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third, a healthy-looking young woman, twenty-eight years ofage, had irregular induration of the right breast, which super-vened upon suckling her only child, and has remained per-sistent ; it is not painful, and is not carcinoma.The ages of the patients varied considerably: nine were

under forty, and twenty over that period, the oldest beingseventy-six years. In the last, the disease had commencedin the left breast two years ago, and was extirpated by Mr.Fergnsson with the knife at King’s College Hospital twelvemonths back. The patient made a good recovery and left thehospital, but the disease retmned in the cicatrix three monthsafterwards, and at the present time it involves the neighbour-ing parts, with the appearance here and there of prominentred and shining tubercles.The experience of the surgeons at this hospital goes to prove

that the disease returns at a much earlier period when causticshave been employed for its removal in preference to the knife;and this, we believe, agrees with the views of most of otherhospital surgeons.

In many of the patients, the entire gland was affected, oftenmuch enlarged, and covered with red shining tubercles; somehad undergone atrophic absorption, and the disease was keptin abeyance for years. The extent of glandular implicationvaried from tumours of the size of a walnut to that of a largeorange.An instance presented itself of that rare form known as the

"cuirass" cancer, the disease commencing near one shoulder,spreading downwards, involving the mamma, and extendingacross to the opposite side of the chest, and attacking theother breast. The whole chest anteriorly was embraced bythe cancer, like a cuirass-hence its designation. A goodillustration of this variety is figured in Velpeau’s "Cancer ofthe Breast," translated by Dr. Mtrsden; in that instance, hardor ligneous scirrhus, in plates, affected the whole of the integu-ments of the breast and the two mammse, in a young woman.The age of the patient at the Cancer Hospital is sixty-four;she is the mother of five children, appears to possess a goodconstitution, and the disease is of two years’ duration. The

right arm is affected with the brawny oedema characteristic ofcancer, and indicates the hold that it possesses on the system.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, MAY 22ND, 1860.

MR. F. C. SKEY, F.R.S., PRESIDENT.

ON TYPHUS AND TYPHOID FEVERS AS SEEN IN DUBLIN.

BY HENRY KENNEDY, M.D.

THE object of the communication was to show that whilethese types or varieties might, in the great majority of in-stances, be distinguished the one from the other, they werestill but the results of a common poison. To the distinctivemarks between the two varieties he had drawn attention, in theDublin Medical Joumal, as far back as the year 1837, threeyears before the appearance of Dr. Stewart’s memoir. The

arguments for the identity of the poison the author dividedinto general and special. Amongst the former he particularlydwelt on the fact of different types of fever coming from theone room; such as cases with and without spots, or some withdark and others with rose spots, or the congestive, nervous,and gastric fevers all existing in one family and at the sametime. Amongst the special arguments the details of some caseswere given where petechias existed together with ulceratedbowels; and also cases of the same variety where the two rasheswere mixed. The author also noticed the fact that intestinalhaemorrhage was at least as common in typhus as in typhoidfevers-contrary to what is usually thought. In conclusion,the author glanced at the views now held by many on thestimulant treatment of acute disease. He observed that theextent to which these doctrines were carried elsewhere had notreached Dublin, nor did he think they would; and he con-sidered there were many points, directly involving the generalquestion, which yet required the fullest consideration. Thoughthe author did not enter at all on the general treatment offever, he spoke of a few points having a special reference tothe treatment of typhoid fever. In particular he drew atten-

