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M. Mandl's Letter. “ Mr President.-M. Velpeau in his last address, has done me the honour to class me among the microscopists who do not admit the existence of characteristic cancer-cells. I beg to say a few words to the Academy on my reasons for so thinking:
“ Shortly after Müller, in 1839, discovered cells in cancerous tumours, I poblished my observations in the Archives de Medicine. But in 1843, I owned that the sanguine hopes which I had at first formed of the advantages to arise from the employment of the microscope in the examination of such pathological specimens, had not been realized; and my researches since then have confirmed this opinion. I had soon abundant opportunities of examining tumours which had appeared to clinical observers to be cancerous, from their origin, progress, and fatal termination, but which contained none of the cells considered by Lebert to be characteristic of the malady, I can remember cases of epithelial and fibro-plastic tumours, but I would more particularly direct attention to cancers of the retina. In four out of five tumours of this last kind, extirpated by Sichel and Bérard, it was impossible to discover any specific cell ; and yet subsequent general infection left no doubt as to their malignant character.
" On the other hand, in the cells found in cancerous tumours, I have not observed the characters which they are said to present in the majority of cases. According to M. Lebert, the nucleus of the cancer-cell has always a mean diameter of, from the tooth to the both of a millimetre. (On Cancer, p. 30). Yet in encephaloid tumours, I have found the nuclei not above the lo other the too of a millemêtre ; and in such cases it is impossible to distinguish theni from the other nuclei of normal tissues. Again, as to nucleoli, I have often found their characters very imperfectly marked. In M. Lebert's work we find examples of these inferior dimensions in cancers of the bones, the stomach, etc. As good, and even better observers than M. Lebert, believe that it is necesa sary to take into consideration all the elements, and also to know the history of the disease before pronouncing a judgment upon its nature. Does not the show that the cell is not sufficiently characteristic of cancer ?
“ The truth of this is proved, not only by observation, but also by the lays governing histogenesis. It seems to me that, in order to solve the problem which we are at present studying, it is indispensibly necessary that we engage in the comparative study of normal histology, and especially in the study of the development of the tissues, Space precludes me from entering into any detailed explanation of development, as so far as it regards this subject; but I shall briefly state the principal results of my researches.
“ All the tissues of the organism form two grand series; the one composed of cells and scales (ou lamelles), the other of fibres: and this essential distinction characterizes the different elements from their very first appearance. Nuciel placed in a soft amorphous substance, became surrounded, in the first instance, by membranes; they increase in size, multiply, and constitute the cells, of which the glandular, epithelial, and other tissues are composed. In the second class on the other hand, the nuclei are placed in an amorphous, homogeneous, soli substance which splits, and goes on subdividing into more and more delicate fibres, so as eventually to constitute a fibrillated tissue. There is no cell-formation in all this series of organic elements, among which may be classed the fibrous, cellular, and serous tissues, etc.
“ This principle of development and of texture, inherent in each series of the tissues, is rigorously maintained in all their various physiological and pathologie cal phases. In the normal renovation which accompanies secretion, growth, el as well as in anomalous renovation or in regeneration, we always observe cells are developed in those places where cells originally existed, and t fibres are developed in the other tissues. Although hypertrophy may occ the same principle continues to preside over the production of the new ments ; fibres do not produce cells, nor cells fibres, but cells are always us veloped in the midst of cells, and fibres in the midst of fibres.
“ Facts have proved to me that these principles hold good in the case of cancer. The cancerous diathesis may affect the blastema, which ought to produce either cells in the glands, scales in the epithelial, or fibres in the fibrous tissues ; and according to the nature of the tissue infected by the diathesis, the morbid blastema will produce either cells or fibres. The product will then be characterized according to the species of the affected blastema ; and we will have either cancer (cancer à cellules), fibro-plastic tumours (cancer à fibres), or cancroid growths (cancer à lamelles). But if it be permitted to us in most, though not in all cases, to recognise the alteration produced by the diathesis in the cells—that is to say, if we are allowed to recognise the cancerous cells, and to distinguish them from other analogous elements—why may we not also take into account fibres and scales as elements of cancerous tumours ? So long as we are unaware in what respect fibres and scales are altered when they are produced under the influence of the cancerous diathesis, so long will the microscope continue to give imperfect information to the surgeon in the diagnosis of tumours.
“ As to the frequency and gravity of recurrences, all histologists know that there is no element which is increased, developed, multiplied and regenerated, with so much facility and rapidity as the cell. Fibres are much more tardy in the stages of their developinent. Now, in which of the varieties of cancer are the recurrences the most frequent and the most serious ? Which species extends most rapidly, invades neighbouring organs most speedily, and destroys most energetically the whole economy ? Undoubtedly it is the cancer with cells (cancer à cellules). The conditions are completely changed when the cancerous diathesis affect a blastema which ought to produce fibres ; and when we see it form incompletely developed fibres, we call it the fibro-plastic element. Fibres, in general, are developed very slowly. I have seen a regenerated tendon presenting incomplete fibres at the end of seven years—that is to say, there was a blastema in which fibrillar division had not been completed. Thus the microscope is capable of informing the practitioner of the severity of the affection, and it also enables him to pronounce a proper prognosis as to its course, and as to the greater or less probability of its recurrence, inasmuch as it acquaints him exactly with the nature of the elements which constitute the tumour.
