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all its organs and functions are attuned to its environment; hence no new need or desire can possibly arise ab intra, for, if such new needs were possible, they would put the animal out of harmony with its environment, would be unsuitable and therefore harmful. But even if a change in structure arose per saltum, and was produced in some generations, it would soon disappear unless artificially cultivated. This we know from experience.
But if the power of environment be the real cause of structure and function in organic life, and if no change can be brought about ab intra, how has the power of environment modified life structure as we see it in the diversified form and function of innumerable animals? In this way, and it seems strange that biologists have not studied the question from that point of view. That they have not done so, I believe to be wholly due to their never clearly understanding the law of adaptation to environment-to me a beautiful, clear, and harmonious law of nature. In this way then, geology tells us that in ages past the earth, in the process to its present stage underwent mighty cataclysmic changes; changes which must have affected and changed vast zones of the earth's surface, changes which no doubt destroyed the greater portion of organic life. But we can well assume that after all, in such great changes some animal and vegetable life would escape destruction to be brought under environment vastly different to their previous one; and slowly and by degrees, this new environment modified their structure and function. What is clearer? Understand the absolute power of adaptation to environment, understand what geologists teach us as regards the changes on the earth's surface, understand Lamark's contentions and we cannot fail to see how to these conditions arose the different species of animals which are present on the surface of the earth. ask my readers to give my theories a little thought; and, above all, criticism. The whole phase of thought is the product of thought directed to the question of the action of homeopathic remedies, and if there be any credit attached to it, I ask my readers to aid me in giving that credit to homeopathy. The phase of thought is this, and in this sequence: (1) The dynamic action of remedies; (2) the cure by the similar remedy through making a path through the body for the disease waves; (3) the evident permanency of disease waves as in infectious diseases, constituting immunity; (4) the curative power of toxins and so-called anti-toxins; (5) drug habit, as showing the permanency of medicinal waves in the body; (6) racial immunity as indicating that not only may disease waves persist in individ
uals, constituting immunity, but that after a time these waves may, through heredity, be transmitted to the offspring, thus constituting racial immunity; (7) that if that is the case as regards disease, how powerful must the effect be of the environment as a whole, thus demonstrating the full force of the process of adaptation to environment, (8) that by virtue of this power of adaptation to environment the origin of species must have been due thereto, and that the geological changes under which this earth passed in earlier ages were sufficient to so markedly modify the environment as to give rise to the various existing species. Surely such evident unity and harmony in nature demands the serious attention of my readers. The theory of the "survival of the fittest" is understood as being based on opposition in nature. Applied to man and disease the idea is, that the tissues of the body are gradually rendered more capable of resisting the disease process, or in case of infective diseases, the germ power. A recent writer in England on the “Evolution of Modern Life," I believe that is the title, bases his theory of progress on this opposition. Besides considering diseases, he takes up the question of alcoholic influence, and makes it appear that the lessened influence alcohol has on the Southern races of Europe is due to the fact of having been longer under the influence of civilization and therefore alcohol, the tissues of the races have gradually acquired a power of resisting the alcoholic influence. On the other hand, the northern races, of a more recent civilization, are unable to resist the effects, the idea being that the fittest can only survive through opposition. Now what I contend for, and what I believe to be more in harmony with natural laws is, that the "survival of the fittest" is not brought about through opposition to the forces of environment, however adverse they may appear to us, but by a gradual adaptation to these so-called adverse influences. I hold that after an indefinite time under which an organic body has been under any influence, whether bad or good, artificial or natural, that the influence modifies the living body in harmony with itself. Let us take the case, say, of alcohol. Alcohol must have a modifying influence on the living body, acting, as a rule, adversely on the functions of the body; but, in time, the impressions being continuous, as in the lives of a people taking alcoholic stimulants, the tissues of the body present therein a path for the alcoholic impressions, and this path being a modification of the molecular structure of the body, in time, through heredity, becomes fixed, and thus become a feature of national or racial life. But this modification of molecular structure,
being a constant feature, the other functions of the body learn, in process of time, to perform their part in spite of the change. In fact, the body generation after generation gets more accustomed to the former inimical presence, so that in time the adverse influences lose their power over the body altogether, just as a person who has a growth on one of his fingers may, after a time, perform all the functions of the hand just as efficiently as if the hand were natural. Thus again, I would point out that the survival of the fittest, is really due to the fittest being able to adapt itself to all incidental, even if adverse influences, and not to the fittest being able to oppose itself to such adverse influences. Now Mr. Picken accepts the view of the "survival of the fittest," as held by scientists, and maintains "that I have said nothing to raise a doubt as to the justness of this interpretation.” This interpretation refers particularly to the opinion that the living body resists disease. He, Mr. Picken, maintaining that the more resistance the body offers, the less symptoms, while I maintain the opposite, in the less resistance, the less symptoms, meaning thereby that if the tissues present an approximate path for the disease, the disturbance in the system, in the symptoms of disease will be lessened in direct ratio to the nearness to an absolute path through the system for the disease waves. We all know that here and there we find a person in whom some common article of food induces poisonous symptoms. Now this is so, undoubtedly, because some molecular disturbance of the ordinary tissue of the body has taken place in utero. So that the ordinary physiological effect has been converted into a pathological one.
