biliary_calculi, fecal matter, and lumbrici, are more or less often met with. Foreign bodies, of the most various kinds, are also to be included in the list, as the sealing-wax, brick-dust, cinders, &c. swallowed by hysterical females, or those who are subjects of the morbid state termed pica, or by actual lunatics. A remarkable case of this kind has been recorded by Mr. Pollock, in the Report of the Pathological Society for 1851-52, in which the stomach was distended by a large mass of hair and string, while another occupied the lower portion of the duodenum and commencement of the jejunum.

VI. ABNORMAL CONDITIONS OF THE INTESTINAL CANAL.

The intestine is not unfrequently defective in some part of its course; this most commonly is the case near its lower termination, and involves an imperforate condition of the anus (atresia ani). Sometimes the intestine is only unusually short and of uniform caliber, or consists of several detached cocal portions, or it may terminate at the umbilicus, or in a cloaca common to it and the genito-urinary organs. Andral refers to a case in which there was only a single straight canal, extending from the termination of the oesophagus to the commencement of the rectum, to another in which the duodenum was double, a third in which there were two colons, to a fourth in which the appendix vermiformis was unusually large, and at the same time double. All these, except the first, are instances of excessive development, though Rokitansky refuses to regard them as such, and considers them as "arrests of formation." Among these, he especially includes the diverticula, which are not very unfrequent, and which deserve a particular description. Andral compares them to the fingers of a glove, and states that they form coecal appendages, one or more in number, which are given off from the intestine at various points, and communicate with its cavity. They are most frequent at from 18 to 24 inches from the termination of the ilium, according to Rokitansky, but have been seen in the jejunum, the duodenum, and even in the rectum. Their length is various; some. times only a few lines, sometimes several inches; their cavity may be equal, greater or less than that of the intestine with which they communicate. It is most usual to find but one, but as many as six have been met with, originating from the same portion of intestine at a little distance from each other. In structure, they are sometimes identical with the intestine; sometimes their several coats appear to be hypertrophied; sometimes, on the contrary, more or less imperfectly formed. Meckel has founded on this difference a distinction of these diverticula into true and false. The false might be regarded as produced by a mere hernia of the mucous membrane, such as occurs in the bladder. True diverticula, Meckel considers to be formed by the non-closure of the vitelline duct at the usual spot, so that a portion of the canal, of varying lengths,