periodicals, so as to assist in passing a few hours profitably. Billiards, chess, draughts, and other games, contribute to the object of keeping the mind diverted. The picturesque environs serve for pedestrian exercise, in which all join daily who are able for the exertion. Once a week, there is an assembly in the concert-room, which continues for two hours, with play, music, and dancing. In the departments of both sexes, are baths constructed with the most recent improvements, to aid as powerful therapeutic means in the cure of insanity. The church annexed to the edifice is kept open for worship, at which such of the patients as are permitted by their mental condition attend and join in the singing.

There are three classes of boarders. The first pay about L.90 yearly; the second L.62; and the third L.45.-El Semanario Médico Espanol, 1854, p. 67.

DRS MOREL AND MENESTREL ON GOÎTRE AND CRETINISM.

Dr Morel, chief physician to the lunatic asylum of Maréville, looks upon cretenism as a degeneration of the species due to a special action, exerted by an intoxicating principle, or deleterious miasma, upon the cerebro-spinal system, either through the medium of the air respired, or through that of the substances taken into the economy, and which is especially found existing in connection with soils in which the magnesian limestone predominates, although it cannot be absolutely affirmed that it is never found in connection with other geological formations. He has just published some most elaborate and interesting papers on the subject of cretinism and goitre in the Annales Psycholo giques, and in the last one he prints a letter from Dr Menestrel, Mayor of Sérécourt, which contains some very interesting matters relative to the prophylaxis of these diseases in goîtrous localities. Sérécourt is a village, near the small town of Darney, in the department of Vosges, between Haute Saône and Haute-Marne. Dr Menestrel says, that although it has never seemed to him fully proved that the use of water, impregnated with the salts of lime and magnesia, and containing no traces of iodine and bromine, could alone induce goître; he has always felt quite convinced that the dolomitic salts exercised a special morbid action upon the thyroid gland, by causing hypertrophy of its structure. And he is of opinion that this deleterious action can be neutralised by means of the solvent properties of iodine, when the water used for drinking contains a small quantity of this metalloid. He also believes that continued atmospheric humidity, want of sufficient isolation, insalubrity of the dwelling-houses, and neglect of the laws of general public hygiène, are the causes which, in connection with the bad quality of the drinking waters, necescessarily give rise to goître, and render it endemic.

In Sérécourt there are 164 goîtrous persons out of 736 inhabitants, that is 22 per cent. Of these 143 are females, whose sedentary lives, in unhealthy dwelling-houses, predisposed them to the disease. Sérécourt contains only one principal street, running from east to west, so that one-half of the houses are exposed to the north, and the other half to the south. Of the 164 cases of goître in the village, 105 were in houses exposed to the north, and 59 only in those fronting the south; facts which are very significant.

Dr Menestrel has solicited the assistance of the state to enable him to carry out a series of experiments, on a large scale, on the whole members of the community, by making them use common salt, slightly impregnated with iodine; and he wishes to be authorized to place, in all the public wells, a small quantity of iodine, enclosed with a capsule of iron, constructed so as to allow of the water becoming slightly impregnated with that mineral. He anticipates immense benefit from these prophylactic measures.-Annales MedicoPsychologiques, Oct. 1854.

M. ARAN ON THE APPLICATION OF INTENSE COLD IN ECZEMA.

Victor Denis, a marble-cutter, was admitted into the Hopital Saint-Antoine, on the 2d June, having his upper and lower extremities covered with a painful

eczema. Huile de Cade; collodion, medicated with tannin, iron, and iodine; and soothing cataplasms; all were tried without benefit. There was a ennsiderable amount of inflammation, and an abundant discharge of matter. when M. Aran resolved to have recourse to refrigerating applications. Two parts of pounded ice were added to one of common salt, and the mixture was put into a bladder, or between folded linen. The limbs of the patient were surrounded with this freezing mixture, and allowed to remain in contact with it from 10 to 15 minutes. When the application was discontinued, the reddened surface of the skin was found to be completely blanched. The skin was tense, hard, and quite insensible. On the removal of the freezing mixture, in order to prevent excessive reaction, the leg was ordered to be covered with compresses soaked, at first, in very cold water, and thereafter in water of the ordinary temperature. In spite of this precaution, reaction took place in the brief space of 15 minutes, at the end of which time the skin had resumed its natural appearance; it thereafter became very hot, and was painfully itchy. These sensations, however, were of very short continuance; they soon passed away, and the limb became cooler, paler, and more comfortable than before the freezing application. No evil results of any kind followed. The congelation was repeated several times, at intervals of seven days, and the limbs were kept enveloped in bandages soaked with glycerine. By this treatment a complete cure was rapidly and satisfactorily established.