(To be concluded.)
Original Articles in Surgery.
SIDNEY F. WILCOX, M.D.
WILLIAM TOD HELMUTH, M.D., LL.D.
GEORGE W. ROBERTS, Ph. B., M.D.
CANCER OF THE RECTUM: KRASKE'S OPERATION.*
By HENRY EDWIN SPALDING, M.D.,
Boston, Mass. T is a lamentable fact that the history of the surgical and medical
treatment of cancer of the rectum presents a dark page of failures. This, however, is not because improved surgery in this special field has not kept abreast with the main line in the grand advance of modern surgery, but that it is crippled in its work, in part, by the prevalent opinion of the profession and laity that “nothing can be done,” and more by the fact that the medical attendant usually fails to recognize the character of the disease until it has so involved other tissues as to make surgical interference not only immediately hazardous, but also hopeless of giving ultimate relief. These cases that the late-called surgeon finds too formidable to attack and surrenders to medical palliation and death, tend to entrench more deeply in the popular mind the idea that in rectal cancer surgery is impotent.
The reasons for the late recognition of the real character of this disease are readily seen. The seat of the disease is usually so far within the bowel as to be hidden from the ocular or digital observation of the patient. In its early stages there is quite often freedom from pain. The presence or absence of constipation indicates little, and frequently diarrhæa is present. Even the cachexia, which is usually so marked when cancer attacks other tissues, is here notably absent until the disease is far advanced. Usually the earliest symptom noticed is the presence of fresh blood with the stool. Since this is unaccompanied by pain, the patient may take little heed of it, unless the hæmorrhage is profuse, which is seldom the case in the early stages. He not unnaturally supposes the bleeding to be from ordinary hæmorrhoids. He has a feeling of weight or pressure under the sacrum, as though defæcation had not been complete. This he attributes to constipation or the piles.'
*Written especially for the North AMERICAN.
If the family physician is consulted, he too often neglects a physical examination, or if one is attempted it is done imperfectly, and the physician accepts the diagnosis already made by the patient, and thus perpetuates the error and encourages him to drift unheeding along until only an early death can offer the hope of relief from suffering
The removal of the anus and the lower segment of the rectum for malignant disease has occasionally been accomplished, with good results for many years. By the older methods, the initial portion of the operation by entering the tissues around the anus, which are normally very vascular and now made more so by disease, entails a heavy loss of blood, which can only be controlled by a free use of ligatures, step by step as the dissection is carried upward to get beyond the limits of the disease. Moreover, to attempt the removal from this direction presupposes that the diseased area is confined to the anus or the lower two or three inches of the rectum.
While at first thought it seems more formidable, the Kraské method presents some decided advantages. By first removing the coccyx and a portion of the sacrum, an open field for operation is obtained. The disease being high up within the rectum does not debar the operation; when not involved in the disease, the anus and sphincters may be left uninjured, the diseased portion of the gut being excised and the divided ends coapted. If the anal end of the rectum and sphincters must be sacrificed, the hæmorrhoidal blood vessels are divided only after the dissection has been completed above, and the bleeding is readily controlled by pressure, torsion and a few ligatures.
Preparatory to the operation the patient's bowels should be thoroughly evacuated. This is best accomplished by the use of saline cathartics administered daily for from two to four days, according as the intestinal obstruction has been more or less nearly complete. The diet should meantime be nourishing as possible, but strictly liquid. The ordinary antiseptic toilet must be carefully attended to. Thus prepared and anesthesia produced, the rectum should be cleansed by a free douching with soap and water, followed by a 1:4000 sublimate, or other like germicide. He is now placed in the prone position, with face turned to one side to facilitate the administration of ether. Again the field of operation is carefully cleansed by shaving and the free use of germicidal washes.
An incision to the bone is now made from the third sacral foramen—a point about the middle ofthe sacrum—in a median lineto near