"The author's friend, Professor Pockels, says that once, from among many melancholy cases, he cured a true carcinoma of the breast by extirpation. In this instance, the structure of the tumor was considered by Professor Pockels to be identical with that already described as carcinoma reticulare. Professor Jungken extirpated, from the orbit of a young woman, a compound carcinoma, partly made up of carcinoma reticulare, partly of carcinoma melanodes: two years have now elapsed since this operation, and the patient continues in perfect health; while other precisely similar cases have had a fatal termination. A carcinoma reticulare of the female breast, which was extirpated by M. v. Graefe, did not return till after the lapse of five years. The author examined the degeneration as it appeared in the breast last affected, and found it to be carcinoma reticulare." 85.

He alludes, with scepticism, to several reputed cures of fungus medullaris. The cases on which most dependence can be placed are those in which fungus medullaris of the globe of the eye retroceded, without any operation having been performed, before the cornea had become perforated. Such cases, indeed, are very rare.

M. Müller refers to chimney-sweepers' cancer, as affording the best instance of a disposition to carcinoma at first merely local, though afterwards tending to become general. He mentions, too, cancerous affections of the face and lip, which are sometimes cured by local treatment, and the malignity of which, must, in those instances, have consisted in a merely local disposition. He adds, that, it is very difficult, and not always possible, to distinguish, by any peculiarity of structure, cancer of the skin from neglected or mismanaged ulcers of that texture. Here the characteristic forms of cancer are very rare; in one only of many instances was the disease found to be carcinoma reticulare. In no part of the pathology of cancer are our notions more unsettled than in this instance. The mere malignity of a sore is insufficient to stamp on it the carcinomatous character, for then must herpes rodens be cancer. To the idea of a local cancerous affection belong the development of the disease from carcinomatous tubercles; the property, when left to itself, of destroying, without intermission, the structure of all tissues with which it meets, whether muscles, mucous membranes, or bones (the last without the phenomena of ordinary caries or necrosis); and, lastly, the property of giving rise to any of the various forms of carcinomatous degeneration. The diagnosis is still more difficult, if a non-carcinomatous ulceration of the skin should, from the supervention of a carcinomatous disposition, become converted into cancer, for then we lose the guide afforded by the origin of the disease from a carcinomatous tubercle.

M. Müller admits the impossibility of comprehending the mode in which the carcinomatous dyscrasia becomes developed from a merely local disposition. It can, however, he thinks, be easily understood, that, when once cells with a productive tendency have been formed, the reception of the germinal nuclei into the circulation may determine their distribution to some part predisposed to receive them, and may thus give rise to the formation of secondary tumors. He is not clear what importance is due to the appearance of masses of fungus medullaris within the cavities of large vessels, especially veins.

8. Some tumors which by nature are not carcinomatous, and part of the

character of which it is to remain local, may, under certain circumstances, originate the local disposition to cancer.

"Aneurism by anastomosis, and nævi materni, must be referred to this class; for, M. v. Walther has shewn that, under long-continued irritation from internal or external causes, they may be converted into fungoid growths possessed of properties similar to those of cancerous tumors. They are less susceptible than other parts of simple inflammation and its consequences.'

90.

9. Many structures differing from carcinoma have, on the other hand, even though repeatedly mismanaged, no inclination to assume the cancerous disposition; or, perhaps, they may be more correctly said to have no greater disposition to pass into the carcinomatous state, than is possessed by many other healthy tissues.

To this class may be referred the simple fatty tumor, and the tendinofibrous or desmoid tumor. M. Müller's observations would lead him to say, that the carcinomatous tendency is not greater in enchondroma, cholesteatoma, and in albuminous sarcoma and osteosarcoma (cellular sarcoma, sarcoma with caudate corpuscules, and fibrous sarcoma.) Irritation and partial excision determine, indeed, an increased growth of these tumors; but if perfectly extirpated they cease to be reproduced, and if at any time they exert an injurious influence on the constitution, it is merely by the loss of fluids which they occasion.

10. Each form of cancer occurs in persons of all ages, and in all organs, but some organs appear to be especially liable to carcinoma at certain periods of life.

"It has already been long known that fungus medullaris occurs indifferently at all periods of life. Many instances have also occurred to the author which prove that carcinoma reticulare, the most common form of cancerous degeneration in the breast of females advanced in life, is a disease incidental to all ages. The author frequently saw it in the orbit of children, where he has also often met with carcinoma medullare. It is, therefore, incorrect to say, that the ordinary cancer of the breast holds, as a distinct form of cancer, any peculiar ætiological relation to the climacteric years in women; such a relation has reference to the organ attacked, not to the disease by which it is affected. The breast is, like the uterus, more frequently attacked by carcinoma at this period; but this form of cancer occurs at all periods of life.

