form usually assumed by the morbid growth in young subjects; colloid appears so far to have been only observed in adult individuals.

Again, the locality of carcinoma is manifestly somewhat under the influence of age. Previously to puberty, the disease is most common in the eye, the lymphatic system, the brain, and the cellular membrane of the extremities; the uterus, mamma, stomach, liver, intestines, and bones enjoy comparative immunity until the thirtieth year. Exceptions to this rule are no doubt met with; Dr. Carswell is of opinion, that the exceptional occurrence of the disease during infancy of early youth in the latter class of organs depends upon their premature or præternatural functional excitement, and the statement appears to hold good in respect of the uterus, testes, and ovaries."

Sex. In the last half year of 1837, it appears that, of 1228 individuals who died of carcinoma during that period, 355 were males, 873 females. By calculating the rate of mortality in proportion to the numbers living of each sex, we learn that the annual mortality from the disease is 103 per thousand in males, and 245 in females: the excess on the side of the latter is therefore as nearly as possible as 2.5: 1. This difference is the more remarkable, from the fact that the mean rate of mortality from all diseases is 20.8 per thousand among males, while it is 19.7 among females.

The influence of town or country habitation is examined. Breschet asserted as an axiom that cancer is rare among persons employed in agriculture. What do Mr. Farr's tables say? From these, says Mr. Wells, we learn, that in the metropolis 185 deaths occurred from cancer, while five counties of nearly equal population, Cornwall, Dorsetshire, Devonshire, Somersetshire, and Wilts, furnished 126 deaths from the same disease. But the excess, on the part of London, is not even so marked as would on first sight appear; for, calculating from the estimated population in October 1837, the annual mortality is 206 per thousand in the capital, 143 per thousand in the counties. And, again, the number of deaths from this affection in a number of our principal manufacturing towns (Leeds, Liverpool, Manchester, Sheffield, &c.), with a total population of 1,762,710, exposed per eminentiam to what are esteemed the insalubrious conditions of the life of town artisans, is 152; while in a number of rural districts, containing 1,776,980 souls, 163 individuals fell victims to the disease. Finally, comparing the deaths from cancer in the metropolis and provincial towns on the one hand, with those in all the rural districts referred to on the other (337 in the former, and 289 in the latter), we obtain an annual mortality of 189 per thousand in large towns, and of 165 in the country. The character of this result is rendered more distinct by comparing it with the rate of mortality, from all diseases indiscriminately, in the same towns and counties: the annual mortality in the former is 27 per thousand; in the latter 16-9 per thousand, showing a remarkable minority in favour of a country life.

Thus a town life exercises no serious influence on the production or mortality of cancer, and when we allow for the circumstances that many patients with cancer in the country, remove to towns for advice or for the hospitals, we shall be the more confirmed in our opinion. When any excess occurs in town mortality, it is curious that it is due to the females.

Mr. Wells is unable to arrive at any satisfactory estimate of the influence of occupation or trade on the disease: nor is that of celibacy or matrimony very well made out, though the following is offered as an approximation to

the truth of the unmarried .07; of the married 0.48; of widows 1.32 per thousand die from carcinoma. But these proportions are probably mainly influenced by the mean age of the different classes of women furnishing them. Mr. Wells appears to doubt the agency of mental affliction, and to lean feebly on hereditary transmission. For our parts we attach more faith to both.

On the causes of cancer we do not see much to detain us. Mr. Wells is sceptical of the efficiency of local injury as an exciting cause, and, of course, it is greatly over-rated; yet, a predisposition to the disease existing, nothing is more likely than that local injury should help to light it up. And, however writers, like M. Bouillaud, may ridicule the notion of predisposition, the common sense of men rises superior to their verbal quibbles and scholastic subtleties.

Mr. Wells endeavours to apply statistics to the frequency, duration, and influence of season on carcinoma. But however laudable the attempt, we do not think that the time is come for any reliance to be placed on the results of arithmetic calculations. The only table we are disposed to notice is the following:

It appears that, as is the case with most chronic diseases, more persons with cancer die in the inclement than in the milder months.

