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almost certain recurrence of the disease after removal goes agreat way to support the notion that it is essentially malignant— view further supported by the opinion of most pathologists,who consider melanotic tumours analogous to common cancer-ous growths, with the pigment superadded. Notwithstandingthis prevailing idea, however, a division of melanosis into twokinds has been made, we think with great propriety and goodreason, into benign and malignant—a division which is sanc-tioned by careful histological examination into the morpholo-gical elements of the disease. Thus, for example, we will finda tumour possessing the external characters of melanosis,which, on careful examination, turns out to be a simple andinnocent structure, with the development of pigmentary matterthroughout its tissue; this will be removed, and either noreturn of the disease takes place, or the patient may remain atleast free from a return for a period of many years. Now, thisform of melanosis is referred to by many men of great expe-rience, who draw a wide distinction between it and the secondform-a point of no small importance in the diagnosis. Wehave heard Mr. Fergusson remark on the importance of beingable to assure our patients in private practice that such atumour was not malignant, or was malignant, and, according ’,to the correct view taken by the surgeon, we believe a possibleassurance can be given as to the return of the disease or not.On the other hand, the malignant form of melanosis, which

very justly may claim the significant name of "black cancer,"is a very different structure altogether. The true elements ofcancer are generally or mostly always present, infiltrated withblack pigment. The form of cancer most commonly met within this class, we might say always, is the encephaloid, anyother variety of cancer constituting the exception. Themelanotic matter is infiltrated throughout the entire mass, oris mostly confined to its outer layers, being sparsely depositedin some instances in its interior. Most of the cases recorded inthe " Mirror" have been of this form. Leaving out cases in whichthe disease attacked the eyeball for a future occasion, when wehope to bring forward an example recently under the care ofMr. France at Guy’s Hospital, who removed the globe, we mayrefer to the following:—Recurrence of a Melanotic Tumour(Mr. Fergusson), THE LANCET, vol. i. 1851, p. 622; MelanoticTumour growing from the Heel (Mr. Le Gros Clark), vol. ii.1852, p. 175; Melanotic Tumours in several parts of the Body(Mr. Fergusson), ibid. p. 176; Melanosis of the Groin (Mr.Fergusson), vol. ii. 1855, p. 439; and numerous records of casesnot in our " Mirror" will be found throughout the volumes ofthis journal.To turn to the case which we have the pleasure of briefly re-

eording to-day. It is one of those in which the disease is mul-tiplied in various parts of the body, affecting the subcutaneousglands. We had hoped when witnessing the removal of someportions of the disease, after listening to the valuable remarksof Mr. Hewett, that there might be an absence of malignancy;but the microscope has pointed out the true nature of thenialady, and relief is therefore only temporary. Nevertheless,we think most surgeons will admit the propriety, even in themalignant form, of an early and complete removal, whichappears to offer the patient a chance of cure, more especially asat first the tumour may be benign, which if allowed to remainwould degenerate into cancer. We do not believe, under anycircumstances, that the mere removal hastens the fatal termi-nation.

George K-, an elderly man, was admitted on the 9th ofApril. He had been an out-patient six weeks ago, with seve-ral large lumps in his groin. There was a large scar on hisright flank, from which place, six years ago, he had a tumourremoved by Mr. Lawrence. Besides a pretty large tumour inthe right groin, a smaller one was present in the oppositegroin; they existed in other parts of the body also, as in theleft ham, in the posterior part of the same thigh, over the rightand left sides of the thorax, in the axilla, &c. Some of thesewere simply subcutaneous, and were freely moveable; and theirsurfaces were discoloured of a bluish-black colour. Six monthsbefore his admission, Mr. Lawrence wanted him to enter Bar-tholomew’s Hospital and get these glands in the groin removed,but he would not consent. When an out-patient, a consulta-tion was held between Mr. Hewett and his colleagues, Mr.Cassar Hawkins, Mr. Tatum, Mr. Cutler, and others, and itwas deemed prudent not to operate, and to leave the diseasealone; the appearance of all these tumours about the body in-clined him not to operate. The patient appeared again at thehospital, and stated he could not work at his trade, which wasthat of a grinder, and required the constant use of his rightleg; that he suffered great misery and severe pain in conse- and would like them removed—at any rate from the

