76

The following hint will be useful to some of our readerswho are engaged in microscopic pursuits. We can speakfrom experience of the accuracy of the statement : -CLEANING GLASSES PREVIOUS TO MOUNTING OBJECTS." It is highly essential, before putting any cement or

liquid on glass which is intended to bear an object, thatit should be perfectly free from greasiness,’ and watershould flow uniformly over the surface. To effect this, itis usual to have recourse to alcohol, alkaline solutions, orsulphuric acid ; but recently the Rev. J. B. Reade hasdiscovered that infusion of nut-galls (which is a solutionof tannic acid) answers the purpose equal to, if not betterthan, any of the preceding."-Physiological Journal.

ON THE ABUNDANCE OF CRYSTALLINE MATTER IN PLANTS.11 Professor Bailey, remarking on the number of

crystals in plants, stated that the number contained in asingle square inch of the liber (inner bark) of many trees, asthe willow, poplar, locust, &c., no thicker than a piece ofwriting-paper, was at least a million; and that, conse-quently, the amount in the whole tree, including wood,bark, and leaves, must be enormous, and yet nearly allthe trees of the forest were thus filled with crystals.Remarks were then made by Professor B. on the import-ant questions concerning the causes and consequences ofthis vast production of crystallised oxalate of lime in thevegetable kingdom, and upon the development of heatand electricity which must attend its formation. He

suggested, as questions worthy of examination, whetheroxalate of lime is a fertiliser ? 1 Whether the fall of theleaves, shedding of bark, &c., might not be nature’smethod of distributing this substance as a fertilisingagent ? Whether it could be detected in soils unchanged? 1And what changes does it undergo during the decompo-sition of vegetable matter?"-Idem.

THE LANCET.

LONDON, SATURDAY, APRIL 6TH, 1844.

THE FACTORY BILL.

We have hitherto been silent spectators of the parlia-mentary proceedings, with reference to Lord ASHLEY’S

Factory Bill. Although silent, however, we have notbeen unconcerned in its welfare ; for we take an ardentinterest in everything calculated to promote the physicaland moral welfare of the working classes. It was, there-

fore, with deep regret that we saw, a few days ago, the

triumph of the friends of humanity in the House of

Commons endangered and compromised by the workingof party feeling. Lord AsHLEY embarked in a noble,in a righteous cause, and we had hoped, from the

energetic and powerful appeal he at first made to the

better feelings of his colleagues, that he would haveshown himself, throughout, the uncompromising, un-flinching champion of the over-worked poor. It is true

that the new bill is to be discussed after Easter,and that LordASHLEY has promised to again bring forward his amend-

ment ; but he must know that he will then have littleor no chance of success. Government has now made the

twelve-hours’ clause a ministerial question, and have op-posed the amendment from the first with dogged per-tinacity. Can it be expected that the small majoritywhich Lord ASHLEY had obtained in his three divisions

will stand before the efforts of the Ministers during theEaster recess ? Certainly not ; the delay, we firmly be-lieve, has sealed the fate of the ten-hour clause.

No class of society is so competent to estimate the effectof any given amount of labour on the human constitutionas that which we are now addressing, the medical com-

munity of the British empire ; and there is not one ofthat community, we feel certain, who, if consulted, wouldnot have told Sir ROBERT that twelve hours’ labour, ex-clusive of meals, is utter destruction to the very sourcesof life in children and very young women. What!

Children, girls, and young women under twenty, are tobe cooped up in the heated atmosphere of a factory, fromsix in the morning until eight at night, working without

interruption, except during their meals, and this, dayafter day, week after week, year after year ! At the verytime of life when the fabric of the body is being slowlyand laboriously built by nature, when good food, suffi-cient rest, and exercise in the open air, are indispensablyrequisite for the proper performance of the functions ofthe economy ! If the laws of Hygiena are to be thusdespised, thus set at nought, during the most importantperiod of our existence, the period when the founda-tion is laid for health and long life, or for disease

and early death; if the processes of nutrition are

to be thus vitiated and interrupted by overwork and allthe other evils which are its attendants, how can we

expect anything but a stunted and diseased population,how can we expect our manufacturing towns to

be anything else but charnel-houses for those who

inhabit them ? And such they become, charnel-houseswhich devour their offspring, and also the regularstreams of healthy life which pour into them from

the rural districts. In the fifth annual report of the

registrar-general, we find it stated (p. 50) that of anEnglish generation of 100,000, born at any givenperiod, after a lapse of fifty years there would still bemore than 50,000 alive in the county of Surrey, 41,000in the metropolis, but in Lancashire there would onlybe 26,000.