“I believe, then, that cancer, capable of occasioning general infection, can exist without the cancerous cell—that heteromorphous element which has been considered to be a peculiar and specific product of the diathesis-being present. This belief of mine has been long ago expressed by M. Velpeau, as well as by Bennett, Paget, Virchow, Vogel, and others.
“ The cancerous diathesis may affect cells, scales (lamelles), and fibres, and accordingly there are as many different varieties, yet microscopical anatomy agrees with clinical observation in classing them together as one family.”
M. AMUSSAT felt confident that he had cured many very serious cases of cancer, which otherwise must have terminated in a painful and horrible death. The influence of grief appeared to him to be, speaking generally, the most frequent cause of cancer in persons of otherwise good constitution; hence he was led to believe that the seat of cancer lay in the nervous system. He trusted that this discussion on the microscopical characters of cancer would elicit fresh researches, which might elucidate the nature of the disease, and lay the foundation for a rational, efficacious treatment of it. He thought the question of the greatest moment in relation to cancer was, whether or not there existed any hereditary taint. If this was present, the most prompt and energetic measures were necessary. When it was resolved to operate, either by means of the knife or caustic, we should freely destroy the surrounding tissues, as the timidity of the operator often occasioned recurrences. When caustics are pre
ferred to the knife, only the strongest should be used. : M. CLOQUET. Cancer was like inflammation - there were many very
different varieties of it, yet all its various forms possessed certain common
characters: they never healed spontaneously ; they were very prone to recur, and, unless extirpated, they infallibly occasioned death. He considered that the microscopists had not formed a separate school of their own—they belonged to the anatomico-pathological school, and, being possessed of more powerful means of investigation, they had arrived at most important results. To ensure our obtaining still more certain and important results, it was necessary that all medical men should unite in strengthening the hands of the microscopists, and in placing within their reach everything which they considered likely to advance the interests of science.
M. DELAFOND proposed to examine the question of cancer in relation to comparative pathology, to surgery, and to micrography.
It had been alleged by M. Leblanc that herbivorous animals were less affected by cancer than carnivorous; but this proposition was too wide; and he believed that the herbivora were equally subject to its ravages. It was by no means rare to find cancer affecting the teats of mares and the testicles of horses, and it often occurred in the viscera of these animals. Asses and mules were very subject to it. Cancer was common among oxen especially affecting the jaw, Pigs were very liable to cancer of the teats, and dogs were often affected by this disease. It also occurred among gallinaceous fowls, and many varieties of birds. Therefore it did not appear that animals deriving their sustenance from the vegetable were less disposed to cancer than those whose nourishment was drawn from the animal kingdom.
He had found, from microscopical investigations, that fibro-plastic tissue re curred like cancer. He did not consider the cell characteristic of cancer. The cancer-cell varied in its appearance according to the stage of the malady. At first, the cells found in a small tumour, not compressed by the surrounding tissues, were of a rounded form, having a nuclei and nucleoli in their centres. Compression subsequently rendered them elongated and ovoid ; subsequently they became still more elongated; and in schirrus cancers compression deformed them still further. In old cancers they become infiltrated with calcareous matters; their nuclei become flattened, and the cells become thin, like fibro-plastic tissue. Secondary cells also become developed within the parent cells, both being enclosed within a common membrane. In encephaloma, where there existed abundance of liquids and fatty matters, the cells were rounded or ovular.
He had read that a German pathologist had been able to produce cancer by injecting the juice of a cancerous tumour into the veins of a healthy dog. He had several times tried this, but had never been able to obtain any such successful results, although he had injected cancerous juice containing abundance of cells into the veins, and had put it into the trachea, and had also inserted it beneath the integuments of animals. The characteristic element of cancer was not the cell, but the juice in which it floated. Inoculation with the pus of glanders produced glanders; that of the varioloid disease of sheep gave rise to the same disease ; and the saliva of the hydrophobic dog occasioned canine rabies ; yet the pus and the saliva in these diseases presented no special cher acters when microscopically examined. Thus there existed different properties with identical appearances.