The assertion has often been made, though without foundation, that certain tissues are affected by peculiar forms of carcinoma. It has, indeed, been allowed, that fungus medullaris may occur in all organs and tissues. In the orbit, it attacks indifferently all parts of the eye. Hence it is evident that the question, whether in this or the other case, the affection began in the optic nerve, or in the choroid coat, or in some other part of the eye, arises from an erroneous conception of the subject. It is true that in some cases the affection may be particularly well marked in this or in the other part; but there are instances in which the same degeneration becomes simultaneously evident in the muscles of the eye, in the sclerotic, choroid coat, optic nerve, and crystalline lens. Proofs of this are afforded by the numerous writings upon this subject, and the author can substantiate them from the results of his own observations on morbid growths, extirpated by M. Jüngken. Medullary sarcoma of the bones of the cranium, of the dura mater, and of the brain, sometimes originates in one of these parts, sometimes simultaneously in them all.

Carcinoma simplex, or scirrhus, has been said to be peculiar to glandular

structures. It is well known that it may appear in the bones at the same time with scirrhus in the breast, as well as after its extirpation." 92.

In a case of extremely hard scirrhus of the breast, the author observed formative globules precisely similar in some very hard tumors which grew from the cancellous structure of the ribs. In another instance, carcinoma fasciculatum was developed in the mammary gland, in the orbit, and in a cancerous fungus of the skin. Carcinoma alveolare and reticulare have likewise an universal distribution, and fungoid melanosis notoriously has so. This completes our able author's account of Carcinoma. We believe that his observations are new to the majority of English readers, and we have therefore given them very much at length. However satisfactorily they may display his industry and his pathological sagacity, we fear they as satisfactorily shew how little microscopical and chemical investigations have hitherto done in clearing up the mystery that surrounds the malignant morbid growths. We cannot conscientiously say that they have added much to our substantial knowledge on the subject. But we are not to despair. Minute researches always leave us rather wiser than they found us, and often when discovery seems as remote as ever, it is actually impending. There ought to be no bounds to our exactness save what nature has made impassable.

We shall return, in our next number to M. Müller's work, and to the noncarcinomatous growths.

THE CYCLOPÆDIA OF PRACTICAL SURGERY, EMBRACING A COMPLETE VIEW OF ALL THE DEPARTMENTS IN OPERATIVE MEDICINE. Edited by William B. Costello, M. D. Member of several Learned Societies, National and Foreign. Part V. London, Sherwood and Co.

THE Part before us opens with the conclusion of Mr. Bennett Lucas's article on Asphyxia. It displays both information and judgment, and it would be well were the injunctions contained in it carefully studied and acted on by the younger members of the profession.

Mr. Lucas dwells very forcibly and very properly on the dangers of insufflation, practised as rudely as it often, we might almost say generally, is. Mr. Lucas joins in the now general condemnation of tracheotomy. He gives a brief account of the ingenious instrument of that most ingenious man, Mr. Read. It consists of a syringe or pump which contains by exact measurement fourteen cubic inches; a mouth-piece or guard; a flexible tube for removing the deteriorated air; a coil of metal tube, by which it is proposed to heat the atmospheric air previously to its introduction into the lungs; an Indian rubber bag which is air-proof, and is furnished with a stop-cock. With this apparatus a portion of the deteriorated air may moved from the lungs in the following manner. The pipe of the mouthguard is to be placed upon the tongue of the patient, and the guard pressed close to the lips by an assistant; one end of the tube is to be inserted into

be re

the mouth-guard, and the other into the pump: the nostrils are then to be closed by an assistant to prevent the admission of air, and by cautiously working the pump not only deteriorated air, but also mucus or any other fluid, can be removed from the windpipe. After each stroke of the pump, if the fingers be removed from the nostrils, the pure atmospheric air will instantly rush in.

Mr. Lucas is of opinion that the operation of the instrument will be most materially assisted by the application of Leroy's bandage. He would not, indeed, employ it without conjoining with it alternate pressure and relaxation on the parietes of the chest.