From the first minute of his existence man is assailed

by innumerable inimical agencies. Life is a continual

struggle between the vital principle on the one hand, anda host of forces on the other, all tending to its annihila-

tion-to the decomposition of the elements of which thehuman fabric is composed. In this perpetual warfareman is certain soon to fall, unless he receives a tolerableconstitution from his parents, and unless that constitu-tion is improved and invigorated during the period ofgrowth. When men have arrived at the age of ma-

turity, they become free. agents, and the State has nolonger any right to interfere in the disposal of their timeand of their labour. But whilst they are young, it is the dutyof the State, and a-duty which has been recognised by go- ·

vernments, from the time of half-civilised Lacedemonians,to protect the young, and to interfere if the workings of

,

society should subject them to labours unequal to theirstrength, to labours calculated to dry up the fountains oflife, to surrender them a prey to disease, and to devotewhole populations to death. Why the plagues and’

pestilenaes of old were less pestilential—less destructive

77

than are the" systems " to which the labouring classesare exposed in this country. We write medically, be itremembered, and not politically.

MEDICAL RELIEF TO THE POOR.

ADVERTING last week to the administration of poor-law medical relief, we mentioned how desirable it was

that the power of granting orders for medical assistanceshould not be allowed to remain, as at present, whollyin the hands of non-medical persons, whose feelings ofbenevolence are seldom very warmly enlisted in favourof the sick poor, and whose principal aim it is to protect,as they term it, the interests of the rate-payers. There is

another reform, of an equally beneficial and humane z,tendency, which might be made in the administration ofmedical relief to the poor, a reform which has been more

than once proposed by the Editor of this Journal to the

legislature of the country; hitherto, we are sorry to say,without effect.

Under the present system the poor who are obliged toresort to the parish for medical relief, have no power what-ever over the choice of the medical practitioner who is toattend them or their families during sickness. Althoughit is well known that confidence, on the part of the patient,in the one who treats disease is an important element inits cure, yet we should not feel warranted in finding faultwith existing institutions on that score, did we think thatthe poor were attended universally by those who pos-sessed the greatest amount of professional knowledge,by practitioners whose standing and reputation alwayscommanded the confidence and respect of their patients.The boards of guardians, however, do not look for the best

qualified medical practitioners, but, generally speaking, forthose who will perform the parish medical duties at the

lowest salary. Too often, indeed, they are willing to acceptany legally-qualified person, if by so doing they can econo-mise on the amount which is demanded by the established

medical practitioners of the neighbourhood, who reallypossess the confidence of the poor; and thus it is that

the latter are often attendedby persons in whom they donot and cannot place that reliance which should alwaysexist between a medical practitioner and his patients.The plan which we again propose would not only

remedy this evil, but would also give to the poor the freechoice of their medical attendant, a power which, as

we have already said, they may not have any legalright to claim, but which we certainly consider desir-able if it can be granted; it is as follows: -Supposingthe « payment by case " were adopted, and this systemwe consider the best of all, a list might be made,at the commencement of the year, of all the’ personswho were thought to have any claim on the parish formedical relief. On any of these, the regular poor,or ’any of the casual poor, applying for medical

relief, a card might be given with the name of the

medical attendant in blank, and this blank mightbe filled up by the name of the practitioner whom theypersonally preferred. Each medical practitioner would

keep the cards which he received, and at the close of the _

year he would forward them to the parish and receive ,payment in proportion to the number of cards in his pos-session, that is, in proportion to the number of cases hehad attended during the year.By the adoption of this system, on the one hand, the

poor would be attended by the person in whom they had the

greatest confidence, and, on the other, the superior medi-cal skill, the superior humanity of any of the medicalinhabitants of the locality would receive the reward thatit deserved. That reward would certainly not, in the first

instance, be a pecuniary one, as the medical attendance

of the poor can never, under any system, be a source ofmuch emolument to the profession, but the love of the

poor is invariably followed by the esteem and respect of Tthe rich, and thus it would be that, eventually, the labourof the truly benevolent and enlightened medical practi-tioner would be repaid, even in a worldly sense. ,

For such a plan to be carried into effect it is, evidently,indispensable that the parish medical officers should be

paid by the case. This system is, we believe, alreadyfollowed in some unions, and found to work well. It is

decidedly the most satisfactory that could be proposed,and we trust yet to see it universally adopted. It is the

only fair one both for the parish and the medical atten-dant, or attendants, and certainly deserves the support ofall who are interested in the welfare of the poor. In addi-

tion to its peculiar feature of fairness to both parties, tothe paying as well as to the paid, it would act as a

stimulus to exertion with medical practitioners. That

such would be the case will be at once admitted when we

reflect that if a salary is received, the less the number of

patients attended the greater is the advantage that

accrues to the medical functionary, whereas, if he is

paid by 11 the case," the more patients he sees the

larger is the income he derives from that source.

