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Medico-Chirurgical Transactions,Vol. XV.

(Continued from page 554.)Observations on the Local Diseases termed

.V,ilignant. By BENJAMIN TRAVERS,Surgeon to St. Thomas’s Hospital.

IN Bumber 309, p. 554, we gave an extendedanalvsis of the contents of the last volume of

the Medico-Chirurgical Transactions, re-

serving for consideration the present paperbc Mr. Travers.

The author commences by remarking, that"chronic local diseases may be divided intotractable and intractable ," and lie then goeson to observe, " that a disease, curable

iuits nature, may be so intractable from itstitualion or extent, or some local peculiarity,as to be extremely difficult, or even not toadmit of cure." The causes, however, fromwhich a disease may be intractable in its

nature, lie states to be as follows :-

First, on account of its depending upona poison absorbed, as the venereal, or an illcoaditioll or habitual morbid state of the

system, as the scrofulous, or an inveteratecachexia compounded of both." Second, from its being a disease of a

part which, when it has reached a certain

stage, generates a poison, and thus diffusesit,4 species and destroys contiguous textures,so that after this stage is reached, howevercomplete its apparent extirpation or destruc-noo, it is liable to re-appear." Third, from its being a disease of the

NMtttution, showing itself primarily and

exclusively in tumours, bearing a similarcharacter 1D various parts of the body, and

proving within a short period destructive tolife, in despite of the earliest interferenceart."To these two latter classes belongs the

genus carcinoma."

Diseases which are intractable in the firsti".nse, assume a nearly similar character tothose of the second class, and being oftenfatal in their results, are considered of a

malignant kind ; but, in the opinion of Mr.Travers, they admit of a distinction, both- their external character and progress, andin their manner of affecting the constitution,and ultimately dearoying life.With reference to the diseases termed

malignant, by which term the author meansable diseases having a tendency to de-

stroy life, there are the following queriesand observations .-

" Is the disease on its first appearancemalignant ? Or does the disease, arising incircumstances favourable to the attainmentof malignity, as texture, sex, temperamenr,age, or climate, may explmri, become in thecourse of time malignant? If, upon its first

appearance, a local affection is stamped withthe essential character of malignity, it is, infact, a disease of the constitution, whence,alone, such a character can be derived. Itis conceivable that a simple local diseasemay become malignant by the influence ofthe constitution upon it, as a simple fevermay become typhoid or putrid, but a strictlylocal affection cannot be malignant. Whenwe speak of the decided malignity of a tu-

mour or ulcer, we mean to say that it is sucha disease of the system showing it self in a part.When we say that it has a malignant aspect,or resembles a malignant tumour or ulcer, wemean that it is analogous to those in whichthe constitution, sooner or later, takes suchan action. We cannot well conceive malig- ’nity as the exclusive or innate property ofapart. A change of structure, whether ofincrease or loss of substance, which not

only resists every remedy, but which, beingextirpated or destroyed, is reproduced,either in the vicinity, or at a distance fromthe original site, is certainly not, in strict-ness, a local disease. But if from any localcause a sore refuses to heal, or falls into gan-grene ; if by the extension of the ulcerativeprocess, blood-vessels are opened, and afatal haemorrhage ensues ; if by the profuse-ness of a secretion a patient dies exhausted ;if by the incessant irritation of the nervoussystem, or the morbid actions set up in vitalorgans, under a protracted symptomatic fever,life is extinguished ; the disease does in norespect imply a malignant nature, thoughoften so considered, malignant diseases be-ing subject to a similar termination. It isto incurableness from causes not local, andconsequently the disposition to appear inmore than one part at the same time, or to

re-appear when the first affected part hasbeen freely removed, that the term malig-nity is applicable.

