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Ulcerated Cancer of the Breast; Removal of the Pain byDR. JAMES ARNOTT’S Freezing Process.

(Under the charge of Mr. SHAW.)

Our attention was attracted, a short time ago, towards apatient in the cancer ward, who suffers from an ulceratedcarcinoma of the breast. This poor woman is far advanced inage, but the breast was attacked only one year ago. Thedisease has, however, made such rapid progress, that thescirrhous tumour is now deeply ulcerated, and at times ex-tremely painful. It appears that Dr. James Arnott’s plan ofproducing insensibility, by freezing the part with a mixture ofice and common salt, was tried in this case, in order to allaythe agonizing pain which the poor woman was suffering. Thistrial was attended with very satisfactory results, and thepatient was so much relieved by the proceeding, that she soonafterwards requested to have the ice applied again, and sheexpresses herself as very grateful for the temporary removalof the severe pain she experiences.Dr. Tyler Smith likewise succeeded, some time ago, at St.

Mary’s Hospital, in relieving excruciating pain by the freezingmixture, in a case of cancer of the uterus. It is plain, however,that the apparatus must be somewhat more complicated whenthe disease has attacked that organ. The fact that the painaccompanying carcinoma of the womb was thus allayed, shouldcertainly not be lost sight of.Most of our readers probably know, that Dr. James Arnott

advises equal quantities of ice and common salt to be mixedtogether, (the former being well pounded,) and then placedinto a gauze bag, the margins of which are attached to agutta-percha ring. By gently touching the part to be renderedinsensible, with the bottom of the bag, for a minute or two,the surface becomes suddenly frozen, insensibility follows, andthe pain of course disappears. To obviate the tingling sensa-tion which is apt to ensue upon the return of sensibility, icewithout salt is to be used, and thus no uneasiness whatever isexperienced. We have seen portions of the human framethus frozen, and always noticed that the insensibility becamevery great.Dr. Arnott has proposed that his process should, in certain

operations, take the place of chloroform; but it is plain thatthe insensibility can hardly be carried deep enough forthe generality of operative purposes. Where, however, a thinstratum only is to be implicated, it might certainly be usedwith advantage. To relieve the pain of cancer, it seems, fromthe preceding case, and others which have been recorded, todeserve attention at the hands of those who have to prescribethe palliatives which are so indispensable in that melancholyaffection.

Reviews and Notices of Books.

On Injuries Qfthe Head afecting the Brain. By G. J. GUTHRIEF.R.S. London: pp. 155. Churchill and Renshaw.

THE work before us is by the author of some of the besttreatises on the more important subdivisions of surgery, andis written in clear and impressive language, while the informa-tion on the subjects of which it treats is of much value and ofgreat practical import, as " injuries of the head affecting thebrain are difficult of distinction, doubtful in their character,treacherous in their course, and for the most part fatal intheir results :’ Mr. Guthrie has not, while inculcating theprecepts which his long experience has taught him, neglectedthe literature of the subject; and the attention paid byhim to this portion of the work has certainly increased bothits interest and worth. Everything in any way bearing uponthe object of the book to be found in the writings of medicalmen, from the times of Hippocrates and Celsus down to thepresent day, is reproduced with much care. In this respectthe work may fairly be said to be exhaustive; and although itis not a large one, still nothing of moment is passed over;and we feel convinced that there are but few members ofthe profession who will not derive from its perusal bothpleasure and profit.The author, after observing that wounds of the brain are

more fatal on the fore part than on the side or middle of the

head, " and much less so on the back part than on the side,"divides the injuries to which the head is liable into two classes-namely, " one denominated injuries from concussion, theother injuries from compression or irritation of the brain." The

very apt and expressive definition of the term concussion, inuse in our sister country, is adopted where, when a man hasbeen suddenly killed by a fall on the head, he is said to havehad his life shook out of him." The case detailed by Littre,and which is very generally supposed to prove that the braindoes not fill the cavity of the cranium so closely as usual afterthe accident of concussion, is given in extenso; but the authoragrees with Chopart in thinking it has been much exaggerated.We here extract some of Mr. Guthrie’s leading inductions inrelation to the important subjects of concussion and com-pression :ņ"In the more dangerous cases, which ultimately prove

fatal, a laceration of the brain, which is often observed to takeplace, complicates the mischief as well as the symptoms, andis, perhaps, the actual cause of death."

Allusion is also made to "a peculiar whiff or puff from theeorner of the mouth, as if the patient were smoking, andwhich, when observed among other urgent symptoms, is

usually followed by death. This sign is considered to be

pathognomonic of large extravasation: "

" The surgeon will then practically be right in consideringthe stertor or whiff in breathing to be accompanied by, if notdirectly dependent on extravasation or lesion; the heavy orlaboured breathing to be dependent generally on a derange-ment of function, which is not perceptible on examination."