FIBROUS TUMOURS OF THE BREAST.

OuR readers will find in our foreign department of thisweek a careful analysis of a very important debate, onfibrous tumours of the breast, which has occupied theprincipal part of the last eight or ten sittings of theAcadémie de Medicine of Paris. To this debate we must’

draw attention, as bearing on a very important and verypractical subject, and, consequently, as deserving a care-ful perusal. The discussion having been protractedduring so lengthened a period, much has been said both.on the question discussed and on others more or less con-:nected with it, which we have not space to reproduce..We feel confident, however, that every important fact Q1’,

opinion which has been uttered, both with reference to,fibrous tumours of the breast, and to the operation for theremoval of cancerous formations, will be found em-

bodied in our analysis.Whatever may be the views entertained with regard,

to the correctness, or non-correctness, of the pathologi-cal assertions of M. CRUVEILHIER, lie is justly entitledto our thanks far having brought before the public, in,;

78

prominent manner, a question of such vital and every-day importance, as the differential diagnosis of malignantand non-malignant mammary tumours. We must alsobear in mind that the scientific position and reputationof M. CRUVEILHIER are such as to entitle his opinionsto a conscientious and searching scrutiny, such, indeed, Ias they have not yet met with from his own countrymen.

I

M. CRUVEILHEiR, whose name is well known to thoseconversant with French medical literature, is at present Iprofessor of pathological anatomy at the Faculty of Paris,and the esteemed author of the most popular and

scientific French works of the day, both on general and

pathological anatomy. As he very correctly remarks, inhis replies to the academical surgeons, who, one and allhave manifested determined opposition to his opinions, the

point of view from which he and they have studied thepathology of tumours of the breast is so different that hecannot accept the conclusions to which they have arrived.He appeals from their past to their future experience, andthus points out, in our opinion, the only true means of

solving the problem. The publicity given to the dis-

cussion in the Parisian academy has been so great, the

impression that it has created on the mind of the Frenchfaculty has been so deep, that there can be no doubt thatall tumours of the breast will henceforth be more

Carefully examined in the living subject than has

hitherto been the case ; that the symptoms presentedwill be more accurately analysed, and that surgeons

Igenerally will be more cautious than they have Ihitherto been in extirpating such tumours. There, ialso, can be no doubt that when an opportunity ’,offers, either through an operation, or through the demise, ifrom other causes, of persons having mammary tumours, Ithe anatomical character of the morbid growth will bemore accurately examined than heretofore, both with l

the scalpel and with the assistance of the microscope.We may thus hope, before a very long period has elapsed,to be in the possession of data which will either invalidate01r corroborate M. CpcvEiLHiER’s assertions ; and wetrust that English surgeons will contribute, by their expe-rience, to the elucidation of the question at issue.The existence of tumours of a fibrous nature in the

breast seems to be admitted by all the French sur-

geons ; it is their frequency, and the possibility of

correct diagnosis, which they deny. These, conse-

quently, are the points which future experience willhave to investigate. To the feminine portion of the

public, which is vividly alive to the fact of reallycancerous tumours generally returning after extirpa-tion, any decided improvement in the diagnosis of

tumours of the breast, will be a great boon. The life of

many a female is now, no doubt, unnecessarily embittered,1rbetber she does not or does submit to an operation ;in the one case through the fear of the possibly cancerouscharacter of a tumour, respecting the nature of which hermedical attendant evidently doubts ; and in the other,through the fear of a relapse, which she hears every oneeay is the rule and not the exception in such cases.