groin. His anxiety was extreme to have the operation per-formed, so that his life could be spared for eight months or ayear, to make some little provision for his family. Underthese circumstances, and as these tumours in the course of twoweeks had increased considerably in size, Mr. Hewett, in con-sultation with his colleagues, consented to remove the diseasedmass from the groin.On the 1st of May chloroform was administered, when Mr.

Hewett made a long incision over the whole length of thetumour, which was here much discoloured, and removed alarge mass of affected glands, together with a quantity of loosetissue surrounding them. The tumour included the deep andsuperficial glands, and was situated immediately over thesaphenous opening, the sheath of the common femoral veinunderneath it being exposed, the tumour having absorbed thecribriform fascia. The dissection was performed with greatcare, and several small vessels were tied. Two or three smalltumours were then removed from the opposite groin. On sec-tion, these tumours presented a dark-brownish colour, resem-bling somewhat coagulated blood.

In his remarks on this case, Mr. Hewett observed that hehad told the patient of the danger of the operation itself, aswas seen when removing the deeper glands when the femoralvessels were exposed; but still the poor man was anxious, not-withstanding, to get rid of them. He requested those presentto bear in mind the history of the patient-their removal sixyears ago,-and he thought the disease must have been of thesame character then as now, a brown-ochrish tissue on cuttinginto it-true melanosis. Sometimes it happens, he observed,that melanosis is not associated with malignant tissue; and if wecan find cancer cells in the specimens removed, although theseare not absolutely diagnostic, then are they malignant. Therehave been some cases published years ago, he said, where theeyeball was removed, and the patient has remained welltwenty or thirty years. In such cases the melanosis could notbe combined with malignant tissue. If combined with encepha-loid disease, then they are fataL When these tumours are not

malignant, it is owing to the infiltration of the black matterinto some simple or benign tumour; hence the disease does notreturn.

May 15th.-Has been going on well since the operation; thewound has almost entirely healed. His general health is ex-cellent, his pulse good, and his appearance is favourable. On

microscopic examination, the tumours were found to be en-cephaloid disease, infiltrated with black matter. True cancercells were found developed within the melanotic portion, andwhere this was not present the true encephaloid disease ap-peared. In other words, the tumours were examples of en-cephaloid disease infiltrated with this black deposit. A returnof the disease, even within a short period, may therefore beexpected.June 5th.-The wounds have perfectly cicatrised, and the

patient is on the eve of leaving the hospital. He has com.

plained of severe pain in the head the last three or four days,accompanied by vomiting, which has been relieved by salinemedicine, and now he is free from it.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, MAY 27TH, 1856.MR. CÆSAR HAWKINS, PRESIDENT.

REMARKS ON THE SANITARY CONDITION OF SCOTLANDDUPING 1855.

BY JOHN WEBSTER, M.D., F.R.S.,VICE-PRESIDENT OF THE SOCIETY, PHYSICIAN TO THE SCOTTISH HOSPITAL.

HEERTOFORE, no general registry of deaths existed in Scot-land, whereby an accurate notion of its actual mortality could beofficially ascertained. However, last year, a system of regis-tration, similar to that pursued in England, having been esta-blished, there now seems every prospect that much very valu-able sanitary information, respecting the northern portion ofGreat Britain, will be henceforth procured. The plan adoptedsupplies a desideratum long felt, promises great beneficial re-sults, and removes the opprobrium that Scotland was one ofthe few countries in Europe where such official registration wasunknown. After several general remarks upon this importantsubject, and its introduction, Dr. Webster strongly animad-