In his remarks on compression of the brain, mention ismade of the injuries which French writers have termed

"plaies de téte par contre-coup;" but Mr. Guthrie is of opinionthat the majority of such cases which have been publishedare examples in which " matter formed in or on the brain,"the result of ineffective treatment. On this supposition, thedeath of Henry the Second of France is explained., "The vomiting which is apt to occur when partial recoveryfrom concussion is fairly established, was formerly," saysthe author, " supposed to be peculiar to cases of concussion,but it is often present in cases evidently of compression orirritation from external violence;" in proof of which a case isquoted from Le grand Petit, who relates that a man whosuffered from continued vomiting for seven hours, when hedied, an enormous quantity of blood was found in the ventrieles-of the brain."When discussing the nature of the treatment proper to be-

followed in cases of concussion, Mr. Guthrie most justly laysdown the rule, that it is useless to open the veins of the patient," for they cannot bleed until he begins to recover, and then theloss of blood would probably kill him. It is as improper to-put strong drinks into his mouth, for he cannot swallow; andif he should be so far recovered as to make the attempt, theymight possibly enter the larynx, and destroy him. Mildstimulants and disagreeable smelling substances, together withpartial as well as general friction, with the warm hands, arethe best means to be adopted, and should be continued until,it be ascertained that life is extinct." "

Again, after reminding his readers, that in all cases of injuryof the head, it is necessary to watch the condition of the

bladder, the author maintains that the simpler the treatmentduring the period of incipient reaction, the better is the

prospect of the patient’s ultimate recovery. But when the

stage of depression is passing into that of excitement, Mr.Guthrie does not look upon the loss of six, or even ten ounoesof blood, as likely to do harm, but he says it may do good.The following observations on the treatment of fracture at

the inferior angle of the parietal bone, are excellent;-

"The artery (middle meningeal) is always in a groove, and’is often imbedded in the bone at its lower part, and may betorn at the moment of fracture. A gradual extravasation ofbiggd on the surface of the brain can be borne to a considers

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able extent, without causing any particular symptoms; a

sudden effusion causes immediate insensibility. When theextravasation is gradual, the patient walks away after theaccident, converses freely, becomes more slowly oppressed,and in the end insensible, as the last drops of blood which areeffused render the compression effective. When these symp-toms occur after a wound in this particular part, attended byfracture, the bone should be immediately examined; and ifthere should be no obvious fracture, and relief cannot beobtained by the abstraction of blood, the trephine must beresorted to as a last resuurce; for if there be truth in thestatement so confidently made of fracture of the inner tableof the bone from concussion of the outer, without fracture, itis here especially that we may be permitted to look for it."

It has been said that medicine is the study of opinions, butthe author, most properly, we think, considers it to consist inthe study of facts. While, therefore, the opinions and prac-tice of nearly every surgeon of note are carefully given, Mr.Guthrie, on the other hand, has not omitted to lay before hisreaders the histories of the cases which have occurred in his iown practice. And who, of all our surgeons now living, has i

enjoyed equal opportunities of making himself conversantwith the facts and phenomena observed in injuries of thehead affecting the brain, with the man who, even in his veryboyhood, was engaged in the practice of his art, and that, too,under the most trying circumstances ? The student of medi-cine will do well to master the contents of this volume.Unlike many of the productions of the day, it is written frompractice, and not with the view of obtaining that which, in aprofession like that of medicine, must be the fruits of pro-longed investigations into the phenomena, and of earnest andclose struggles with the powers, of disease. ,

But we must not conclude our review of this excellent

work, without quoting from it a few sentences, which we feelit our imperative duty once more to recommend to the atten-tion and consideration of the executive government of thiscountry. Mr. Guthrie, in deservedly eulogizing the conductof the medical officers who served with him in our last warwith France, writes :-

" I regret to add, that the treatment many of these gentle-men have since met with, is highly discreditable to the country.If I were to permit myself to say more, I should, in statingonly the truth, excite many painful and perhaps angry feel-ings. I will therefore refrain, with the hope that the strongsense of right and wrong possessed by the officer who at

present holds the military purse-strings of the country, willinduce him to relieve the medical officers of the army fromthe degrading state of humiliation to which they have beenreduced by his predecessors, and to give to science and tolearning that support and protection which ought always tcbe characteristic of a great and civilized country like GreatBritain."

Medical Societies.

ROYAL MEDICAL AND CHIRURGICAL SOCIETYTUESDAY, MARCH 9, 1852.—MR. HODGSON, PRESIDENT.

THE library was crowded this evening, unusual interesthaving been excited by the announcement that Dr. Gregory’spaper was to be read.A vote of thanks having been passed to Dr. Seth Thompson,

the retiring secretary,The PRESIDENT announced, that by an alteration made in the

laws at the late anniversary meeting, all the candidates forelection proposed after the lst of March would be ballottedfor at the first meeting of the Society in November. All pro-posed before the 1st of March would be ballotted for and ad-mitted as usual.