M. Aran has been in the habit of using refrigerating applications, with great success, for the treatment of various uterine affections; especially acute inflam mations of the uterine mucous membrane, granulations and erosions of the cervix, inflexions, etc.-Gazette des Hopitaux.

SULPHURIC ACID, VERSUS URINE.

Mr James E. Huxley has pointed out that in the wards of insane establishments which are wet and dirty, no scrubbing or scalding will effect more than a temporary improvement, as the floor becomes a reservoir for the perpetual exhalation of the volatile ammonia. But if dilute sulphuric acid be poured over such floors, in the proportion of one ounce of acid to twenty-four of water, and allowed to remain twenty-four hours, a white film (sulphate of ammonia) will form, which may be removed by washing, and will leave the room sweet. The principle is that of converting a volatile into a fixed salt that may easily be got rid of.-Asylum Journal.

M. LABE'S CASE OF SINGLE KIDNEY.

In an old man who died at the Bicêtre, M. Labé found the left kidney ab sent. There was neither a renal artery nor vein on the left side, and the bladder showed no trace of a left artery ever having existed. The right kidney. considerably hypertrophied, occupied its normal position; while its ureter was single, and showed no bifurcation.-Comptes Rendus de la Societé de Biologie: and Gaz. des Hôp. 7th November 1854.

SURGERY.

DISCUSSION ON THE CURABILITY OF CANCER, AND ITS DIAGNOSIS BY MEANS OF THE MICROSCOPE, AT THE FRENCH ACADEMY OF MEDICINE.

(Continued from page 555, vol. xix.)

Nov. 7, 1854.-M. VELPEAU.-At the commencement of this discussion advanced two propositions; 1st, That cancer was sometimes curable; and 26. That certain cases of cancer could be recognised without the aid of the microscope. To these questions I mean now to confine myself, seeing that the discussion has embraced too many topics for me to overtake; and I intend also to state by what observations and researches I was led to form the opinions I then expressed.

I have said that the "cell" is not the specific element of cancer, as these gentlemen thought; and that there are epithelial cancers which contain no cells. 1. Larrey must have spoken unthinkingly when he appealed to the unanimity of microscopists in this matter, for certain of them admit what others deny. Contrary to the opinion of Lebert and Broca, it is admitted by Mandl, Virchow, Bennett, Paget, and others, that there are epithelial cancers without cells. Microscopists are not all agreed, because cells do not exist in all cancers. There is some other thing in cancer of greater importance than the cell; and in the blood of patients having the cancerous cachexia there certainly exists something peculiar to the condition which we do not as yet know. The cell is one of the manifestations and material characteristics of cancer, but it is not the principle of the disease, or the malady itself. This cancer-cell has been found elsewhere than in cancers, and it existed in a non-cancerous portion of the vesical mucous membrane, lately exhibited to the Societé de Biologie. It appears to me not to be a sufficiently constant characteristic to enable us to distinguish the different varieties of tumours, and therefore, I have tried to diagnose them by other signs. I have examined a very large number of cancers, and admit the occasional, but by no means the constant existence of the so-called cancer-cells. It may be said that the cases where the cells were absent, were not true cancers; be it so, I am willing to set them aside as doubtful. But I have seen tumours containing cells which were not cancerous. It has been asked whether I consider them to have been benign on account of their non-recurrence, and it has been objected that I cannot base my opinion on this character, if I admit that cancer is sometimes curable, and consequently does not constantly recur, but it is not from the non-recurrence of the tumours alone that I judge, but from the tout ensemble of their physical characters and clinical signs.

I affirm, then, that cancer-cells have been demonstrated in non-cancerous growths, and that they are often absent in true cancers.