We would draw attention to the following circumstance in connexion with the symptoms.

"The vascular character of encephaloid seems to render it an à priori probability that under favourable circumstances pulsation might be detected in it. The existence of pulsation is in fact one of the signs of meningeal encephaloid growths protruding through the cranium; but observers are not agreed as to whether this is a motion transmitted from the subjacent brain or arising in the substance of the tumor itself. The same indecision exists with respect to the beating noticed by Dr. W. Stokes in a case of intra-thoracic carcinoma. On

the other hand Dupuytren makes no question of the occurrence of interstitial pulsation, and describes the phenomenon as at first deep-seated, becoming gradually more superficial and distinct, isochronous with the pulse, unattended with rustling sound (bruissement), accompanied sometimes in advanced cases with general expansion of the mass, ceasing when the chief artery leading to the part is compressed, and produced by simultaneous dilatation of all the minute arteries of the tumor."

What Mr. Wells speaks of so hesitatingly, occurs, for we have ourselves twice seen it. In one instance the tumor was in the groin and outer side of the thigh, in the other in the iliac fossa. In the former instance, the femoral artery was tied, under the supposition that the tumor was an aneurysm. And, if we remember aright, the same thing occurred to Mr. Guthrie.

Before we quit Mr. Wells, we may allude to the sense in which he uses the terms diathesis and cachexia. By diathesis, he understands the state of constitution in which the multiplication of cancer occurs in the economyby cachexia the sum of general symptoms attending the disease. Mr. Wells observes, in reference to M. Cruveilhier, that, "considering the cancerous cachexia and diathesis as one and the same thing, he explains the occurrence of both on the principle of venous transmission :-hence the existence of either involves that of the other. In this confusion of diathesis and cachexia the Parisian pathologist is joined by Müller. Yet that the distinction between the two is not a scholastic refinement, but actually exists in nature, is rendered clear even by the examination of the present question. In fact, no regular relation subsists between the intensity of the cachexia and the number of organs secondarily affected; cancer of the uterus, which, habitually gives rise to most intense general reaction, rarely induces, as has been stated, extensive secondary formation; nor is it exceedingly uncommon to find numerous organs affected in subjects who have suffered to a slight amount only from cachectic symptoms. The necessary inference from these facts seems to be that the diathesis and the cachexia are produced in different modes; and as we have seen that strong probabilities argue in favour of the production of the former by cancerous impregnation of the venous blood, we cannot do otherwise than reject the agency of this in respect of the cachexia. Yet it must be confessed, that until an extended investigation into the condition of the blood at all periods and under all circumstances of the disease shall have been undertaken, these questions are destined to remain undecided."

come.

On the treatment of carcinoma, to which Mr. Wells proceeds, we fancy we need say nothing. The interest of such a section is, unfortunately, to We cannot, however, conclude without expressing the very favourable opinion we entertain of the manner in which Mr. Wells has executed his task. It reflects credit both on his industry and judgment.

THE TRANSACTIONS OF THE PROVINCIAL MEDICAL AND SURGICAL ASSOCIATION. Instituted 1832. Volume VIII. London: J. Churchill, 1839.

THE contents of the present volume, in the publication of which an unavoidable delay has taken place, are as follows:-Proceedings of the Association at Liverpool; Report of the Council; Report on Medical Reform; Report of Benevolent Fund; Report on Quackery; Report of the Section appointed to enquire into the present state of Vaccination, as read at the Anniversary Meeting of the Provincial Medical and Surgical Association, held at Liverpool, July 25, 1839; The Retrospective Address delivered at the Seventh Anniversary Meeting of the Provincial Medical and Surgical Association, held at Liverpool, July 24th and 25th, 1839, by John Addington Symonds, M. D., Senior Physician to the Bristol General Hospital, Lecturer on the Practice of Medicine, &c.; Retrospective Address in Surgery, from July 1836, to July 1839, by J. H. James, Esq. Surgeon to the Devon and Exeter Hospital; Observations on the Variola Vaccinæ, as they occasionally appear in the Vale of Aylesbury, with an account of some recent experiments in the Vaccination, Retro-Vaccination, and Variolation of Cows, by Robert Ceely, Esq. Surgeon to the Buckinghamshire Infirmary, (illustrated by engravings from original drawings.)