" If a local disease were, from its earliestgerm, impressed with a malignant charac-ter, derived from a morbific matter in the

constitution, it would be so much a consti-tutional disease, that the removal could

never be urged on the ground of permanentbenefit. To one species of malignant dis-l ease this character is applicable. But al-

though a local disease, strictly speaking,cannot be malignant, it is clear that a dis-ease, altogether local in its commencement,may in its progress stir up an action of the

; constitution, which imparts to it that cha-0 racter, or a malignant constitutional disease

620

may only show itself in a part. Again, con.stitutional malignancy may not show itselfin any part by a specific organic change, asis the case with some poisons and conta-gious fevers ; whereas the disease of a partmust derive its malignant property from theconstitution.

" A scirrhous tumour may, therefore, be,and undoubtedly is, in the first instance, alocal and single disease. The proof of thismay be found, allowing for all the prejudicesagainst the operation, and all the mistakesof pathology, in the record of a thousandinstances of the early and complete removalof the disease, without threat of return,during many years of the patients’ after-life ;nay, the ulcerated stage is not always too

late for recovery, and under otherwise fa-vourable circumstances, the removal of thefungating ulcer of the cancerous breast, andother parts, has been successful. This

single fact is an answer to the fact, whetherscirrhus is local or constitutional in its

origin."Under the order " malignant diseases,"

Mr. Travers ranks carcinoma as a genus,having two species, the scirrhous and themedullary, the respective modifications andvarieties of which, are referrible to differ-ences of the structure affected. Scirrhous

cancer, he says, always originates in somesecretory structure, such as the follicles ofinternal mucous membranes; of the reflect-ed integument at the orifices of canals, andof the skin ; in the conglomerate glands, theliver, pancreas, and testicle ; and in the

lymphatic or absorbent glands. As to

the cause of these parts being especiallysubject to disease, the subjoined opinionsare hazarded :-

" Glandular organs are the seat of scir-rhus, because they are more abundantly thanother parts supplied with vessels, whoseoffice is the separation and combination ofnew materials from the circulating fluid ;and it is sufficiently probable, that when,having been habitually and actively em-ployed, they cease to be so, these vesselsmake preternatural deposits, and expendtheir energies, wantonly as it were, uponnew and useless structures. This seems tome the origin of scirrhous tubercle."We thank you, Mr. Travers, for the in-

formation, that glandular vessels, sometimes,wantonly spend their energies, and, if youwill pardon us the illustration, we wouldsay, like unto yourself, while scribbling sucha paper as this. To this ingenious speculationsucceeds some observations on the periodof life at which scirrhus usually forms, and

next are some remarks on the structure :

scirrhus, its external and internal charac

ters, from which we take the subjuredextracts :-

" Structure of8eirrhus.-External Cha-racters-hardness, with increase of weightsinelasticity or toughness in some cases,

knotty or cragged in duration in other-,

circumscription and mobility beneath *J..skin in its earliest stage, but not to such adegree as to allow of the fingers passis;beneath the tumour, and turning its edgeupwards. Next, i.e. in the second stage,close adhesion to the tegument, and suchincorporation with the glandular organ awhich it is seated, as to have no mobilitybut that of the gland itself on the pa"ibeneath. The adhesion of the skin ratherpartially stretches or puckers it, accordingto the smooth or unequal surface cf th;tumour, and to the close or loose attach-ment, and particular conformation of the

integument at the spot, as for example, nextthe nipple, and at a distance from it; cr

beneath the mucous membrane of the pylo-rus or rectum, and the common integumentof the body. Third stage: -Contraction anddiminution, by pressure, of volume in thegland, as the tumour increases; abruptprc.jection of one large coloured tubercle, some.times of several smaller tubercles. Tran-sient pains, which have been hitherto ob-scure and occasional, now more distinct andfrequent, like the pricking of a sharp in.strument, with a sense of heat or burning;dusky, or red livid colour of the skin, withresplendent tension ; excoriation, or crack-ing of the skin at the summit or base of detubercles and fungous elevations, with icbo.rous and samous oozing. The external cha.racters are, in the main, sufficient, thoughthey furnish no unique diagnostic sign.Internal Characters.—These, tliocei

