508

growths. Even Mr. Pag.?t has lately addressed his AbernethianSociety friends on what he calls the degeneration of cancer.The final result of all this may possibly be to put more faith innature, and less in lenses. At an operation last Saturday at St.Bartholomew’s for what proved a malignant growth, opinionsseemed about equally divided as to its removal; the microscopetold nothing. In the present case of a Mr. Partridge’s there wasno doubt at all, the tumour was growing rather in the gland.Where we have no cancer-cells we have nbro-plastio tissue,but what the exact connexion between these may be, seemsstill open to doubt. Velpeau was called to see a polypus-like growth on the nose of a private patient, which Le-bert, a microscopist pur sang, declared non-malignant. Itwas removed, but returned again, and the man died. Inanother case, according to the verdict of the microscope, atumour in one breast of a woman was malignant, as being fullof cells, but a similar tumour in the other breast non-malignant,being free from cells ! The malignancy of epithelial cancer bythis test alone of cells or heteromorphic elements, must remainvery unsatisfactory and dubious. A case, published by Mr.Paget, was operated upon as fibro-plastic tumour in 1836, andonce again, but remained cured. Malgaigne, indeed, gives therather inspiriting opinion, that operation, notwithstanding theschool of Mr. John Simon, of London, and others, does in

reality cure cancer; nay more, from the experience of Frenchhospitals, he is quite sathned a patient may have two cancers,so to call them, in his life, one quite independent and uncon-nected, except by the histologists, with the other. Were the

microscope less exacting in its verdicts, we might obviously bemore correct. One speaker said he could bring thirty cases toprove the existence of malignant cancer where there were nocells, and cells where there was no cancer. A good deal ofthe discussion has taken place betvyeen the old and new schoolsof physic. Very possibly, on one side we may have prejudicesas strong as on the other; for in the later parts of the discus-sion some of Velpeau’s facts have been a little staggered. Themicroscope cannot, any more than the stethoscope, lay claimto infallibility. We may or may not be able to tell theexistence of tubercles at their first dawn in the lungs, but wemay from the previous history of the case. There are subtledifferences or degrees in cancer, epithelial growths, fibro-plastictumours, &c. We should not wish, however, for any divorcebetween medicine and the microscope; but a closer, morerational, and perhaps less exacting, union of the two.

Medical Societies.

MEDICAL SOCIETY OF LONDON.SATURDAY, DECEMBER 9TH, 1854.

MR. HEADLAND, PRESIDENT.

ARREST OF DEVELOPMENT.

A CHILD, thirteen months old, was exhibited by Mr.YEARSLEY, which had been born at the full period, withouteither the upper or the lower extremities. The scapula andclavicle were present, with the rudiment of the head of thehumerus. There was no trace of a hip-joint.

AN EGG-CUP IN THE ILIUM.

An egg-cup was exhibited which had been removed fromthe ilium of a man who died from strangulated hernia. Thecase occurred in the practice of Mr. DENDY, and was reportedin THE LANCET upwards of twenty years since. The patientwould not consent to an operation to relieve the strangulatedintestine, and the cup was discovered in the position stated.All the small intestines were diseased. No previous history ofthe case could be obtained.

POISONING 13Y ESSENCE OF ALMONDS.

Mr. STREETER related the case of a child, about six yearsof age, who had swallowed few drops of "essence of almonds,"which had been obtained from a chemist’s for the purpose of

flavouring a custard. The symptoms developed themselvesabout half an hour after the poison was swallowed, and con-sisted of vomiting, with tetanic cenvulsions. Sulphate of zincwas administered as an emetic, and the child placed in a warmbath, cold being applied to the head at the same time. Thechild recovered.

Dr. THUDICUM exhibited aNEW BROTH FOR THE SICK.