M. Malgaigne has suggested that in these cases of cancer without cells I have mistaken fibro-plastic for schirrous tumours. This I have taken special care to avoid doing, and when I speak of cases of schirrus they were undoubtedly true cases of it. It has been said that the cells were not found, because the whole tumour was not examined. I have never attempted to puzzle the microscopists, and I have always given them the entire tumours for examination. Cancerous tumours, like other pathological specimens, are not equally diseased throughout their whole extent; there is generally a central portion in them in which the disease is most marked; but if we have a section made through this part it is just as good as if we had the entire tumour. If cancercells are not found in such a section they are certain not to exist elsewhere, I have cited cases of tumours, which contained no cancer-cells at first, recurring afterwards, and exhibiting these cells in their structure. I have seen two or three such cases. In one of these a man had a cancerous tumour, a portion of which was removed and sent to M. Lebert for examination. Finding no cells in it, he pronounced it to be benign. M. Richet therefore operated on the patient; things went well at first, and the cicatrix looked healthy; but ere long the tumour returned and killed the patient. The second tumour contained cancer-cells. Again, a woman had a mass of vegetations on the left breast which resembled neither encephaloma, schirrus, nor fungus. I removed one of these vegetations and found that it contained no cancer-cells; but I was not therefore convinced that it was not a cancer. The woman returned after some time, having the right breast affected with all the most marked characters of cancer-partial indurations, and retraction of the nipple. She soon died of the affection. M. Robin found cancer-cells in the tumour of the right breast, and also numerous nodules, in the lungs and liver, containing cancer-cells. Can we say that in this case the tumour of the right side was a cancer, while that of the left was non-malignant? Certainly not. Moreover, the cells were found on the side on which the tumour was least degenerated. M. Leblanc has at

tempted to explain these differences by admitting the existence of mixed tumours;" and he believes that cancer may become developed in a tumour net primarily malignant. Microscopists, however, deny the transformations of tumours. I myself am doubtful as to whether benign tumours may degenerate, and I would not be understood either to affirm or to deny it; for facts have led me to believe that such a change may be quite possible.

It appears to me, then, 1st, that there are cells without cancer, and 2d, that there are cancers without cells; and if these facts be once admitted they go very far to negative the assertions of the microscopists. A new definition of cer" is asked, but the remodelling of definitions is a barren and unprofitable work. It is far easier to attack an old definition than to make a new one, even when it relates to something we understand very well. For example, 1 should be puzzled to define M. Robert with exactitude, yet I can quite well re cognise him. I would characterise cancer as a malady, which may appear as an excresence, a tumour, an ulcer, or a fungosity; the specific nature of which is, when once established, to spread, to invade diseased tissues, and, finally, to cause death.

Let us look now at the tumours which the microscopists refuse to admit as cancers. They deny that epithelial tumours are cancerous, because their tissues are homeomorphous, and such a structure, they say, cannot be malignant. They allege that these tumours do not recur, or if they do, that they affect only the original spot, but that they do not affect the lymphatics, or become generalised. Every-day experience, however, shows that these tumours may recur, not only on the original site, but also in the glands; and that their recurrence, far from being exceptional, is very frequent. Hence M. Lebert and other microscopists have considerably modified their first opinion. Yet they affirm that epithelial tumours never, like cancer, become generalised. Now, M. Robert himself has adduced instances of their generalisation; and others are recorded by Paget, Virchow, and Rokitansky, in which they become developed in the heart, lungs, and liver. Yet this, say they, happens very rarely. I do not know; but whether it occurs often or seldom does not a alter the question. We remove a small tumour of this sort from the lip; at the end of two, three, six, or twelve months, we find that it returns; again we excise it, and again it recurs. Finally, we dare not touch it; and it kills the patient as surely as cancer. Wherein lies the difference between them?