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verted upon the penal clause, which enacts that any medicalpractitioner who shall have been in attendance during the lastillness, until the patient’s decease, must transmit within four-teen days after death, under the penalty of " forty shillings," acertificate of such event to the district-registrar. Having ex-pressed a very decided opinion on this point, he proceeded todetail the chief characteristics of public health recorded through-out Scotland, during the twelve months ending last December.In that period, 62,154 deaths were recorded, being in the pro-portion of about one case of disease terminating fatally to every4S persons then living. This indicated a rather favourablesanitary condition of the general population, and showed therate of mortality ranged even lower than in England during theparallel season. However, as might be expected the ratio ofdeaths, taken in the aggregate, was more or less exceeded bythose countries, of whose population a large number dwelt intowns, compared with residents of rural districts. Throughoutthe former localities, having nearly one and a half million in-habitants, and containing every large town, the per-centageof mortality reached one in 38 ; whereas, in country parisheswith an equal population, the amount of fatal cases was onlyone in 58 residents, thus showing a greater loss of human lifefrom influences connected with urban residences, than occurredelsewhere. In other words, dwellers in towns died at the rateof 261 out of every 10,000; while the rural population onlyfurnished 169 deaths amongst the same number of personsliving in such localities. Speaking generally, the mortalityranged higher during the first part of the year, or cold months,than in the mild seasons of summer and early autumn, butagain augmented towards winter, whereby the most healthyperiod was August and September, the least salubrious beingMarch and February, the total deaths amounting to ’7227 inFebruary, contradistinguished to 4047 in September, thus

furnishing 3180 less during the latter month, or actually 44 percent. diminution. The author subsequently entered intonumerous interesting statistical details respecting the severalquarters of last year, and their respective death-rates bydisease; but as any abstract would convey only a brief andimperfect idea of the numerous facts related-all, however,based upon official authority-it may suffice to observe, thatthe amount of mortality varied considerably in differentcounties, having been usually greatest on the northern andeastern coasts, whilst in the south-western, or manufacturingdistricts, it often proved much more considerable. Notwith-standing the generally healthy condition of Scotland, particu-larly during the latter half of last year, virulent epidemicattacks of variola and scarlatina prevailed in different localities.In reference to the former malady, Dr. Webster added thismost important observation-viz., in every place where small-pox broke out, and often proved exceedingly fatal, nearly allthe deaths by that cause occurred amongst persons who hadnot been vaccinated. Indeed, he further said, many individualsappeared to have woefully neglected availing themselves andoffspring of the invaluable safeguard of cow-pox, hence throwingmuch discredit upon all parties. Such conduct doubtlessoriginated either in gross ignorance, wilful neglect, or obstinateprejudice against the protective influence of vaccination, andthis even in a country much famed for its often intellectually-cultivated population. These remarks respecting variola applyin a special manner to such places as Dundee and Greenock,where the above-named loathsome disease has, for some yearspast, caused nearly double the mortality thereby recorded inEnglish towns, and which therefore makes this fatality trulyexcessive. Various practical questions were afterwards dis-cussed, of which one may be here specially noted-namely,the very large number of infants and children who died underfive years of age, the amount being generally greatest in Glasgow,Greenock, and Dundee. In these towns, the death-rate of suchparties often exceeded 50 per cent. of the entire mortality. Nay,it was even 61 per cent. during September; and in August, thereturns show, that actually 64 deaths in every 100 registeredwere of young persons under five years old. Again, the pro-portion of still-born infants was likewise considerable. Forinstance, in Dundee, the ratio, of late years, has ranged 7 andnearly one-fifth per cent.; while, in Glasgow, 7 still-born caseswere also reported in 100 births. Compared with other largetowns, or even capitals, both in England and on the continent,such casualties do not often attain so high a figure as that re-corded in several districts of Scotland. Thus, in London, theproportion is about 3’4 per cent.; in Berlin, it falls under 5per cent.; at Stockholm, the ratio is less than 4 per 100births; and, in Paris, it is 7 per cent., or almost the sameamount as in Dundee. These respective statements are bothcurious and instructive; while they amply illustrate the very

grave question now brought under discussion; and which,therefore, assumes such an important feature as to demandserious attention by the Legislature and philanthropists, with

