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reflex-parts of the dyspnea the patients were less able to take a deep inspiration. On one occasion, in a very sensitive young man, cough was reflected through the inferior cervical and superior dorsal vertebræ and indeed with such violence, that he gave over the examination on the other vertebræ. Not rarely was the epigastrium very sensitive on pressure and the seat of very severe, acute pains in two cases, which were increased during inspiration, and often by pinching the skin, or gently rubbing it in the above-mentioned regions, and were felt as if they were very deepseated. They extended to the adjoining costal cartilages as far as the hypochondria, occurred most frequently in the case of pneumonia of the right side, and were reflected through the upper dorsal vertebræ, at most as far as the sixth or eighth, once however through the inferior dorsal vertebræ, being generally accompanied with dyspnea. Pungent pain in the left lobe of the liver was frequently combined with pains in the epigastrium ; this pain did not admit of pressure; nor was it ever reflected. In two cases the painfulness on pressure extended over the principal part of the abdomen. On one occasion there were tolerably intense pains along the last five ribs, and in the adjacent muscular parts, and still deeper in the lumbar region, from whence they extended along the crest of the ilium as far the inguinal region; they were at the same time increased by pressure on the painful parts, and reflected through the lumbar vertebrae corresponding to their seat, and, as well as the increased sensibility of the abdomen, were present only on the side corresponding to the seat of the pneumonia. Nurnbness of the extremities was no rare occurrence; it affected either all the four extremities, or only those of one side, twice only the right arm. In this case, as well as where merely the upper or lower extremity of the right side participated, inflammation of the right lung with pain in the epigastrium and left lobe of the liver was constantly present along with the bilious phenomena already mentioned ; in two such cases there was associated pain in the right clavicular and lateral cervical region, once also in the trachea and larynx, with reflexion through the last cervical and superior dorsal vertebræ. In tuberculated lungs the head and thoracic symptoms were about the same as in pneumonia. The sensations of pain, dryness, constriction in the larynx, as well as the hoarseness, were reflected through the last fourth or fifth cervical vertebræ. The abdominal symptoms observed in pneumonia were not observed here by the author. The author continues to consider the various reflexions accompanying hæmoptoe, pleuritis, endocarditis, &c. He then proceeds to the consideration of Idiopathic Spinal Irritation, and the first example he gives of that is Febris Intermittens. The instances of reflexion in the stages of this disease being neither numerous nor interesting, we shall pass on to the next affection noticed by our author, viz. hysteria ; in this affection the prominent symptoms, as pain in the frontal and supra-orbital regions, pains in the back of the head and vertex, vertigo, sensation of heat ascending from the back of the head over the vertex as far as the forehead and cheeks, dimness of vision, &c. were in the generality of the cases usually combined the one with the other, and were at the same time reflected, and chiefly through the superior cervical vertebræ ; frequently the capability of reflexion extended itself from thence over the chief part of the cervical, and often of the dorsal vertebræ. Sometimes delirium set in without reflexion. The feeling of constriction in the neck was reflected by from the fourth to the sixth cervical vertebræ. The dyspnæa with other thoracic symptoms was reflected for the most part through a greater or less number of the dorsal vertebræ.
Our author now proceeds to the Second Section, in which he attempts to account for the phenomena of Spinal Irritation. He states, of spinal irritation in general, that it arises for the most part from this circumstance, viz. that the spinal marrow becomes abnormally affected either through the nerves passing through it from the organ originally diseased, which may be called excitory nerves, or through the blood circulating in its capillary vessels.
This affection, or irritation, as we may call it, extends farther from the insertion-places of the excitory nerves in the spinal marrow, and produces, by touching the places where other nerves arise, various nervous symptoms whose apparent seat is in the parts supplied by these, whilst they solely result from an affection of the central extremities of the nerves, and are accordingly excentric phenomena. By the irritation extending to the spinal origins of the sensitive nerves of the posterior parts of the neck and trunk, i. e. of the dorsal nerves, it produces spinal sensibility. The chief arguments adduced in support of this view by Stilling, are: 1. Pain on pressure manifests itself in vertebræ as immovable, and where, therefore, the pain cannot be the consequence of a mechanical effect produced ou the spinal marrow by locomotion of the vertebræ. 2. The spinal pain is often occasioned, not by pressure on the vertebræ, but on the soft parts lying near it. 3. It is frequently occasioned by gently touching the skin in the vicinity of the vertebræ. The reflexion of the symptoms is accounted for, in fine, by the propagation of the excitement occasioned by pressure in the sensitive dorsal nerves, through the medium of the spinal marrow as far as the origins of those nerves, which are the seat of the reflected symptoms. (The latter, the author calls reflex symptoms, and the nerves, which are their seat, reflex nerves). Between the reflex symptoms an essential distinction is to be made; some being excentric phenomena, a mere effect of spinal irritation, as, for instance, numbness of the extreInities in pneumonia; whilst the others are no more than mere sensations, which have their seat in the organ primarily diseased (as for instance, pains in the ovaries or ovaritis); as the nerves of these organs produce spinal irritation in the parts where they are connected with the spinal system, it happens that the latter symptoms are reflected. The latter, therefore, are called improper, the former, on the contrary, proper refler symptoms.