tion to the necessity for making a distinction between thestimulants in common use, of which wine and beef-tea wereinstanced. In his experience the effects of the former were muchless likely to be followed by any unpleasant results than thoseof the latter; and this he had remarked not only in fever, butalso in some of the phleemasipe. The cause of this differenceDr. Kennedy attributed to the difference in the constituentparts of the two fluids. To the carbonate of ammonia he alsodirected attention, as being in general use; and yet, in his ex-perience, he had found it very apt to cause diarrhoea, and latterlyhad entirely given it up. The medicine he now placed themost reliance on was the dilute sulphuric acid; and he hadarrived at this conclusion after having tried the ordinary astrin-gents. The acid, however, was not a new remedy. With theacid he always joined local treatment, such as leeching andblistering; nor of its efficacy-when used with ordinary dis-cretion-had he the slightest doubt, notwithstanding all thathad been recently urged against it. In the last place, theauthor spoke of a certain class of oases of typhoid fever inwhich it seemed as if the poison were flitting about the system,at one time attacking the abdomen, again the chest, or thebrain. In such cases he had adopted the expedient of keepinga blister open, usually on the chest, for some days; and fromthis plan he had seen very marked advantage.

Dr. A. P. STEWART said that Dr. Kennedy’s paper had dis-appointed him. It contained nothing which refuted the factsand principles advanced by Drs. Jenner and Murchison, andother writers upon fevers, and which were now generallyaccepted by the profession. The fact that the petechial erup-tion of typhus and typhoid fevers might co-exist had been longknown. Sometimes, indeed, it was found connected withscarlet fever and other eruptive diseases. The real point ofimportance in the question was this: Are the two eruptionsso far identical that they might both become dark, semi-petechial, then petechial, and not disappearing under pressure?From a long observation of the two fevers, he had ampleopportunities of testing the question, and he had never wit.nessed a case in which the eruption of typhoid fever had everbecome petechial or dark. This held good even in extremecases, the last crops of typhoid fever eruption being as brightand rosy as the first. On the contrary, the typhus eruption,as the gravity of the case increased, had a constant tendencyto become dark and petechial, and did not disappear underpressure. Dr. Kennedy’s paper did not contain that largebasis of fact which was necessary to establish his proposition.

Dr. MuRCHsoON said that the records of the London Fever

Hospital were diametrically opposed to the experience of Dr.Kennedy as recorded in the paper. During the last twelveyears, four thousand cases of typhus and two thousand oftyphoid fever had been admitted into that institution. Ofthese, seven hundred cases of typhus and four hundred oftyphoid fever had proved fatal. These cases had been fullyand completely recorded, and those ending fatally were exa-mined after death. Now in no one instance had the character-istic eruption of typhus fever been observed during life, and thecharacteristic lesion of typhoid fever been present after death.The converse was also always found to obtain. His (Dr. Mur-chison’s) experience of the diseases in Edinburgh was of a similarcharacter. It was supposed by some that when diarrhoea ap-peared as a complication of fever the disease was necessarily ofthe typhoid form, and that the appearance of petechiee indi-cated the existence of typhus. But this was a grave mistake.Diarrhoea was no unfrequent complication of typhus. In theCrimea typhus was often complicated with dysentery. In no in-stance, however, of such complication was typhus fever, as

proved after death, attpnded with ulceration of Peyer’s glands.Petechial eruptions were not characteristic simply of typhus,but existed in many diseases which were not idiopathic fevers,and they were quite distinct from the bulloid or mulberry rashof typhus fever. In a case which had been recorded in THELANCET by Dr. Kennedy, he stated that the rash of typhoidfever was present during life, and that after death there wasno ulceration of Peyer’s glands. But Dr. Kennedy in this casehad given a description really of the eruption of typhus fever,and hence the conclusion which he drew was erroneous. The

eruption of typhus appeared all at once within a period of oneor two days, continued during the whole length of the fever,and got darker every day. The eruption of typhoid fever, onthe contrary, came out in successive crops, not becoming, asthe author stated, converted into petechise on the fourth day,for by that time the characteristic eruption of typhoid feverwas disappearing. The identity of typhoid and typhus feverwas no more proved by the occasional coexistence of the twoeruptions, than the coexistence of the eruption of typhoid fever

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with scarlatina, which he had observed in seven or eight cases,was proof of the identity of these diseases. Dr. Murchisonthen criticized with some severity the mode in which Dr. Ken-nedy had recorded his cases in the paper read before the So-ciety, and contended that the descriptions which he had givenwere so meagre and incomplete that they could not enable usto arrive at a just conclusion as to the exact nature of the caseswhich he had recorded.