Again as to fibro-plastic tumours. To constitute them a distinct group from cancers, the microscopists have been obliged to class with them many tumours to which they have no analogy. How can fibro-plastic tumours, which prove fatal to the patients, be confounded with simple glandular hypertrophies and in what respects do they resemble each other? Although the anatomical structure of both may be similar, there doubtless exists in them some unknown element which constitutes their essential difference. M. Lebert has said that these tumours like the epithelial, do not recur, or if they do, that it is only locally; but I have shown that gentleman many instances of their reproduction in the viscera. M. Robert has cited cases to prove the non-recurrence of fibro-plastic tumours, but-so great is the blindness which an adherence to a preconceived idea occasions-all these cases occurred before the use of the microscope. For thirty years I have constantly applied the great law of Bichat-cited by M. Robert-to every thing in pathological anatomy. But. in pathology, anatomy, though very necessary, is not all-important; for we must also take into consideration the oftentimes obscure nature and causes of disease. There exists in cancer something special, something not anatomical, which has hitherto escaped all the investigation of our senses, and of which the microscedists have taken no note.

Here, then, is my basis for the distinction of tumours. Cancerous tumours að possess one character in common:-they have all a tendency to destroy the tissu 5 by becoming generalised. All that can be said against this proposition lack demonstration, and proves nothing.

I turn now to the question of its curability: and the first difficulty that presents itself is diagnosis. And first of all I would remark that it has been said that I lay pretensions to infallibility of diagnosis, and that I boast I am never deceived. God knows that I lay claim to no such lofty pretensions. I have merely said that there are certain tumours, whose clinical characters are so well marked, that it is impossible for any one to be deceived. I have taken notes for the past year of 120 cases of tumours; 66 of which were cancers. Among these 65 cases I have removed 49 cancerous mammæ ; in every case the extirpated tumours were examined by the microscope, and in every instance the microscope confirmed the diagnosis I had made before the operation. Let me add, however, that I have never alleged that a correct diagnosis can always be made. When I say that in certain cases I cannot be deceived, I allude to those in which the characters are so well marked that any surgeon could recognise them.

I come now to the important point :-Why may not cancer be curable? When I advanced facts supporting the curability of cancer, it was said that they were inconclusive, because they were anterior to the use of the microscope. But when, in the 49 cases I have mentioned, which were microscopically examined, my diagnosis was in no instance wrong, how can it be said that I was deceived before the introduction of the instrument? As regards my statistics it has been said that 20 cures in 50 cases is too good to be true; but I have not alleged that I cured 20 out of 50 patients, but out of 200, one half of whom died. (Here M. Velpeau cited several cases of persons who were cured of cancer-that is to say, who never had any recurrence of the disease for a greater or less number of years after the extirpation of a cancer-cases which were almost all witnessed and examined by the microscopists). These facts, said he, are authentic; and the curability of cancer cannot be denied. M. Robert has alluded to the case of a lady operated on in 1850; but he has not observed that in detailing this case I made reservations in respect to it.

As to relapses occurring long after the operation, as after ten, fifteen, or twenty years, may we not inquire whether or not it is possible that cancer, like other diseases, may become twice manifested in the same individual, without this being looked upon as a recurrence? I am always asked why we are unwilling that cancer should be curable?—and what interest microscopists have in maintaining that it is so? I have never been able to understand it. Statistics and the authority of highly respectable names-as Munro, Boyer, etc., -have been cited in support of the incurability of cancer. But the statistics of Munro and Boyer are of great value; those of Hill and Flajani do not militate against mine; and as to the recent ones of MM. Lebert and Broca they do not appear to me a whit more conclusive, as many of the patients enumerated in them were entirely lost sight of.

What we seek here is truth; but we should not make the obtaining of it depend upon a mere theoretical opinion; since theory alone has given rise to the unbelief in the curability of cancer, which I so much deplore. As to the microscope, I maintain that it has done good service to science; I believe that it will render still more; but I am confident that it has also committed several errors. I accept all the new facts which it has revealed to us; and I only contest the false or doubtful explanations which have been given to them. And as regards the question at present under debate, I think that its resolution should be made with great caution and reserve, inasmuch as there probably exists some special element with which we are not yet acquainted. I have ever encouraged, and I will continue to encourage fresh researches; but I will only accept as true what I find to be satisfactorily demonstrated. I hail the march of progress with unmixed delight, so long as the car of science is propelled, but is not overturned.

Nov. 14, 1854.-The secretary read the following letter, addressed by M. MANDL, to the president.

NEW SERIES.-NO. 1. JANUARY 1855.

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