The seat of Spinal Irritation corresponds ordinarily with the painful or reflecting parts in the Spine; the reason of which is this, that the posterior branches of the spinal nerves, which give off the sensitive dorsal nerves, have generally a very short course, and accordingly their branches as well as their peripheric ramifications, both of which may be affected by dorsal pressure, are placed in the proximity of their origin from the spinal
According to the view now given of Spinal Irritation, the spinal marrow presents the middle point of the affection. On the contrary, the
phenomena of spinal irritation may be understood in many cases, even if we leave the spinal marrow altogether out of consideration. It is known that the spinal nerves are formed of an anterior motor, and a posterior sensitive root, furnished with a ganglion; the common trunk of every spinal nerve, hence arising, contains one or more fibres of the sympathetic nerve which lies near it, which, enclosed with it in a common sheath, run along to the roots, and so come in contact with the ganglia of the sensitive roots. In those cases of spinal irritation where the fibres of the sympathetic nerve are excitor nerves, one may represent to himself, that these fibres, as they enter the spinal ganglia, create an irritation there, which becomes transferred through the medium of the grey ganglionic substance to the fibres of the sensitive nerves placed in juxta-position in these gan. glia, whereby the occurrence of the reflex symptoms, the spinal sensi. bility and the reflexion are accounted for, because both the fibres of the reflex, as also those of the sensitive dorsal nerves, pass through the gan. glia already mentioned.
The presence of sympathetic fibres in the spinal marrow, as demonstrated by Remak, does not invalidate this explanation ; for-1, it is possible that only a part of the sympathetic fibres goes to the spinal marrow, and another terminates in the spinal ganglia; and, 2, if all the sympathetic fibres merely passed the spinal ganglia, a transference might be conceirable through the medium of the grey substance of these ganglia to the fibres of the sensitive spinal nerve.
In those cases, on the contrary, where the sensitive spinal nerves are excitors, it is extremely probable that the spinal marrow is the scat of the irritation, and this may be inferred, almost with certainty, from the presence of certain motory symptoms, a circumstance which makes one very much disposed to suspect an affection of the spinal cord in all cases of spinal irritation, but, which, however, cannot serve to prove this assumption, as it must now be deemed possible, that even in one and the same patient certain phenomena depend on irritation of the spinal cord, whilst others owe their origin to a mere affection of the spinal ganglia.
Trigeminus Symptoms.-From circumstances mentioned by the author, in his Sketches of Disease, he infers that various painful sensations in the frontal and temporal regions, and in the eyes, in cases of gastric fever, ophthalmic inflammation, and inflammation of other organs attended with fever, hysteria, &c. are reflected through the upper cervical vertebræ, more especially from the first to the third. Considering the moveability that exists between the first and second cervical vertebræ one would feel tempted to ascribe this to a locomotion of the medulla oblongata occa. sioned by pressure, or of the parts of the brain thereby affected; it mili. tates, however, against this view, that in many cases reflexion occurred, not through the uppermost, but through the third and fourth vertebræ, and it frequently followed on light pressure or on pinching the skin ; accord. ingly, in the cases instanced, spinal irritation was present in the region of the superior cervical vertebræ. Stilling maintains the above-mentioned symptoms to be excentric phenomena, dependent on irritation of the n. trigeminus, the sensitive nerve of the head, whose roots in the spinal marrow reached as far as the region of the second cervical vertebræ. He supports these assertions by Magendie's experiments. He saw division of the ni trigeminus on one side in dogs followed by anæsthesia of the correponding half of the face; the same thing happened, according to him, after dividing the spinal marrow on one side above the second cervical vertebræ ; this, however, was not the case, when the division was carried deeper down between the second and third vertebræ. These experiments, and the conclusions drawn by Stilling, accord very well with the pathological facts observed by the author ; for, if certain head-symptoms depend on irritation of the roots of the trigeminus reaching into the region of the second cervical verterbræ in the spinal marrow, the spinal sensibility, and the capability of reflexion in this region are accounted for in a very simple way. Notwithstanding, Stilling's view of the matter is not to be considered as proved; for, in the first place, admitting the correctness of Magendie's experiments, these were made only on dogs; in the second place, the roots of the sensitive portion of the n. trigeminus, though they have been traced as far as the corpus restiforme of the medulla oblongata, have not been traced any farther down; in the third place, the connexion of the head-symptoms above-mentioned with spinal irritation in the superior cervical vertebræ may be directly accounted for without any affection of the origins of the trigeminus in the same way as the author already accounted for the phenomena of spinal irritation with out the intervention of the spinal marrow at all, by substituting the Gasserian ganglion for the spinal ganglia. For if it be admitted that the spinal irritation in the upper cervical ganglion is not occasioned by any irritation of the spinal marrow, but is an affection of the uppermost cervical ganglion of the n. sympatheticus, the occurrence of the head-symptoms is accounted for by the extension of the irritation from the above-mentioned ganglion to the Gasserian ganglion through the medium of the connecting fibres existing between both, but the spinal sensibility and capability of reflexion in the upper cervical vertebræ is then a consequence of the extension of the irritation from the uppermost sympathetic ganglion to the posterior sensible roots of the four superior spinal nerves, to which it is known there are sent connecting twigs.
