tion, its relation to eating and defecation, its suppression by means of warmth, antacid remedies, etc., and the relation to it of secondary symptoms such as icterus, hematemesis, melena, and pains in certain regions.-Medical News.

WHAT CONSTITUTES DEATH AND WHEN DOES IT OCCUR ?

(This interesting article is from the Medical Record, August 8, 1903.) Herbert Spencer, it will be remembered, has defined life as a continued adjustment of internal relations to external relations, and it is doubtful whether any definition of death would be better than a rupture of that adjustment. Ordinarily, of course, every one thinks that he knows when a man is dead. But when looked at more closely the subject is not quite so simple. For example, shall we say that a patient is "dead" when respiration ceases? In the writer's experience a woman suddenly became unconscious and ceased all attempts (even the slightest) at respiration. Under artificial respiration, however, the heart beat for five hours, when the artificial respiration was given up. The autopsy showed hemorrhage into the ventricles of the brain. Was, then, the woman "living" during the five hours of artificial respiration, or not? The question, while it may have somewhat the aspects of a metaphysical juggle, is by no means entirely of that nature. For on it might depend the question of survivorship; the question in law "of which died first," involving an entirely different inheritance of property.

Again, shall the criterion be the cessation of the action of the heart? Brouardel cites a case witnessed by Drs. Regnard and Paul Loye, in which the heart beat for one hour in a decapitated murderer, and he himself has seen the heart-beat persist fifteen, twenty, and twenty-five minutes, in decapitated dogs and in those dying from hemorrhage. It is no easier if we turn to the brain, for its functional activities are no more necessarily co-extensive with life than are those of the heart and lungs. Unconsciousness is normally periodic in sleep, and pathologically it frequently occurs without involving the cessation of "life." The solution of the riddle really lies in the fact that "death" is a negative term denoting merely the cessa

tion of "life." This throws us back upon the question of what "life" is. Without any desire to dogmatize on this much-debated question (and leaving others to inject into it any additional factors or elements that they please), "life" appears to be merely a convenient name for a series of physicochemical processes which avowedly differ much in complexity from "inorganic" phenomena, but which have never yet been shown to differ from them in kind. On the contrary, the more we learn about physical and chemical phenomena, the more "physiological" phenomena we are able to explain. The essential of "life" then consists in the capability of responding serially and appropriately, by continual adjustments, to changes in the environment. It is not the actual demonstration at every moment of its presence that constitutes "life." For, unless we are to introduce some metaphysical dodge-the-issue (as, for example, capable of life yet not living," or other empty phrase), bodies are either alive" or "dead." What meaning, however, has the word "alive " when applied to the seeds of wheat which grew after having lain thousands of years in a mummy's coffin? Evidently this: A seed represents a collection of chemical compounds which, under suitable conditions (of temperature and moisture) are capable of producing, by their mutual interactions, another series of compounds, which, in their turn, are capable of producing, by their interactions, a third series of compounds; the first, second, and third series of compounds representing in their totality respectively the first, second, and third stages in the development of the plant. But, as Ryder has shown, this repetition in heredity is conditioned upon repetition in environment-that is, the seed will respond in a regular serial order only provided the physical and chemical forces act upon it in the regular serial order to which it has been adapted, through countless generations, to respond. If beyond certain rather narrow limits, the forces acting upon the seed depart from the order and extent for which it has become adapted, then something other than the accustomed "normal" development takes place; and the result is some form of monstrosity." The eggs of fishes when extruded are flabby and collapsed, and in this condition they appear to be in physicochemical equilibrium. Placed in water, however,

during the first twenty minutes they imbibe it, swell, and become round and smooth, and fertilization occurs. But after the swelling and fertilization have occurred, the contents of the eggs are in a different physical and chemical condition than when first extruded, and this different physical and chemical condition it is which involves the next change of state, cleavage. Yet that the latter change is no necessary outcome of the swollen, fertilized condition is shown by the possibility of inhibiting it indefinitely by a lowering of the temperature. When two cleavage spheres are formed, the physicochemical momenta are different from those acting prior to the first cleavage, and just such as to bring about the redivision into four; and so on; each stage bringing about, under the "normal" conditions, the succeeding stage.