Dr. WEBSTER said he wished that Dr. Kennedy had enteredinto the question of the comparative prevalence of the diseaseat the present time and formerly; also the period of its attacksand the relative susceptibility of the two sexes. Fever wasmost fatal in Sweden in the coldest seasons, and amongst themale sex. It was most prevalent in the hot months in Spain,and was more fatal amongst females. It had always been afearfully fatal disease in that country. In 1857, fever ravagedLisbon, and was most severe in the month of October. Threemen to one female died, women and children being rarely at-tacked by it. More women than men died from fever in

England; but the disease was less prevalent in this countryand Scotland than it was twelve years ago.

Dr. JENNER had paid great attention to the subject of feverfor the last fourteen years. For six or seven years he hadspent seven or eight hours daily in the Fever Hospital, andhad recorded with great care each case that came under hisnotice. Of late years, his experience had been less extensive,but it had served to confirm the opinions at which he had pre-viously arrived. Ample experience had proved to him, thatthe state of the intestines after death could be predicted fromthe nature of the eruption. The presence of petechial erup-tions was not confined to cases of fever. It existed in severecases of erysipelas, small-pox, and scarlet fever; but thisafforded no proof that these diseases were identical. Dr.Kennedy had remarked, that in order to arrive at a full know-ledge of fever, it ought to be studied all over the world; but it Ihad been so studied. On the banks of the Bosphorus, Dr.Parkes had found that the Turkish physicians recognised thedistinction between typhus and typhoid fevers. In Dr. Flint’s

report on fever in India, the same distinction was made. Dr.

Kennedy had supposed that it was generally believed thattyphoid fever was symptomatic of intestinal lesion; but thiswas not the case. He (Dr. Jenner) had published some of hisearly cases with the intention of showing that the fever andthe lesion bore no relation to each other. As a patient mightdie of virulent small-pox almost before the eruption had ap-peared, so typhoid fever might prove fatal from the generaldisturbance of the system, with very little intestinal lesion.

Dr. ‘ViLhs had been taught that typhus and typhoid feverwere identical, and he was somewhat prejudiced in favour ofthis opinion; but he had, on the publication of Dr. Jenner’scases, ten or eleven years ago, commenced testing the subjectafresh in the wards of Guy’s Hospital. The result of this in-

vestigation was his conviction that the two diseases were alto-gether distinct. He thought there was sufficient to establishthe distinction in the anatomical differences which presentedthemselves-the presence of the lesions in the one case, andtheir absence in the other. His investigations had been suffi-cient to convince him that the number of cases in which therewas a difficulty in diagnosing typhus from typhoid fever wasless than the number of those in which it was found difficultto diagnose between fever and chest, or lung and heart disease.Whatever difficulties existed in either case were removed bythe post-mortem appearances. It must be acknowledged, how-ever, that in some instances during life there was considerabledifficulty in deciding between cases of typhus and typhoiddisease.

Dr. WYNN WILLIAMS had heard nothing to alter his opinionas to the non-identity of the two diseases. During the epi-demics of typhoid fever and small-pox which he had observedin the neighbourhood of Llamberis, the presence of petechise inchildren was not uncommon. Even when no epidemic pre-vailed, he had frequently found petechise in children, whosehealth had been impaired from deficiency of food or othercauses. When petechise were present, he could never get a propervaccine vesicle, and had found it necessary to restore the healthby tonics previous to the performance of vaccination. Hediffered from Dr. Kennedy in thinking that haemorrhage wasbeneficial. During an epidemic of typhoid fever, he remem-bered the case of a woman which was nearly fatal from theprofuse discharge of blood from the bowels. He had succeededin arresting it by an injection of two drachms of tannin to apint of water. He had tried this remedy in several cases, andalways with a successful result.