’ "

a view to mitigate, if not prevent, if possible, similar cala-mitous consequences in future. Subsequently Dr. Webster

observed, although the data upon which useful deductionscould be fairly inferred, in respect of the special diseaseswhich proved most fatal in particular districts, were yetof rather a limited character, nevertheless, one or two generalremarks, he thought, might be legitimately made respecting,three of the most populous Scottish towns, in order to showhow far several diseases-not epidemics-differed in theirmortality during the past season. Thus, in Aberdeen, situatedon the east coast, and having about half the population ofEdinburgh, pneumonia, bronchitis, and croup all proved muchless fatal than either in the modern Athens or in Glasgow,due regard being had to their relative populations. Pneumoniacaused twice the proportional number of deaths in Glasgow tothose recorded by the same cause in Edinburgh, and nearquadruple the ratio reported at Aberdeen. Bronchitis alsoexhibited analogous results; whilst croup was five times moremortiferous in Glasgow than in the just-named northernuniversity city; and lastly, apoplexy oftener caused death inthe capital than elsewhere; but dropsy seemed twice as fatalat Aberdeen, in reference to its aggregate population. Review-

ing all the facts brought forward to illustrate the subject in-vestigated, the author believed he was fully warranted in’

saying, when concluding his paper, that Glasgow seemed muchthe most insalubrious locality, where any large collection ofanimated beings are congregated together, not only in Scotland,but throughout Great Britain, viewed comparatively. Henceit may truly be reckoned an undesirable place of residence, andis, besides, equally remarkable for the brevity of human life sofrequently recorded amongst its mongrel population, howeverenterprising, charitable, and wealthy many eminent citizens-have become, whilst everywhere numerous indications are dis-played of progressive civilization.

Dr. E. SMITH inquired what was the cause of the very greatmortality in infants ?

Dr. PEACOCK asked why the Island of Bute was regarded asso unhealthy in the return ?

Dr. WEBSTER remarked that he had received some informa-tion respecting the great amount of infant mortality, but itwas not conclusive, and therefore he should not make anystatement upon that point. The reason why the rate of mor-tality was so high in the Island of Bute resulted from the factthat many invalids went there for health, and died there.

Dr. E. SMITH believed that there was no county in Englandor district on the continent where the mortality was 1 in 23,as stated to be the case in Lanarkshire.

Dr. WEBSTER observed that the high rate of mortalityalluded to was confined to the towns in Lanarkshire, and didnot include the rural districts, where the deaths were only Iin 37. The depraved state of the atmosphere in Glasgow,abounding as it did in smoke, and the prevalence of whisky-drinking, &c., had a great effect in increasing the ratio of deaths.

Dr. STEWART attributed the high mortality of Glasgow tothe quantity of carbon constantly suspended in the atmo-sphere. In a large proportion of the post-mortem examinationshe had made when residing in that city, the lungs were foundimpregnated with carbonaceous matter, not always sufficientto produce organic disease, but frequently a cause of it. Glas-

gow was, in fact, one of the most unhealthy cities in the world,some of its lanes and alleys being worse than anything seen int. Giles’s in old times.

Dr. BARCLAY remarked that statistics of mortality should be-classed more distinctly with reference to the population beingrural or urban; it served only to confuse when we comparedthe mortality of a country containing large manufacturingtowns with one with few or no such towns. What was themortality of the rural population of Lanarkshire, independentof Glasgow ? Was it not less that that of Clackmannanshire?

Dr. WEBSTER observed that the returns to which he hadreferred were obtained from every parish, but his paper onlygave the general returns of the manufacturing and agriculturaldistricts.