presenting more variety, are more n bedepended upon. In the first stage, a toughinorganisable and pretty compact mass, t-"’a white and yellow-brown colour, smooth,and moistened by a slightly unctuous fluid-its consistence is not uniform, being blaldi,.the centre, so as to form a nucleus, :.-

circumference is defined bv the tprmi:,f.’.::.of red vessels, forming a vascular bourdaryUpon floating in water, and still mor, by-certain maceration, the texture opens to bring into view concentric areolæ, havtheir interstices filled by a white gra ,:

matter, which may be picked out from:-:meshes. These areobe are crossed by

white faint lines, at irregular interrab. : ::the direction of radii from a centre, visiteto the naked eye, and very couspicuol-5 .’-*der a magnifier, giving the section

analogy to that of a lemon. In the

stage, wben inflammatory action commences

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is announced by shoots of pain, the’ firmuess of the centre and circum-e of the tubercle becomes reversed, centre being pulpy or broken, while the

circumference retains its firmness. The

surrounding parts are now found to have lost’, r ea:ural elasticity by condensation ofre, and partake of the firmness and

weight of the scirrhus, giving considerable:. s’Mt increase of volume to the tumour,which is now less defined at its margin, and,:: fact, of a compound character. The denseque white lines which, traversing thetumour in the direction of radii, diminish indensity as they proceed outward, and arelost in the extreme circumference of thegland, are not the production of disease,but the septa which divide and support theoles of which the gland is composed, inan opaque and thickened state. Within thewall ot the tubercles one or more cysts, con-ning a dark yellow, or coffee-brown fluid,are sometimes met with, but are not oftenp;esent;’The facts of scirrhus being sometimes

‘

coml)letely removed by a sloughing process,’:d of its remaining innoxious to the sys-tem, through many years, are regarded byMr. Travers as additional evidences in sup-port of his opinion, that the disease is,mginaUy, strictly local in its character.Not so, however, with medullary cancer orfungous bsmatodes, which, it is stated,ciffn from scirrhous cancer,

"In its property of affecting all tex-tures-in travelling as much by the blood-ressels as the absorbents of the part-in ‘external characters, which are the reversetf those of scirrhus—in internal characters.It differs last, but not least, from scirrhus, Iin being the disease of early, rather than ad-vanced, life, and from the first a truly malig-taet, and, therefore, a constitutional dis-ease."

of its disposition to return after opera-tion, the author says :.--." I have never known a person survive

this disease, after its removal by the knife,.^..re than four years, and, in very few in-’’.dt.ces, so long ; when, as often happens, it:-’.u’B5 upon the part or neighbourhood, its’ c_ress to destruction is vastly more rapid.After removing a medullary cancerous tu-rmr t’rom the calf of the leg in a young I was compelled, within three months,’. amputate high in the thigh. After re-: oving such a tumour from the foot, in-

some of the toes and metatarsal- --s. if a oung woman, she was attacked- e cisease in the groin, and died within.. s. So, after extirpating the testes,

the disease has presented itself in the groin.Two young gentlemen, for one of whom asmall tumour was removed from the thigh,and, for the other, amputation at the thighperformed for a tumour involving the knee-joint, lived each from three to four years,without any reappearance of the disease ex-

ternally, and with very little interruption tohealth m the interval; both died of diseasein the chest."

Scirrhous cancer, it is admitted, may andoccasionally does develop itself in remoteorgans after the removal, and without re-

turn of the external tumour. But Mr.