We, ourselves, believe that M. CRUVEILHIER is rightin his pathological views, and that the frequency of thesefibrous growths of the breast, the existence of which

cannot be denied, is much greater than is generally sup-posed. We, however, also think, that M. Cii.UVEIL,HIERhas much exaggerated the similarity of texture whichhe states to exist between these growths and fibrous

formations in other parts of the body. The identity ofcondensed cellular and fibrous tissues is so great that itis a mere dispute of words to say, as M. Bi.ANDTN did,that the mammas contain cellular tissue but no fibrous

tissue. In this respect it is that the principal differenceexists between fibrous growths of the uterus and those ofof the breast. In the uterus the fibrous element forms

lamellae, regular fibres, which are not seen in the mammae.In the latter region the fibrous tumours are composed ofclosely aggregated fibres, interwoven in an inextricablemaze, very similar to the tissue of the gland itself in theaged, when the granular or glandular structure has be-come atrophied. The chronic mammary tumour of Sir

ASTLEY COOPER is evidently the same disease as that

which M. CRUVEILHIER describes. The descriptiongiven by Sir AsTLEY is exactly the same as

that read before the Academy of Medicine by the Paris

physician. The diagnosis of these forms of morbid

growth is, no doubt, very difficult, especially if we con-

fine ourselves to the anatomical characters on which M.

CRUVEILHIER lays principal stress, the objective symp-toms, as German pathologists would say, viz., the globu-lar form, superficial position, the apparent want of con-nection with, or of adhesion to, the mammary gland, the

skin, or any other part. But Sir ASTLEY, with greatpropriety, insists on other important data; the youth ofthe patient, the soundness of the general health, thecomplete absence of pain, &c. By uniting all these datawe believe that, even in the present state of science, a

tolerably correct diagnosis may be made.The debate on fibrous tumours has likewise elicited a

full exposé of the opinions of the principal French sur-geons of the present day on the propriety of operating forcancer, a question to which the admirable clinical

lectures of Sir BENJAMIN BRODIE have lately drawnattention in our own country. The Paris surgeons

appear decidedly in favour of operating in nearly all

cases. M. Roux, the oldest of the hospital surgeons, and,certainly, of all of them the one who has performed themost operations of every kind, sometimes operates, hestates, two or three times on the same patient, in cases

of relapse, and, which is the most important point, hasdone so successfully in several instances. His experienceis certainly very valuable, as he is a really scientific

man, and not likely to commit those errors, with

regard to the anatomical characters of cancerous forma-

tion, which have been but too common in the history of

surgery. M. Roux was the pupil of a surgeon, theillustrious BOYER, who believed that cancer was an incur-able disease, that it always returned, and who, says M.

Roux, used to state, when it did not return, that the

79

diagnosis had been faulty, and that the morbid growthextirpated could not have been of a cancerous nature.The other surgeons who took part in the discussion,VELPEAU, BERARD, AMUSSAT, LISFRANC, &c., all seemed

to agree in admitting the curability of cancer by opera-tion in some cases, and therefore the propriety of operat-ing as a general rule. The contrast between the opinionsof the French surgeons and those manifested at the con-

gress of Lucca, of which we gave a brief sketch last

week, by the Italian surgeons, is certainly very great.

HOSPITAL REPORTS.GUY’S HOSPITAL.

CASES FURNISHED BY THE CLINICAL SOCIETYOF THE HOSPITAL.

Reported by H. A. OLDFIELD, Esq.

RUPTURED BLADDER. DEATH. EXAMINATION.

J. H., aged 42, an attorney’s clerk, married, andresiding in the Borough, was admitted into the accidentward under Mr. Key, Dec. 26, 1843, a waggon havingpassed over his body. He was of middle height, withdark eyes and hair, and a rather muscular frame. His

general health was said to be good, but his habits werevery intemperate. While much intoxicated he reeledinto the road, and, falling on his back, the wheel of alarge empty waggon passed over the lower part of hisabdomen ; his bladder being probably much distended atthe time as a consequence of his drunkenness. He was

immediately (at five, p.m.) brought into the hospital, notcomplaining of pain, but so violent and noisy from intoxi-cation that it was necessary to tie him down in his bed.There were no external marks of injury ; but on exami-nation the fifth and sixth ribs on the left side were foundto be fractured about their middle. On learning thenature of the accident, immediately on the patient’sadmission, a catheter was passed without any difficultyinto his bladder, and about an ounce and a half ofbloody urine was drawn off. As soon as he had becomequiet and tractable he was placed in a warm bed, hotbottles being applied to his feet, &c., as he complainedmuch of cold. It was discovered that he had no power topass his urine, although no stricture existed in the urethra,and the catheter met with no obstruction of any kind.The functions of all except the urinary viscera wereintact: the patient had had a cough for some years,which was habitually aggravated in the winter, butbesides this no circumstance of his previous historydeserves record.On the 27th, early, he was very restless and low, having

had no sleep during the previous night. At ten, a.m., hisextremities felt cold; he complained of great tendernessover the lower part of the abdomen, which was tense anddistended. He was much relieved by a catheter beingintroduced into the bladder, and about a pint and a half offluid drawn off, consisting more of uncoagulated bloodthan of urine, and as dark in colour as treacle. Hesuffers much from severe spasmodic pains in the chest,especially on the left side, and in the left shoulder.Ordered an enema of house-medicine immediately.