Dr. WEST observed that the question of the ratio of still-bornchildren to a population would depend in a great measure, hethought, upon the fecundity of the parties. Where there wasremarkable fertility in a few, the cases of still-born childrenwould be in a greater ratio than when the number of pregnan-cies was divided amongst a larger number of mothers, so asnot to exceed the average rate of fecundity. Dr. Whitehead,of Manchester, had stated that pregnancies terminating in

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abortion are generally those occurring after the sixth. ’ His(Dr. West’s) experience corroborated’this.

Dr. O’CONNOR inquired whether the great mortality, inchildren below five years, in Glasgow, was due in any way tothe prevalence of infanticide ? ?

Dr. WEBSTER replied that there was no coroner’s court inScotland, and he could not answer the question.

Dr. BARCLAY said the great prevalence of the strumous dia-thesis in Glasgow was a cause both of death in infancy and ofcases of still-birth.

__

EPIDEMIOLOGICAL SOCIETY.

MONDAY, JUNE 2ND, 1856.DR. MILROY IN THE CHAIR.

DR. MACWILLIAM read a paper, by W. LAUDEH LINDSAY,M.D., Perth, entitled,.SUGGESTIONS FOR OBSERVATIONS ON THE NATURAL INFLUENCE

OF CHOLERA ON THE LOWER ANIMALS.

Dr. Lindsay considers that for the successful prosecution of thestudy of cholera as affecting the lower animals as well as man,two classes of observers are necessary; for it seldom happens-nay, it is scarcely reasonable to expect-that the same mind is.equally fitted on the one hand accurately to observe and labo-riously accumulate facts; and on the other, to sift, arrange,and reason upon these, so as to deduce general principles. No;he who gathers in the harvest of facts into the storehouses ofknowledge is the type of one class of naturalists-the careful,plodding, and unostentatious observer: he may be said to beactuated by a spirit of acquisitiveness; while he who subjectsthe grain thus accumulated to the machinery of mental andscientific analysis, who separates the wheat from the chaff,’who from a chaos of apparently unconnected data evolves har-monious laws, and exhibits their natural relations and signi-fications, is the type of an opposite class, whose labours areguided by the spirit of inductive philosophy. Dr. Lindsaysaid that from observations and experiments made in variousparts of central Europe, and to a less extent in India andBritain, it would appear that coincident in date with choleraepidemics in man, there have frequently appeared choleraepizootics amongst the inferior animals, especially amongst thedomesticated animals; that this cholera in animals resemblesthat of man in symptomatology and pathology; and that it iscommunicable not only between different individuals, but be-tween different species and genera, and also to or from man.The faculty of medicine at Vienna reported, after the choleraepidemy of 1832, that while in Lower Austria, Galicia,Moravia, and Bohemia, no animals were exempt from the in-fluence of that epidemic, the disease most closely resembledthe human cholera in animals having similar structure andhabits to man, such as the dog. The chief animals in whichcholera has been noted to have occurred in Europe are horses,cattle, dogs, cats, and poultry, or, in other words, the domes-ticated animals; while in India and other foreign countries, inaddition, racoons, camels, zebras, and monkeys, have beenmentioned. Some facts that have been recorded would lead tothe inference that the cholera poison is deleterious to plants aswell as to the lower animals and man; but the whole subjectis one that still remains open to rigorous investigation, in-

cluding minute chemical, histological, and microscopical exa-mination. Dr. Lindsay concluded by propounding a veryelaborate system of investigation, by veterinary surgeons,grooms, horsebreakers, poultrymen, and others, as well as bythe medical profession, and from the mass of facts accumulatedby numbers of observers it may be hoped such general prin-ciples may be established as shall throw some light on thenature of this mysterious scourge.A discussion followed the reading of this paper, in which

Dr. Snow, Dr. Greenhow, Dr. Webster, Dr. Milroy, Dr. Camps,Dr. Rogers, Dr. Chowne, and Dr. MacWilliam took part.