Travers would infer that, in such cases, thescirrhous disease had not been removeduntil absorption of a poison into the systemhad taken place; hence arises the import-ant practical consideration, of the periodat which scirrhus becomes a constitutional

disease." That the mischief (says the author) per.

vades the system long before the process ofexternal ulceration, is proved by the num-berless cases in which the glands next inthe course of absorption have previouslyundergone the first, if not the fatal change.This is of itself regarded as a bar to the

operation by most surgeons ; but it shoulddepend on the degree of induration and thestate, especially the freedom from adhesionof the principal tumour, whether they oughtto be so regarded."From all which we have quoted, it will

be perceived that, in the opinion of the

author, medullary cancer is dependent upona poison circulating in the system ; whilst,in scirrhous cancer, a poison is engenderedin the diseased part, and ultimately talienup into the system. It is certain that fun-

gous hæmatodes -does, in most instances,appear to be a constitutional disorder, va-rious parts being simultaneously affected,and the disease returning externally or in.ternally after the removal of the part prima-rily affected ; but there are some cases

which equally favour the opinion of itsbeing, with scirrhus, a local disease, fromwhich a poison is evolved, and carried intothe habit. We may take, for example, acase of simple chronic enlargement of thetesticle, which, under some local excite-

ment, takes on a malignant action, and truefungoid disease is produced ; but it may besaid, if the fungus be removed, the maladyeither appears at the original site, or in

some internal viscus, under which the pa-

tient sinks, and this sufficiently proves the

622

universality of the poison. It does so, but,at the same time, does not disprove that i1may have had a local origin; unless, indeed,it should be said that the same individual

would have been affected with medullarycancer, if the diseased structure had not

previously existed.In the second part of the paper, the

author enters into a description of the pecu-liar circumstances which distinguish malig-nant diseases, properly so called, in differentparts of the body. They are divided as

follows :-14 1st. Malignant diseases of the face and

head." 2d. Malignant diseases of the external

conglomerate glands, viz. the salivary, themammary, and the testicle." 3d. Malignant diseases of the organs of

generation in both sexes.° 4th. Malignant diseases of the trunk,

including the viscera and the extremities."This portion of the paper, however, pro-

ceeds no further than the first division, theauthor postponing the remainder to a futurecommunication. We sball give an abstractfrom each, described under the head of

malignant diseases of the head and face." lst. Cancer of the Face—begins in a

small warty tubercle, hard, irritable ratherthan painful, sometimes discoloured, so asto look like a dirt-spot. It is usually seatedupon the side of the face, upon or betweenthe zygoma and base of the lower jaw.When fretted by frequent handling, or

wounded, or irritated by caustic and stimu-lant applications, it inflames superficiallyand becomes ulcerated, discharging a thinmatter. It next acquires a broader base ofinduration, has a livid circumference, andan even and glossy surface of an unhealthybrightness. The health continues unaltered.The third stage into which the disease shifts,is that of extensive ulceration both inbreadth and depth ; the ulcer having an ir-regular margin and surface, and a profusesuppurative discharge of a peculiar odour.The pain is now frequent, if not constant,burning and shooting. The complexion,strength, and flesh, undergo a gradual, butsensible change-the mind becomes irritableand anxious-appetite and natural sleepfail, the pulse is rapid and small, and spon-taneous bleedings take place at intervals." This disease is more incidental to the

inhabitants of the country than of London,both in higher and lower life, and to the ageof from fifty-five to seventy more than anyother period. The application of caustic tothe diseased part is in every sense injurious.The proper and the urgent remedy is a free

, excision, both in breadth and depth, u v - indurated wart or tubprcle. The abs

glands are seldom affected before ulceraor at least so affected as to contra-indicateexcision. In the last stage I do not believethat it admits of cure, and after trying ara.

: riety of applications, I have come to the

conclusion, that whatever irritates the can-cerous ulcer, although it changes the surface,quickens the destructive action : that sr-

iug applications, which administer t’t

ease of the patient, retard it, as the watesolution, or epithem of opium, infouon Nhemlock, &c., under a simple emolientointment or poultice. The best tonic, andat the same time unirritating ointments, arethose of the oxydes of bismuth, and of z,.neproperly diluted.