The possibility of the continuance of "life" then depends upon the ability of the chemical compounds which (collectively and at any given moment) we term "the body," to give rise to another similar collection which shall be able inter se to maintain a similar adjustment of internal relations to external relations. Conversely, when the formation of such a derivative collection is no longer possible "death" ensues. Less abstractly put, "death" is the name we give to the inability of the organs to act together with the harmony which characterizes "life." The rupture of the vital harmony does not, however, preclude a certain amount of activity of individual organs. Thus, perfused with blood, or other suitable fluids, the heart may continue to beat, the liver to secrete, etc., though the individual is dead." This mode of viewing the question seems to be the only philosophical one. For just as there is no possibility of assigning a moment at which, in development, the physicochemical forces pass over into the "vital," so here there is no possibility of saying when the "vital" forces pass over into the physicochemical. All we can do is to set an arbitrary limit, by way of definition, and say that the "individual" is "dead" when the harmony of interaction in the "vital tripod" ceases.

$25.000.00 is offered by the American Grape Acid Assn., of San Francisco, to the chemist who can devise a process to utilize grapes for grape acid (tartaric acid) at a cost to make it commercially valuable.

Sections.

MEDICINE.

Under charge of H. D'ARCY POWER, L. S. A. Eng., L. R. C. P. Ire. Professor of Principles and Practice of Medicine, College of Physicians and Surgeons, San Francisco.

What is Sciatica ?

This is a question Dr. Wm. Bruce propounds and seeks to answer in a recent address, reported in the Lancet of August 22nd. The author's conclusions are based on a thirty years' experience of over 800 cases; during the past thirteen years notes were taken of 418 cases, and of these an analysis is given. From this it appears that the proportion of males to females is as 90 to 100, and that the great majority of cases occur between 50 and 70 years of age. This table is supplemented by two other tables here reproduced:

Diagnostic results obtained from 125 specially observed

cases:

Gout or rheumatism observed in 65 cases or 52 per cent. Lumbago,

66

66

28

22

One or other of these signs was observed in 100 cases or

Dr. William Bruce insists that in the routine examination of sciatica cases too much attention is paid to the sciatic nerve and too little to the hip joint, and that the evidence of primary disease of the nerve is altogether inconclusive. The author gives rules for the examination

of patients which are of sufficient importance to merit the careful attention of all practitioners. He says: "Ask the patient to lie down, as he stands in his clothes, on his back on an even, firm couch; then, bending the affected limb at the knee, perform the passive movements of flexion, external rotation, internal rotation and extension, by Thomas' method, at the hip joint of the affected leg. If the case be at all recent, one or more of these movements will cause pain, very often sharp pain, as the patient's countenance frequently reveals. Having carefully noted these signs, then ask him to undress, and proceed to inspect the gluteal region. With the patient lying flat on his face, and relaxing his muscles, you note whether there is wasting in this region or a diminution in the original number of the folds of the nates, and on comparing those of the opposite hip and the two thighs also together, I venture to predict that in almost every case of sciatica you will discover softening or wasting and flattening of the hip muscles, and more or less obliteration of the natal folds of the affected side. With the patient lying on his sound side, you then proceed to inspect the capsule of the hip joint. In some cases you will find it more prominent on the affected side, and in a very few (but very seldom, for obvious reasons) you may be able to discover that there is increased heat over the joint. The position of the articulation is best made out by making sure of the exact relation of the anterior superior iliac spine and the highest point of the trochanter, corresponding to the joint you suppose to be affected. The next thing to do is to examine carefully and without prejudice the presence or absence of tenderness on pressure over the capsule. This investigation has to be gone about keeping in view the fact that the patient is not an impartial witness, so to speak; he is very apt to confound symptoms with signs, and his mind has been so intent on the suffering, say, in his foot, that he refuses to help you in your attempts to discover the important sign you wish to make out, i. e., whether coxal tenderness be present or absent. When it is considerable you are independent of his preconceived ideas. In many cases moderate pressure with the point of the thumb over some part of the capsule causes so much pain that he winces unmistakably. Of course, to make yourself certain, you compare the two