To prepare this broth, half a pound of the flesh of a recently-killed animal (beef, or the flesh of a fowl) is chopped fine, and

well mixed with a pound and an eighth of distilled water, towhich four drops of pure muriatic acid, and from half to adrachm of common salt, have been added. After an hour, thewhole is thrown on a common hair sieve, and the fluid isallowed to run off without pressure. The first portion, whichis turbid, is poured back, until the fluid runs off quite clear.On to the fleshy residue in the sieve half a pound of distilledwater is thrown in small portions. In this way a pound offluid (cold extract of meat) is obtained, of a red colour, and anagreeable taste of broth. The sick are allowed to drink a

cupful cold at pleasure. It must not be heated, as it thenbecomes turbid, and deposits a thick coagulum of animalalbumen and hæmatin. The broth possessed great advantagesover other preparations of meat, from containing albumen, andbeing remarkably easy of digestion. Cases were referred to inwhich its efficacy in this respect had been tested. Some con-versation took place on the advantages which this broth pos-sessed over concentrated beef-tea, &c.

Mr. JABEZ HOGG exhibited-A PLACENTA WITH DOUBLE MEMBRANES, ETC.

It was thrown off by a patient during her ninth pregnancy,four of which had been healthy, and she has now living asmany children. At intervals, she had miscarried, and thethree last pregnancies in succession, extending over a periodof twenty-seven months, had been of the same character as theone now described. The patient is a fine, healthy woman,thirty-three years of age. Her pregnancy proceeded well upto the sixth month, when she complained of a rapid increasein size, and, during the next fortnight, was unable to moveabout without causing pain, which was accompanied by aslight haemorrhage. Treatment was of no avail; and at theseventh month she was seized with labour pains, and in abouttwo hours from this time the membranes were ruptured, andthe bed and bedding saturated with the amnotic fluid; thiscontinued to flow for some minutes into a footbath which wasat hand; another pain quickly followed, and another streamof fluid, which in all amounted to upwards of a gallon, caughtin the bath. The child was brought down at the same

moment, and the placenta, with membranes of an unusuallylarge size. The child was, as on the former occasions, still-born, and covered thickly over with the vernix caseosce. Thesubstance of the placenta when examined under the micros-cope appeared to be made up of hypertrophied or dilatedtubules of fibrous tissue, enclosing within them granularmatter. Upon digesting a small portion of this in dilutehydrochloric acid the greater part dissolved out with effer-vescenee. Another portion, after drying upon bibulous paper,was digested in ether; this -was carefully decanted andevaporated, and found to consist wholly of fat-globules.

Dr. COTTON read a paperON A PREVAILING FORM OF CHRONIC PNEUMONIA.

After a brief comment on the increasing frequency of chronicdiseases within the last few years, the author entered uponthe description of a peculiar form of low or chronic pneumoniawhich has fallen under his notice at the Consumption Hospital.The old and the young, the strong and the feeble, are, withnearly equal frequency, the subjects of the disease. There is,at the commencement of the attack, very seldom any localpain; neither is there dyspnœa nor much cough. The expec-toration is scanty, or perhaps entirely wanting, the rust-colouredsputa so characteristic of active pneumonia being but rarelyobserved. The pulse is at first very slightly aifected, seldomexceeding eighty or ninety in the minute. There is littlesymptomatic fever. Every symptom of the disease, indeed,is of a passive character, scarcely exciting the apprehensioneven of the medical attendant. It may thus continue forweeks or even months, until a little local pain or slightdyspnœa, or a severe and intractable cough, with perhapsemaciation and night p erspirations, lead to a suspicion of some-thing more formidable than the dyspepsia or the bronchitis, towhich hitherto the symptoms had probably been referred. Theauthor was of opinion that, under early and judicious treat-ment, the great majority of cases may recover; but that thedisease too often either degenerated into true pulmonary tuber-culosis, or ended in a fatal softening and breaking up of thepulmonary structure. He dwelt particularly on the import-ance of an early and careful examination of the chest, statingthat dulness on percussion, with weak and harsh, but notbronchial, respiration, and little if any change in the externalform of the chest, were the characteristics of the early stage,the breathing becoming weaker, and marked by sub-crepitantrhonchi, and the thoracic parietes undergoing contraction, asthe disease advances. He had very rarely, indeed, heard the