" 2d. Medullary Tumour of the Face ardAngle of the Jaw-is sometimes seated inthe cellular membrane, more frequently inthe lymphatic glands. I have seen it occu.

pying the situation of the zvgomatic (os-s,and also over the parotid gland, coveringthis and a portion of the buccinator muscle.The lymphatic gland over the parotid, audthe glands at the angle of the jaw, are not

unfrequently the seat of medullary cancer,The section of these exhibits a compoundcharacter, the remaining firmness and natu.ral colour of the gland, in parts, beiiia mixedwith the soft medullary matter, and givingit a mottled appearance. I assisted at theremoval of one of these tumours in an elderlylady, from behind the angle of the jaw. Thedisease reappeared in the cicatrix, and provedfatal very soon afterwards." 3d. Cancer of the Eyelids and Con-

tesets of the Orbit-begins in the form of ahard, fretful, pimply ulcer, upon either pal-pebra, or one of the borders or angles of thetarsi. It is discoloured by inflammation,and sometimes itches, discharges a thin

matter, and scabs repeatedly. When it

draws surgical attention it is an irregularsore, notching or puckering the border ofthe affected lid by removal of its substance-,and creeping around the orbit. Its progressis slow, but after some time, the conjunc-tiva of the palpebra becomes elevated, t6uk,and rigid. The ulcer at length environs U.corbit and eyeball, and a luxuriant fungousovershoots, and, together with the hangingremnants of the lids, buries the eye—that, although the globe remains, it becomesdifficult to be seen. The pam is itching and

burning. The ultimate stage of the diseasepresents a horrible appearance. I have em

tirpated this disease when, as is rare, 16 commenced in the loose conjunctiva, remov-ing the entire contents of the orbit. T disease reappeared upon the infenor bra. The lachrymal gland is sometimes ex-clusively affected with scirrhus, and it thisstate, previous to internal ulceration, I have

623

Kmeved it: the patient remained for somerears free from disease. I have since lost

sight of Lim." 4th. Medullary Tumour of the Eye-

bull and Corztents of the Orbit.—The pecu-Ear metallo-lustrous, or tapetum-like ap-pearance of the fundus of the eye, is not

diagnostic. I have seen several cases in

which this appearance was stationary, andthe eyeball dwindled, which might, there-

fore, fairly be presumed not to have beeninstances of malignant disease. The best

diagnosis is founded on the increase of vo-lume of the eyeball, or the contrary, priorto the giving way of the tunics; but theprogressive advance of the tumour to thecornea, and the shrinking and sloughing ofthe latter membrane, which happens priorto the protrusion of the fungus, is decisive ofall doubts. I have extirpated the eye af-fected with medullary cancer in several in-stances ; but I am not acquainted with anycase in which the patient, who has survivedtwo years, has not been revisited by thedisease." 5th. Cancer of the Lower Lip.—The

comnienceinent of this common and well-known disease is in the interjacent cellulartissue of the mucous membrane and skin. Theenlargement and induration render it con-spicuous before the villous surface of the lipcracks transversely, and oozes a thin fluid,then exuleerates, and scabs by turns, andultimately ulcerates deeper, and fungates.There is a mode of operating which I preferto that for hare-lip ; and slow as the progressof the disease is, and little painful, thewisest way is to remove it freely in its earlystage. The mode of operating is the simpleremoval, by a full crescent-shaped section ofthe substance of the lip. The commissuresof the mouth should, if possible, be left: nosuture is, of course, required. The contrac-tion during the healing process, under adouble-headed bandage, passing over thevertex and occiput, so as to keep a littlemoistened lint, or simple ointment, on thecut surface, shapes and adapts the lip withsingular neatness; and what is more re-markable, the cut surface takes a depth ofcolour and a plumpness, and a defined border,which has much the appearance of the natu-ral surface.