Dr. BARCLAY had no doubt that the conclusions at which

Dr. Kennedy had arrived had been founded on a large numberof facts. For himself he was unable to give an opinion oneway or the other. He agreed with Dr. Wilks that the anato-mical lesions which presented themselves constituted the mostimportant point of consideration. When registrar of St. George’sHospital, he had made special notes of all cases of fever in thatinstitution. A careful study of the " reports" which were issuedfrom time to time, recording the distinguishing characters offever spots, had convinced him that these descriptions were notin harmony with the appearances which presented themselveson the bodies of patients. With regard to the duration of thespots in typhoid fever, which Dr. Murchison limited to four orfive days, he had known them last fourteen or fifteen days.He regarded as one of the great difficulties which presentedthemselves in coming to a decision on this question, that arisingfrom inaccuracies in the description of these spots from thebeginning to the termination of the attack.

Dr. JENNER remarked that the real point of importance wasnot the length of time the spots lasted, but whether theypassed into true petechias, and became ultimately ineffaceableby pressure.

Dr. KENNEDY, in reply, said he could only do so generally.More than one of the speakers had stated that petechial3 werenot uncommon in other diseases besides typhus fever. Whilstadmitting this well-known fact, he did not see how it affectedthe question at issue at all. He had assumed that petechialspots, when united with the symptoms of fever, constitutedtyphus fever; and he had yet tu learn that this was incorrect.Other gentlemen thought the details of the cases too brief.But he (the author) was at a loss to understand how anyminuteness of detail could alter the fact that petechiae hadbeen found in connexion with ulceration. The details of thecases had been purposely of the briefest, because much had tobe compressed into a small space; and this was so with thelast case given, even when sent for publication to THE LANCET;for he was well aware of the great pressure on the pages ofthat well-read journal. By some of the speakers he had beenunderstood to say that in this last remarkable case the roselenticular spots had become changed into petechise. This wasan erroneous impression. What he did state was that petechiehad been superadded to the typhoid rash. One gentlemanargued that the result of pressure on the different kinds ofspots was enough in itself to separate the two types of fever.He had not found this difference exist; and Dr. Watson-nomean authority-bore him out in it. He could have wished.that some gentleman present had noticed the important fact inreference to the occurrence of haemorrhage, whether intestinalor from the nose, and which he had found at least as frequentin typhus as typhoid fevers, The meeting would observe thatin anything he (the author) had advanced he did not standalone; and for proof he referred to the able works of Huss,Flint, and Bartlett, all of whom had given cases fully asstriking as any detailed by himself. In the last place, he wasglad to find that some of the speakers were so familiar withthe fact that the varied rashes of fever were often combined.To prove this was one of the main objects of the paper; andwhen it, together with the other anomalies to which attentionhad been drawn, were more generally recognised, he was fullypersuaded that the current views of the day would be mate-rially modified.

PATHOLOGICAL SOCIETY OF LONDON.

TUESDAY, MAY 15TH, 1860.MR. FERGUSSON, PRESIDENT.

CALCULI OF THE BLADDER.

MR. FERGUSSON exhibited some calculi from two patients,removed by lithotomy, in which the form was rather remark--able, observing that we know very little of the causes whichoperate to produce some of the varieties of form met with.One was flat and disc-shaped; the others were extremelyirregular.

TUMOUR FROJ’,1 THE MAMMA.

Mr. FERGUSSON showed this as a large specimen of the fibroustumour of the mamma. It weighed between three and fourpounds, and had been fifteen years in developing. Some of theoriginal tissue of the breast was still to be detected.

ATROPHIED BONE.

Mr. PARTRIDGE exhibited specimens of wasted bone: a tibiafrom a bed-ridden patient, which was remarkably atrophied,