The Reflexion of the pain in carious teeth, and in neuralgia alveolaris, through the superior cervical vertebræ, may be easily understood from the preceding, the dental nerves being branches of the trigeminus.
The Reflexion of pain as well as the sensation of heat on the vertex and occiput in hysterical patients, through the superior cervical vertebræ, is accounted for by the circumstance, that the skin of the above-mentioned regions is supplied in a great measure by the second spinal nerves, and partly, too, by the n. trigeminus.
In the same manner the other reflex symptoms are accounted for anatomically, as they occur in different parts of the body. We have given an account of these investigations, to put our readers au niveau of the notions of the day. For our own parts, we do not hesitate to own ourselves incredulous respecting them.
ON REGIMEN AND LONGEVITY: COMPRISING MATERIA ALIMEN
TARIA, NATIONAL DIETETIC USAGES, AND THE INFLUENCE of CiviliZATION ON HEALTH AND THE DURATION OF LIFE.'
By John Bell, M.D. The object of this little work is stated to be, to set forth the conditions and attainable means by which communities are kept in health, and longevity attained, rather than to afford minute specifications of the arts by which a luxurious and pampered individual may compromise between his appetites and his health, and procure enjoyment, if it were possible, without complying with the laws through which alone it is procurable.
Accordingly, a considerable portion of the book is devoted to the consideration of the dietetic usages of ancient and modern nations, and of the nature of the substance used for food in most parts of the inhabited globe. It is to this part of the subject, a very interesting one, that we shall principally confine the present notice.
With regard to the connection between health and longevity, and personal enjoyment and prolonged usefulness, the subjects of which the author first treats, we need say nothing. It requires no ghost to tell us, that without health there can be but little personal enjoyment, and without long life there can scarcely be prolonged usefulness.
Influence of Civilization on the Duration of Life.-In proportion as civilization advances it would appear that the mortality decreases. This would, at first sight perhaps, not seem so obvious to those who consider the deleterious effects upon the health produced by the constant strife for the means of existence rendered necessary by the increased density of the population. But, in proportion as civilization advances and the relations of men to each other become multiplied and complex, a more methodical and continued attention is paid to all suitable measures, calculated to prevent the injurious operation on the public health of personal or local impurity and taint. The rich inhabitants of spacious mansions are obliged, for their own sakes, to attend to the condition of the dwellings of their pauper neighbours. At any rate, whatever may be the reasoning, such, if we are to put any trust in statistical tables, is the fact.
In the city of Geneva, where an accurate account has been kept of the population, births, and deaths, for nearly the three last centuries, according to M. Mallet, the mean duration of the lives of the citizens of that republic, from 1560 to 1600, was twenty-one years and two months. In the seventeenth century, or from 1600 to 1700, the mean life was twenty; five years, nine months; and during the period from 1701 to 1760, it had increased to thirty-two years, nine months. This estimate of M. Mallett, strongly as it marks the difference in the duration of human life, in the above periods, is below that of some preceding writers, who did not make allowances for certain defects and omissions, which he points out, in the official tables. In 1833, the mean duration of life for the people of Geneva was forty years and five months ; being nearly twice as long as it was rather more than two centuries before.
We have no means of comparing the mean duration of life in modern with that of ancient times, but according to Dr. Southwood Smith, whose opinion is founded on a document recorded by Domitius Vlpianus, Secre