R Protochloride of mercury ; ;Powdered opium, of each a grain. Mix for a

dose, to be taken immediately, and repeated every threehours.At five o’clock in the afternoon of the same day he

was again suffering greatly from tension and tendernessin the abdomen, and another pint and a half of blood andurine; of the same character as that removed in themorning, was drawn off by a catheter. At ten, p.m., hewas in much pain owing to tension over the bladder; acatheter was introduced, but no urine followed, the bladderappearing to be distended with coagulated blood; pulsesmall, running, irregular, 140 ; extremities cold; skin

moistened with cold and clammy perspiration. He isperfectly sensible, but very low and depressed. Orderedtincture of opium, half a drachm, to be taken imme-diately.

28. Had been very restless and in great pain during thenight; had no sleep. At five, a.m., a catheter had beenpassed, but only about a tablespoonful of blood could bedrawn off. The tincture was also repeated. Is con-

stantly sick, and brings up everything as soon as swat-lowed. There is less tension in the abdomen; thetenderness also is less, but it seems more generallydiffused, and is now greatest in the left lumbar region ; ;pulse soft, small, and very feeble, but more regular, 112;tongue moist; skin moist, and rather cool; hands verycold ; feet kept warm by hot bottles. He feels very low.Considerable ecchymosis exhibited itself in the integu-ments over the whole of the left femoral region, but noneat all over the abdomen. At one, p.m., a catheter waspassed, and about half a pint of blood and urine drawnoff. Ordered-

R Soda water and brandy;Alum, fifteen grains;Mint julep. To be taken every three hours if the

vomiting continues.The patient remained in the condition last described for

several hours, gradually sinking. The pain increased inseverity, until it seemed to be beyond his endurance.Hot fomentations were applied to the abdomen, butwithout giving much relief. An elastic catheter wasmaintained in the bladder, but no fluid of any kind cameaway. The vomiting became nearly incessant, the trunkand extremities cold, and covered with a clammy sweat.During the last two hours the patient’s breathing wasmuch impeded by a sense of 11 stumness" and suffocationin the throat. The mouth filled with a fluid, whichfrothed copiously from his lips ; speech gradually failed,though he remained perfectly sensible to the last. Heexpired at ten, p.m., just fifty-three hours after theaccident.

Necropsy, Fifteen Hours after Deatfc.On opening the abdomen between three and four pints

of nearly pure, uncoagulated blood, were found effusedinto the cavity of the peritoneum. In the upper andposterior part of the bladder, which was firm and con-

tracted, there was a transverse rent extending also ,

through its peritoneal covering. Clots of blood pluggedthe mouths of the lacerated vessels, and there was tMextravasation of blood into the cellular tissue of thepelvis. A little ecchymosis appeared beneath the peri-toneum over the lumbar vertebrae on the left side. The

kidneys and ureters were sound; the liver unhurt, pale,and mottled. The bony structure of the pelvis was notin any way injured. As has been stated, the fifth and

, sixth left ribs were fractured; but the pleura was notlacerated, nor had the lungs sustained any injury.

UNIVERSITY COLLEGE HOSPITAL.CLINICAL PRIZE REPORTS.

By H. FEARNSIDE, M.B.

CASE I.-Hypertrophy and dilatation of both rentrieles 4ifthe heat ; dilatation of the auricles, and of the ascendi1a6portion of the aorta; deposit of calcareous matter beneath thelining membrane of the latter; disease of the valves; con-densation of the summits of both lungs, and presence ofcretaceous matter in them hepatisation of portion of thethe lower lobe of the right lung granular degeneration ofthe kidneys.

WILLIAM ROBB, 2etat. 33, admitted into UniversityCollege Hospital under Dr. Williams, April 22,1843. Heis a man of rather slight conformation, a native ofScotland, but has been a resident in London for severalyears; when in his native country he was in the habit ofdrinking freely, especially of spirituous liquors, but sincehis removal to England he has been more temperate ; hehas always had a sufficiency of wholesome food, and hisplace of abode has generally been in an open andhealthy situation. His father died of phthisis ; his motherof old age.

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