Friction, volatile stimuli to the nostrils, stimulating injections into the stomach, electricity, are all proper subsidiary measures. On electricity Mr. Lucas remarks:-A new method has been proposed by Leroy: he introduced acupuncture needles, one on either side, between the eighth and ninth ribs, until they penetrated a short distance into the fibres of the diaphragm; he then completed the galvanic circle by means of a pile of twenty-five or thirty pairs of plates, one inch in diameter, when the diaphragm immediately contracted and depressed the abdominal viscera, and an inspiration was made. The circle was then interrupted, when the diaphragm, urged by the weight of the abdominal viscera, and assisted by a gentle pressure made on the abdomen by the hand, returned to its former position, and an expiration was accomplished. By alternately repeating these operations respiration was reinduced: but when a continuous current was applied, the respiratory movements were irregular. In the experiments of Leroy, which were witnessed by Magendie, animals were often resuscitated after five minutes submersion by the application of galvanism in the manner just described. Electricity is hardly accessible in private practice, but at the stations for the reception of asphyxiated persons they should be kept and used in the most efficient manner.

Mr. L. states, in reference to the period of submersion in water, compatible with recovery, that it is difficult to lay down any rule by which it can be determined à priori, whether our attempts at restoration will be successful, beyond the signs which characterize the existence of total death. Whilst on the one hand, a few minutes' submersion has been sufficient to baffle the most energetic and well-directed measures of the practitioner in his attempts at re-animation, cases on the other hand are on record, where recovery has crowned his efforts after the body has been fifteen, twenty, and even thirty minutes in the water. The longest period recorded by the Humane Society, of recovery after submersion, is three-quarters of an hour.

After noticing in an interesting manner asphyxia from hanging, and observing that he found, after macerating the bones of a criminal, that the dentata was fractured at the junction of its lamina with its body, but, from the little displacement of the fractured pieces, no pressure could have been exerted upon the spinal cord; Mr. Lucas passes to asphyxia from the inhalation of carbonic acid gas. We need not follow him through his account of this, but merely state that Mr. Snow informed him, that he had inspired some pure carbonic acid gas, and that it only produced a tickling of the fauces.

Mr. Lucas thinks very favourably of the use of Mr. Read's apparatus in a case of this kind, its capability of exhausting the lungs appearing demonstrated. Its application, therefore, in those cases of suspended animation,

where a gas of the specific gravity of carbonic acid, is in large quantities in the lungs, cannot but be desirable for the purpose of removing a portion of this deleterious agent before sending into these organs pure atmospheric air, or even oxygen itself.

Auscultation is treated shortly and succinctly by Dr. Benson. He notices its various applications-among others, that to the detection of calculus in the urinary bladder. The stethoscope may be applied to the pubes or sacrum. The loud clear sound, he says, of calculus, the dull sound of a fungus, and the sort of pumping noise occasioned by moving the sound about in an empty bladder, may be easily distinguished, one from the other, by mediate auscultation, though these different conditions often embarrass the surgeon who trusts to the touch alone.

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Laennec had previously directed attention to auscultation of the tympanum, and as the subject of aural diseases is now attracting much attention, we are induced to resuscitate his observations. If," writes Laennec, we apply the stethoscope upon the mastoid process of the temporal bone, while the patient inspires forcibly with the nostril of the same side (the other being closed with the finger) we perceive a blowing sound, indicating the penetration of air into the mastoid cells. If there is any moisture in the Eustachian tube, or tympanum, we perceive a gurgling very like that of the mucous rattle; and if the mucus happens to obstruct the tube all sound ceases. From this and other analogous facts, we may ascertain the patency, or obliteration, of the Eustachian tube, and may thus be enabled to determine more particularly the cases in which it is proper to attempt curing deafness by throwing injections into this, or by perforating the membrane of the tympanum."

Avulsion, meaning the forcible separation from each other of parts of the body which were previously, more or less, intimately united, is well handled by Dr. Macfarlane. He considers it under the heads of accidental avulsion, and avulsion employed as a surgical process.

He alludes, of course, to the circumstance which has long attracted attention-the little tendency to hæmorrhage displayed by lacerated arteries. observes that the formation of the clot, necessarily occupying a certain time, can furnish no explanation-nor can the retraction of the artery exert much influence, because this is not nearly so complete as when the vessel is simply cut across. He thinks, and so do we, that the explanation of Béclard is the most rational-namely, that the obstruction to the hæmorrhage consists in the lacerated inequalities of the inner coat of the artery. Dr. Macfarlane has been enabled to verify this opinion by accurate examination, in two instances. One of the cases was admitted into the Glasgow Royal Infirmary; and the other occurred in private practice. In both, an arm was torn off by machinery. One lived twelve, and the other thirty hours. The inequality of the inner coat of the brachial artery from laceration extended up along the vessel about an inch and a half from its torn extremity. It was, in several places, partially detached from the middle coat, so as to form several small projections, which almost completely filled the calibre of the vessel, and must have afforded not a single, but a series of obstructions, to the effusion of blood. In both cases the artery projected about an inch and