" 6th. Cancer of the Alveolar Membraneof the Lower Jau:.-Tlis is a rare, but veryiuarked form of malignant disease. I havesFen it only in aged persons. It commencesat the point of reflection of the membrane ofthe gum on the alveolus, or on the inner sideM the gum at the root of the teeth, wherethe sore mouth, from mercury, is commonly ’,,c’st perceived. Small granular eminences, ier tubercles, are formed, by which the mem-brane of the gum is raised and thickenedinto a small lump. The disease begins about

the root of the last incisor or bicuspid, andthence gradually enlarges backwards to themiddle molar teeth. Ulceration then ensues,the edges of the ulcer fungating and bleed-ing frequently; it is slowly, but progres-sively phagedenic, destroying the soft parts,and ultimately, by ulcerative absorption, thesubstance of the maxilla, so as even to di-vide the bone. It admits only of palliationby the frequent use of antiseptic and deter-gent gargles and lotions, as of lime-water,camphor, myrrh, borax, honey, &c. Oxy-phosphate of iron, and compositions of ver-digris and caustic, are of no avail. Sarsapa-rilla dissolved in milk, boiled bread andmilk, animal jellies, and soft nutritive mu-cilages, are best adapted for sustenance andmedicine. No sign of ossific adhesive in-flammation, as osteo-sarcoma, or exostosis,appears. The patient dies of exhaustionfrom deficient nourishment, pain, and re-peated haemorrhages.

" 7th. Medullary Tumour of the Mouthand Fauces.-1’he difference between thetwo last described affections is, that this is

growth, the other decrement of substance ;the former being an eroding ulcerative dis-ease,the latter a fungous production-the for-mer a scirrhous, the latter a medullary cancer.

" 8th. Cancer of the Tongue.—This is

not a smooth and firm rounded tubercle, butan irregular rugged knob in its first stage,generally situated in the anterior third, andmidway between the raphe and ope edge.It sometimes, but seldom, extends acrossthe middle line, although it often extends

alongside of it. The hardness is unyielding,inelastic, and the mucous surface puckeredand rigid. It also gives to the finger andthumb of the surgeon the sensation of soli-dity, or of its penetrating the entire mus-cular substance, being perceived equally oneither surface. Sharp shoots of pain are

felt through the side of the. affected organ,towards the angle of the jaw and ear. Thedisease tends to run backward toward thebase or posterior edge. It sometimes ac-

quires great bulk before ulceration takes

place, so as to project the tongue from themouth. The ulceration often extends fromthe edge of the tongue to the membrane ofthe mouth and gums, when the elevated anddistended membrane at length gives way,and ulceration is rapid. The surface of theulcer is very uneven, clean and bright gra-nulations appearing in parts, and in othersdeep and sloughy hollows. The darting painis very acute, but only occasional. There isa dull aching always present, and as con-stant a spitting as in deep salivation. Theirritation is such as soon impairs the powersof life. It happens to strong and hithertohealthy persons, for the most part males,from the age of forty onwards. There is

generally an evening paroxysm of pain, and

624

the nights are much disturbed, by tle secre-tion accumulating in the throat, which ex-cites cough. Towards the fatal. terminationof the disease, occasional profuse hæmor-

rhages take place at shortening intervals." Of all diseased states, this is one of the

most pitiable. It admits of palliatives only,and these very ineffective. I have seen

only one case, wherein the ligature or knifehad been employed, and in which 1 did notwitness, or hear of a recurrence of the dis-ease before a twelvemonth had elapsed. Inseveral, in which the ligature had beenreported successful from the finished state ofthe cicatrix, the disease returned. Excisionis hardly safe, when practicable, throughthe sound parts. The actual cautery andthe lunar caustic are decidedly aggravant ofthe malady. All stimulant applications,myrrh, alum, zinc, copper, and even borax,are painful, and augment the mischief. Thecarbonate of iron, and alkaline carbonates,are of no benefit in my experience. Theblack wasli (ss. of calomel suspended bymucilage in ij. of lime-water) is, upon thewhole. the best application.