509

fine crepitation of more acute pneumonia. Dr. Cotton con-sidered that in the early stage the lung was simply engorged;that at a later period it was the seat of an albuminous orfibrinous exudation, which, in cases still further advanced,had undergone the softening process. He illustrated thesestatements by briefly narrating cases in point. He was anxiousto distinguish the disease he was describing from pleuro- pneumonia, which he considered was usually a more severe and acute seizure, although he believed that now and then the one may pass into the other. When the attack was of recentdate, cupping or leeching were recommended; but if, as gene-rally happened, the state of engorgement were passing away Ibefore the case came under treatment, counter-irritation with blisters, and subsequently with stimulating and iodine lini-ments, were specially advised; the author, indeed, considered this practice of equal or even greater importance than any , other part of the general treatment. Mercury, in moderatedoses, (except in cases evidently associated with phthisis, ) ’with (in some instances) antimony and general expectorantsand sedatives, were the appropriate remedies for the early iperiods of the disease; slight mercurial action, together with tonics, being suited to the more advanced and chronic stages. iAmongst the latter class of medicines, the author particularlyspoke of the iodide of iron and cod-liver oil, either separatelyor in conjunction, the iodide of potassium, quinine, and steel.Whatever medical means were resorted to, he insisted uponthe great importance of hygiene, stating his conviction thathealthful and happy associations, with thorough physical and mental relaxation, together with a liberal and nourishing diet, ishould ever form a part of the physician’s prescription.

Dr. GLOVER thought the cases related were analogous tothose instances of disease recorded in " G uy’s Hospital Reports,"by Dr. Addison, under the title of "Albuminous Infiltration of :the Lung"-a disease neither tuberculous nor inflammatory. It !attacked the middle portion of the lung, whilst pneumonia ! attacked the lower, and phthisis the upper portions. The effu-sion was more organized than that of scrofula, and less than !that of pneumonia.

Dr. CAMPS thought the cases detailed were not new, but hadbeen overlooked formerly from our imperfect means of diagnosis. !

Mr. Ross had seen cases similar to those detailed by Dr. iCotton, and which, though of a chronic kind, presented all the Imarks of acute pneumonia. He had noticed that the occur-rence of diarrhoea was a critical and favourable symptom inthese cases. The same kind of disease had been prevalent inEdinburgh, and had been described by Dr. Hughes Bennet.

Dr. ANDREW CLARK said there were several points of greatscientific, as well as practical, importance in Dr. Cotton’s vahi-able paper. He was of opinion, however, that the termpneumonia, could not be correctly applied to the cases detailed.This seemed proved by the symptoms during life, and parti-cularly by the appearances found after death. The generalsymptoms, auscultatory signs, long duration of the disease, andresults of treatment, went, on the whole, to show that thedisease described was not a true pneumonia. This inferencewas rendered almost certain by what was found in the twocases examined after death. In the first, the lung was con-tracted and carnified. The state of Carnlficatxoll had no directrelation to pneumonia, and rarely led to it. The condition of

lung termed splenization had such a relation, and was usuallyconsidered as the first stage of pneumonia. But between thesetwo states there was great difference. The carnified lung wastough, firm, fleshy, diminished in volume, collapsed, devoid ofair, rather dry, free from exudation, and rolling between thefingers like a piece of muscle. In splenization the lung was offull volume, soft, friable, of a bright red colour, not devoicl ofair, and loaded with sero-sanguinolent or viscid fluid. Forthese reasons he considered the state of lung resembled collapsemore than any other. Exclusive of abscess, the only form ofpneumonia leading to contraction was the interlobular, thatwhich attacked the investing areolar tissue of the lobules. Inthe second case there ’were small abscesses. These, he did notthink, proved the existence of pneumonia. Abscess, and p,-,r-ticularly small abscesses, were rare as the result of pneumonia.The state of lung described was probably owing to some othercause, to capillary phlebitis perhaps, or some blood disease.In any case he did not consider it probable that a state of in-flammatory stasis would continue for three months withoutadvancing to exudation or subsiding into resolution. Dr.Clark agreed with Dr. Cotton in his treatment, and concludedwith some remarks on the presence of hæmoptysis, and its prac-tical value as an indication of disease.