L01VGEVITY IN THE CITY.-An eminent citizen of Lon-don recently gave a dinner to celebrate his seventy-secondbirth-day, when, out of sixteen guests, fourteen had attainedseventy and upwards, their united ages amounting to 1048years, the average being seventy-five, and the two oldest wereeach eighty-six last birth. It is seldom that, in any country,such an assemblage of ha-le old gentlemen have ever met toge-ther on a similar festive occasion; and the fact is now recordedfrom its rarity, and as indicative of the great ages of manypersons living in this metropolis.

Reviews and Notices of Books.A Practical Treatise on Vesicular Hydatids of the Uterus;By WILLIAM HENRY ASHLEY, M.D., F.R.C.S. London:Bailliere.

THIS little treatise scarcely deserves the title of " prac-tical ;" nor can it claim that of being theoretical. It is verydefective in the exposition of the researches of the most recentand accurate observers who have examined the subject, withall the advantages derived from the writings and experience ofolder authors, the light of a more advanced pathology, and theapplication of infinitely more efficient means of physical obser-vation. The work should rather be called "historical," forit is the stringing together a number of quotations from themore ancient authors that constitutes its chief feature.But even the history of the subject appears to have had no

charms for Dr. Ashley, below a rather remote epoch. He has

stopped short precisely at that era when exact research tookthe place of rude prinaa facie observation and pure hypothesis.Were it not for a note in the appendix at the end of this littlevolume, it would be justly assumed that Dr. Ashley had neverheard of the labours of Desormeaux, Mettenheimer, Paget, andBarnes. These pathologists have abundantly proved, bynumerous observations, that the uterine hydatid is simply acystic development or degeneration of the chorion. Dr. Ashleydisposes of this doctrine in the following not very lucid para-graph :

" Upon reviewing all that has been said in reference to thepathologico’histological characters of these cysts, (and theseremarks must be considered suggestive, rather than dogmatic,)it appears to me, that their development in the uterus of themarried female and virgin is genetically the same; that theyare, however, conjoined with divers transformations, fromwhich they are, ab origine, essentially independent; and thatthe involution of the villi of the placenta and chorion intoattached cysts must be considered in the light of mere hypo-thesis" !

Dr. Ashley-we do not say it dogmatica,lly, but suggestively-would have done better to have afforded his readers the oppor-tunity of judging of this question for themselves, by layingbefore them an account of the minute observations upon which

this, to him, " mere hypothesis" is founded. As he has failedto do this, those of his readers who are not already better in-formed than the author, will, no doubt, consult the excellentarticles of Dr. Barnes on the I I Diseases of the Placenta," in theBritish and Foreign ltledico-Chirurgical Revieto.We regret to be obliged to point out grave defects in a book

which evinces much painstaking and literary research. But

we feel compelled to express our opinion, that when an authorprofesses in his title-page to give " a general view of theetiology, pathology, semeiology, prognosis, and treatment" ofa disease, it is incumbent upon him to bring down his observa-tions to the date of publication, and not to stop short at theend of the last century. In a question of placental pathology,this duty is the more palpable, since almost all that is reallyvaluable in this department of pathology, and that challengesanalysis, is the fruit of the last twenty years’ research.

A leo7iolic D2-ink-s; theii- A buses and their Uses. Bya SURGEON.Nottingham. pp. 31.

An Address delivered by the Medical Officer of a Society ofOdd Fellows to its members. It is marked by sound senseand extended information; and in the following presume of theauthor exists the pith of all that can be said pro and con upona very vexed matter :-

" It is, then, incontrovertible, that in the use of these stimu-lants moderat1:on is the exercise of philosophy and good sense;for our very instincts set at defiance the refinements and re-strictions of extreme opinions. No one certainly can deny thattheir too liberal employment has been the occasion of a vast