" 9th. Cancer of the Antrum.—This mostdisfiguring and destructive disease beginsupon the lining membrane, and first showsitself in a bulging of the cleek under andupon the malar bone. The tumour is ele-vated, circumscribed, and hard, and the in-tegumenthas a blush of colour. The pain isinconsiderable, when the patient is alarmedby the appearance and increase of the swell-ing. The nostril soon becomes closed onthe same side, and the teeth loose ; they fallout, or are extracted, and a copious oozingof purulent ichor takes place into the mouth.The introduction of the probe by the nostril,or palate, is followed by free bleeding. Ifthe alveolus is trephined, a fungus shootsup, fills the opening, and covers the gum.Next, the palate becomes depressed, so thatthe arch on that side is lost, and either theeyelids are closed, or the eye protruded;and completely amaurotic in either case. Inthe mean time the external swelling gainssize, is quite immoveable, and the skin ac-quires a livid hue. There are, commonly,one or more depressions where the bone isabsorbed. These break and discharge pus.The patient suffers a good deal of burningand darting pain. The ulceration extendsuntil the mouth communicates directly withthe surface, and fluids escape from the wideopening in the cheek. The examination ofthese cases throws no light upon their ori-gin. It is a chaotic mass of coagula of

lymph, and blood holding spicula of bone.° It is common for persons to refer this

disease to the extraction of a molar tooth,which they say was followed by swelling,discharge, and locked jaw of long continu-ance ; but the probability is, that the dis-

. ease in most cases had commenced before

the tooth was extracted." 10th. Cancerous Furtgus of the esand Antrum.—This is a grocstii essentially

malignant, to which the common lining mem-brane is subject, though it is happily r.

It has no character of tubercle, but, on the

contrary, is a brittle or friable fungus, u.cessively vascular, growing fromttie whole

surface of the cell. I have seen it com-

mencing in, and proper to, the nares, bu: Itis more frequently situated in the antrum. Itdistends the parietes enormously by its ra-

pid growth, and although masses of it arecut or torn away, and the cautery applied tothe cleared surface, it is reproduced againand again within the space of a few weeks.The separation is followed by excessive,even dangeious, haemorrhage. It is deno-minated, improperly, the malignant polypus.

" 11th. Cancer of the Fauces and Pito-rynx.—Scirrhous tonsil is seldom seen. Butthe broad papills at the root of the tongueadjoining the base of the epialottis, the ton.sil glands, and the mucous follicles of thecommon membrane of the glottis and plia.rynx, are each of them occasionally properseats of the disease, beginning in tumour andinduration, and terminating in fungus.

" 12th. Cancer of the E.rterzzcel Ear.—The ear is rarely an original seat of cancer,although not unfreqiiently attacked by theencroachment of an ulcer on the check. Ihave once, however, seen the upper thirdof the external ear the exclusive seat of anindurated sore, having every character ofcancer, and amputated the diseased pJeCe.The wound lieaied, and the patient, 1 be-lieve, remains sound.

" 13th. Medullary Tumour of the Inter-nal Ear.—I have seen one example of thisdisease. The sufferings of the patient iieresevere, from the confinement of its situation,and the displacement of parts; and the de-formity was excessive."! A brief description of the diseases of thehead and face, which are sometimes mis-taken for cancer, concludes the paper. The

crustaceous herpes ; a peculiar affection oithe integuments, resembling elephantiasis;lupus ; vatious species of ulcer affecting themucous membrane of the mouth and tongue;a globular (curable) tumour of the tongue,and polypi, vasicular and fleshy, are enume-rated as amongst the most frequent maladiesliable to be confounded with mali-nant dis-ease. We copy what is stated of the glo-bular tumour of the tongue :-

" Globular Tumour of the Tongue.—There is a tumour of the tongue, mist ake amarble in size and to the touch, sdeeply in iti substance, and very

625

and unyielding in its surface. I have inva-

riably found it disappear under the use ofmedicines calculated to improve the tone

and secretions of the stomach, as the alka-lies, with bark or steel. It is ocêasionallymistaken for scirrhus. From the completeabsorption which the tumour undergoes, Ishould suppose it to be a cyst containing analbuminous fluid; but I have never woundedit."