Dr. THEOPHILUS THOMPSON considered the diarrhoea in thesecases was neither critical nor useful, but a dangerous complica-tion. When it occurred, it was usually in weak constitutions,

and produced by the same cause as the chest affection. Inthese cases only the mildest remedies could be employed. Thediarrhoea should not be controlled by opium, and was besttreated by mild doses of mercury and chalk, followed by thetrisnitrate of bismuth. Dr. Cotton, he thought, had groupedtogether a variety of conditions in his paper. The remedies hehad employed, with the exception of mercury, appeared tohave been given, rather to remove the results of diseased actionthan to combat disease itself. He doubted the value of counter-irritation in acute cases of chest affection, such as those de-scribed , but it was valuable in pleurisy and bronchial irritation.In the cases detailed, when curable, mercury, antimony, andiodine were the chief remedies. Mercury combined with anti-mony must be used cautiously, with The avoidance of ptyalism.If he used iodine in these cases, he did it in the form of iodideof potassium, combined with small closes of antimony. Incertain cases in which debility was early developed, he gaveiron, combined with citrate of ammonia or antimony, from thefirst.

Dr. GIBB mentioned a case of chronic pneumonia terminatingin tuberculosis.

Dr. RADCLIFFE agreed mainly with the remarks of Dr. Clark.During the last six or eight months there had been no lack ofaffections of the chest, but they were usually of the astheniccharacter, the middle lobe of the lung being that which waF3

affected. In no case scarcely could the disease be treated asinflammatory. Support must be given from the first. Blisters

. in some cases could be applied with advantage.! Dr. O’CONNOR did not regard the clisease described by Dr.! Cotton as pneumonia, but allied to that condition of the lung! which was an accompaniment or sequela of some other disease,: such as fever. When exudation was present, the cautioususe of mercury was useful. The treatment recommended in

! the paper was that suggested by Drs. Stokes and Graves.Mr. HINTON suggested that the condition described by Dr.

Cotton was rather one of degeneration than inflammation, and! analogous to cirrhosis of the liver, which had been classed byDr. Jones under the head of clegeneratien.

Dr. BURKE H.YAN had seen cases in St. Mary’s Hospital; similar to those described by Dr. Cotton, the lower part of theupper and the middle lobes of the lung being the parts affected.

Dr. COTTON in reply, stated his belief that the increasingfrequency with which we now recognised the disease was notowing to improved diagnosis, as he could show that year byyear more cases were actually occurring, where the same-pains had long been taken in the examination of patients; thedisease he had been describing being, in this respect, com-parable to the furuncular inflammation which has lately becomeso common. He could not regard the diarrhœa said to be insuch cases of a critical character in that light, but agreed withhis colleague, Dr. Thompson, in always looking upon thissymptom with extreme dread, as being too generally the pre-cursor of dissolution. In answer to some objections, as to thedisease he had been describing deserving the name of pneu-

monia, and which lie confessed he had anticipated, he knewnot what else to call it, as it resembled acute infiammation ofthe lung in everything but its acuteness, being attended withthe same pathological changes, and giving rise, indeed, to verymany of the same symptoms, modified simply by a differenttype of the disease. The pneumonia of typhus was a disease ofa different nature, both as to its cause and its results. Although.haemoptysis had occurred in three cases lie had seen. Dr. Cottonregarded this symptom as far from being a common one, and in

’ every case warranting the suspicion of phthisis, although hehad known it occur in cases which afterwards proved not tohave been tuberculous. Altogether, he must regard the form ofpneumonia lie had been describing, and which he was pleasedto hear other fellows had seen likewise, of no little importance,both from its own character and from the ease with which it may

! be overlooked.

Reviews and Notices of Books.

Transactions of the Pcttlaoloyeul Society of London. Vol. V.’

Including the Report of the Proceedings for the Sessiolt1853-54. pp. 371.

(Concluded from p. 422.)

! D2dCCtous, ci.’C., of the Urinary and Generative Organs.UNDER this head, twenty-four coia7im-unicat, oils, with reports; upon some of them, are arranged.

: Dr. SEMPLE exhibited the kidneys of a man who had.

died from Bright’s disease. They were large, striated, and