A paper was read, entitled-

VACCINATION TESTED BY THE EXPERIENCE OF 1IALF-A-CE1TURY.By Dr. GEORGE GREGORY.

The author commenced by observing that variolous inocula-tion was first heard of at Constantinople, in 1700, but was notpractised in England till 1721, and did not become general

till 1750. In 1746 the Small-Pox and Inoculation Hospitalwas established; and from this period variolous inoculationmade favourable progress in the good opinion of the publicthroughout England. In France, however, during the sameperiod, it was met with neglect, notwithstanding the efforts ofDe La Condamine to convince his countrymen of the meritsof inoculation; and prejudice extended so far, that the parlia-ment of Paris, in 1763, prohibited the practice of variolousinoculation within the walls of that metropolis. The authorthen proceeded to notice the twofold object with whichinoculation was perforined-first, to banish from the mind allanxiety as to the taking of small-pox in after-life, by giving itat once; and secondly, to ensure a mild form of the disease,free at least from secondary fever. Inoculation was eminentlysuccessful in fulfilling and attaining these objects. Neverthe-less it undoubtedly had its disadvantages: it was essential topractise it in early life, before the infantine constitutioncould be known; and it thus often lighted up the dormantembers of scrofula. In 1798 the practice of variolous inocu-lation had been tested by the experience of half-a-century.In this year Jenner published his first treatise on Vaccine

: Inoculation, the advantages of which were at once confidently proclaimed; and in the following year seventy-three of themost eminent physicians and surgeons of the metropolis hadsigned a document, purporting " that persons who have hadthe cow-pox are perfectly secure from the future infection ofthe small-pox." The first claims of Jenner in favour ofI vaccination were singularly modest; but in 1802, he announcedto the House of Commons-first, " that vaccination is attendedwith the singularly beneficial effect of rendering, throughlife, the person so inoculated, perfectly secure from the infec-tion of small-pox;" and secondly, "that vaccination hadalready checked the progress of the small-pox, and, from itsnature, must finally annihilate that dreadful disorder." Thequantity of small-pox that still prevails, and the practice ofre-vaccination almost universal, lead to the conclusion, thatthese broadly urged claims in favour of vaccination, have notbeen substantiated. Fifty years have passed since Jennerpetitioned parliament; and the author proposed by the expe-rience of this half-century, to test the merits of vaccination.But first, what is understood by vaccination? Somethingprophylactic of small-pox; or something identical with small-pox ? Cow-pox is a disease sui generis, and it cannot be saidthat he who has undergone vaccination has had small-pox ina mild form. A certain relationship exists betwen the two;but though variola by passing through the cow becomes cow-pox, yet cow-pox has never, in its turn, been converted intosmall-pox. Cow-pox and small-pox are, at all times, and inall countries, clearly and readily distinguishable. The objectof inoculation was to give the disease of small-pox, not to pre-vent it. The object of vaccination is to prevent, not to give,small-pox. Recurring small-pox, and small-pox after vac-cination, are not merely different from each other, butactually opposed to each other. " If a person inoculatedin childhood contracts small-pox in adult life, he sufferssmall-pox a second time, but a person taking small-pox aftervaccination, takes the disease for the first time." Theenemies of inoculation, as well as the supporters of vaccina-tion. had severallv taken their stand on recurrent or secon-dary small-pox. De La Condamine declared that not oneperson in 10,000 ever took small-pox a second time. The fateof Louis XV. was alluded to, and it was shown that the king’sdisease in early life (1724) was not small-pox, but a sharpyet brief attack of fever: that living in the constant dread ofsmall-pox, his distrust of inoculation was fearfully chastisedby his death under a most aggravated attack of confluentsmall-pox. The author then noticed the extreme rarity ofrecurrent small-pox. The Transactions of the Society, ex-tending through a period of forty-seven years, contained only onesolitary case of recurrent small-pox. In many cases of so-calledsecondary small-pox, the evidence of antecedent variola couldnot be relied on,as a case narrated in the Edinburgh Medical and<S’M)*g’M6t/bM7’Ke,Oct. 1818, clearly established. Many of the caseswhich the author had inquired into, were equally undeservingof credit. To arrive at a trustworthy conclusion, the details ofboth attacks should be carefully given. Very few medical menhave in such cases witnessed both the primary and secondaryseizure, and the author emphatically expresses himself asthoroughly convinced that the recurrence of small-pox is amongthe most rare events in the annals of medicine. The authorthen contrasted the occurrence of small-pox after vaccination.The records of the Small-Pox Hospital throw much light onthis subject. The following is a summary of the statisticaldetails appended to the paper:-During the last eleven years,4092 persons have been admitted into the hospital, having