THEOLOGICAL ANATOMY.

To the Editor of THE LANCET.

SIR,—I have read and preserved everyNumber of THE LANCET, from the first to

the last yet published, and consider it themost valuable medical work extant, but amsorry to find its pages so frequently takenup with metaphysical nonsense. I particu-larly allude to the communications ofMessrs. Dermott and Thomas, who, I under-stand, are anatomists, and whose theories, or,rather, incomprehensible reveries, on vitalprinciple, mind, or soul, betray their igno-rance of the subject, and are tiresome andunprofitable to the readers of THE LANCET.It has been already declared bv a gentlemanof much higher authority than Messrs. Der-mott and Thomas, that this soul cannot befound in a dissecting-room, and, as I pre-sume they will still be unable to find it, theybad much better confine their researches tothat which they can find and demonstrate.Should these metaphysico-theologico-anato-mists wish to acquire any rational informa-tion respecting " the soul and the spiritualsystem," I take leave to recommend to theirperusal " Mirabaud’s System of Nature,"particularly the 98th and following pages ofsol, i.There is an impression on the public

mind, that some of the most celebratedanatomists in London are inclined to be

sceptical—a thing which. in this age of cantand humbug, is a dreadful imputation, andmay materially injure the men who have thecourage and honesty to avow it; of this,no doubt, Messrs. Dermott and Thomasare aware. 1 am fully sensible that they arereally religious, pious, and good men, but asthe world is very censorious, some evil dis-posed persons may say, or think, that byprofessing to teach religious anatomy, thetheatres of the sceptical anatomists will bedeserted, and theirs filled with pious andreligious students.

I am, Sir, very faithfully,M. R. C.

Stockton on Tees, July 29, 1829.

VACCINATION—MR. LAMING’S CASE.

To the Editor of THE LANCET.SIR,—Will you. correct an impression

which, I perceive, has been made by a

paper of mine on vaccination, inserted atpage 420. It is certainly no compliment tobe made to deny that variola is often effec-

tually prevented by vaccination ; but I domean to say that vaccination is not now de-

pended on by the profession as a preventive,and that since its occasional failure in this

respect is acknowledged, we can, in strict

logic, depend only on its preparative influ-ence against supervening small-pox. Thissense 1 intended to have conveyed, but theremarks of ° Medicus Edinensis," iiNo. 309, have demonstrated that even a

sensible man may require of another to re-peat his ABC before he will award himthe cledit of possessing so abstruse an ac-quirement.Perhaps your correspondent 11 O." has,

by this time, met with some one who willkindly undertake to expound to his capacitywhat is usually meant by being " convincedof error ?"

1 am, Sir, your obedient servant,RICHARD LAMING.

89, Bishopsgate Within,Aug. 3, 1829.

RICHARD LAMING.

THE COUNCIL OF THE COLLEGE.

To the Editor of THE LANCET.SIR,—In your Number for August 1, you

give us the welcome information that" thereare not less than eight highly liberal andhonourable-minded men" among the twenty-one who form our College Council. Un

meeting with this observation, I was agree-ably surprised ; for having been accustomedto consider individuals with such qualifica-tions as " rari nuntes in gurgite vasto," Iwas not a little rejoiced to find so fine abrood of them amid the gentlemen of theCouncil, till I recollected that their mottowas monopoly. [then thought it right to

examine lor myself, but was, upon inquiry,completely tantalised between the pleasureof your news on the one hand, and the con-tradictory aspect of the list you have printedon the other. Will there be any impro-priety then, Mr. Editor, in my putting to

yourself and correspondents the query-Who these eight can be’! ?Hoping I shall be satisfied with the solu.

tion, I am, Sir, yours, &c.,PATENS.

As we cannot answer the very rational

question of our correspondent, we must begto refer him to Mr. Belfour, or to Mr. Whiteof the Westminster Hospital.—ED. L.