From this enumeration it will be seen that the purely medical articles are limited to the subject of vaccination.

The Report of the Section appointed to enquire into the present state of vaccination has been considered with care, and is reported with ability. It is too voluminous and too circumstantial to admit of analysis on our part, and all that we can do is to select some of the important statements it contains, and put our readers in possession of them. It is gratifying to be enabled to add that they tend eminently to fortify our confidence in vaccination. The Reporters observe:-"The first division of the report embraces those points that have received what we take to be a satisfactory demonstration. The other divisions, all more or less dependent upon it, have been drawn up from authentic documents, and set forth the past and present experience of many of the most respectable professional gentlemen in this country, in a faithful and condensed form; this at least has been our aim. It must, at the same time, be admitted, that the testimony has not always accorded. In arriving at conclusions we have been compelled to weigh and balance evidence; but as the facts which have guided us are fairly stated, our opinions can at once be brought to the test, and of course will avail no more than as they appear to be conformable to the truth. With this admission we desire it to be understood that nothing has been introduced of an hypothetical or speculative nature; nothing has been kept back unfavourable to the cause of vaccination; neither has anything been withheld that was calculated to produce an impression of a different kind." They subjoin their programme :-" We shall now state the order in which we mean to arrange the different heads or sections. The first will treat of the affinities between human small-pox and cow small-pox. The second will contain what we deem essential to render vaccination correct, with some observations on the

impediments to that practice. We will then proceed to consider the protecting power of vaccination. Our fourth section will comprise remarks on small-pox after small-pox; which will be followed by a brief examination of the question of re-vaccination. Lastly, we shall enquire into the state of the population generally, both with regard to small-pox and vaccination; the means at present employed for the dissemination of the former, with suggestions for restraining it, and promoting genuine effectual vaccination."

AFFINITIES BETWEEN SMALL-POX AND COW-Pox.

The reporters remark with cordial exultation, that the great problem respecting the nature of the security afforded to man by the communication of the vaccine disease, is solved. And they pay a high compliment to Jenner's sagacity for having insisted on the probable identity of the vaccine and variolous diseases.

The reporters refer to various epizootics which prevailed from time to time, and were of the nature of variola. Horses as well as cows were liable to the affection. "This interesting fact," they say, "illustrates and explains one of the most difficult and perplexing events in the practice of vaccination. It was known that a disease from the horse was sometimes communicated to the cow by men employed in dressing the heels of the one, and afterwards milking the other. This disease was supposed to be what is vulgarly called the grease, and was imagined by Dr. Jenner, in the outset of his enquiry, to be the origin of small-pox. This idea he lived to correct; but the prejudices it excited, and the erroneous views to which it gave birth, have unhappily been perpetuated. It is ascertained that the horse is liable to a vesicular disease of a variolous nature as well as the cow; and that lymph taken from the horse and inserted into man, will produce an affection in all respects like that derived from the cow, and equally protective. The error consisted in believing that this affection was the grease, and that it required to be transmitted through the cow to give it efficacy. A misapprehension of this kind may well be excused in the infancy of so complicated an investigation. The disease appearing for the most part on the thin skin of the heels of the horse, and the traditions among the farriers in the country, leading to the mistake. We now know that the vesicle may appear on other parts of the animal's body; and that the horse as well as the cow has, in different ages and in different countries, suffered both from the mild and malignant variola."

The reporters cite some facts for the purpose of shewing that the variolous disease in the cow may be very aggravated as well as mild, and communicate to man an equally aggravated as well as mild distemper. Had inoculations, they are of opinion, been performed on man with lymph taken from the cattle as they were afflicted in the middle and latter part of the last century in England, we should probably have witnessed the very same results that have recently taken place in Bengal.

A point on which the reporters insist is the simultaneous existence of small-pox among men and the lower animals in this country-a circumstance observed on many occasions, and indeed not in this country only, but abroad. The facts which they adduce, have all but proved, say the reporters, that the