As regarded the dimensions of the cells, he considered that the cells of fibro plastic tissue were the smallest ; those of encephaloma the largest ; whilst those of schirrus were of a medium size, between that of the other two. The appearance of the nuclei and nucleoli varied very much, according to the variety of cancer examined ;- they were very small in fibro-plastic growths These facts accorded well with clinical results ; for it was known that ence phaloid tumours grew more rapidly, spread more certainly, and produced general infection more speedily, than any other variety of cancer,
He described the effects of various reagents on the cancer-cell, and showed the importance of acetic acid in rendering more distinct the nucleus and nu. cleolus.
He eloquently defended the use of the microscope, and maintained that it had great claims to the attention of all practical men, because if by means of it they perceived the cells which ordinarily accompanied cancer, their diagnosis became more certain, and they knew that they had to deal with either fibroplastic, schirrous, or encephaloid tissue.
As regarded the treatment of cancer, he recommended early extirpation. He had found that, after the removal of a cancer, there were a great many of the-he would not say characteristic, but habitual cells of cancer, disseminated through all the normal tissues near the spot affected, and also through those which were at some distance from it. Hence, in excising cancers, we ought to cut away a considerable portion of the surrounding tissues, even though they appeared healthy and unchanged, and that we ought even to cauterise them afterwards. By microscopically examining the discharges from wounds left by operations for the excision of cancer, he had ascertained that, so long as the pus contained cancer-cells mixed with the pus cells, that cicatrization did not take place ; and that, simultaneously with the disappearance of the cancercells, the process of reunion commenced. He was therefore of opinion that, after removing a cancer, we should allow the wound to suppurate for a certain time, in order to allow the cancer-cells to be eliminated by this channel.
[This discussion continues to drag its slow length along. That the elder practitioners would be forced some day seriously to consider the labours of histologists was to be expected, but it was scarcely anticipated that they would have spoken at such length about what they avowedly do not understand. The important problems connected with the pathology of cancer, are no more likely to be solved by words and long speeches, than they were capable of being crushed by sneers and ridicule. The facts of M. Velpeau, however, are to the histologist of extreme value; and the observations of M. Delafond on the lower animals, are useful. M. Mandl is the only one who has brought forward a new idea, during the whole discussion.]
MIDWIFERY. MAUER ON THE EFFECT OF LABOUR PAINS ON THE PULSE. This author made a series of interesting observations on 100 women, in Professor Martin's Clinique, in order to verify Professor Hohl's statements concerning the increased frequency of the pulse, occasioned by the contractions of the parturient uterus. In these researches he was assisted by a friend ; and one of the observers devoted his attention to the radial pulse, while the other studied that existing in the uterus. To feel the contractions, and judge of their force, one finger of the observer was inserted into the cervix, while the other was placed upon the abdomen.
Mauer's researches have convinced him that, at each pain, the pulse is first accelerated, and then diminished in frequency ; that it speedily thereafter becomes normal, and remains so until the next uterine contraction. Its increase of frequency varies at different periods of the labour; and Mauer found that, in the first four of the five stages into which Naegele divides labour, the acceleration went on progressively increasing, but that it was sensibly diminished in the last or fifth stage. The time during which the pulse remains increased varies according to the intensity of the pain ; and the frequency of the pulse during the intervals between the pains becomes increased as the labour advances. The length of the interval between the pains is in inverse ratio to the time during which the rhythm of the pulse is altered. It has already been observed that the length of the intervals diminishes gradually as the labour proceeds.-(Hohl, Explor. Obstet. Halle, 1833, p. 36.)
When the pains are feeble or convulsive, these phenomena are not observed to occur with regularity. The cries, etc., of the patient have a great influence over the number of the arterial pulsations. Excitants—as ipecacuanha, sinapisms, and heat-increase the pulse, but only during the intervals, not during the pains. Ergot, however, accelerates the pulse, even during the pains. Although, under the influence of chloroform, the heart's action becomes somewhat slackened, the pulse remains as frequent during the uterine contractions as during the intervals between the pains. The more regularly the acceleration of the pulse, and its subsequent return to its normal rhythm, take place, the more perfect and efficient are the labour pains.
The force of the pulse is usually decreased during the contractions of the uterus.
Mauer does not consider these modifications in the frequency of the pulse attributable to muscular contraction. It cannot be explained by modifications of the respiration ; for although Weber has shown that deep inspirations produce analogous effects, Mauer has satisfied himself that an increased amount of respiratory action was not always coincident with these phenomena, which were so regular in their occurrence in the arteries. Nor can an impediment to the circulation compression of the uterine vessels reacting on the heartbe considered the cause of the phenomenon. Mauer believes the acceleration of the pulse to be due to excitation of one of the nervous centres ; and he believes that the great sympathetic is the seat of this special action.–Archiv. für Physiol. Heilkunde.
WEBER'S CASE OF FETUS IN FÆTU. M. Weber relates a case which he says is peculiarly interesting from the fact that the tumour containing the fætus was successfully removed by openstion, which had never occurred before.
The tumour, which was soft, immobile, firmly adherent, and as large as a child's head, was situated upon the sacrum, and it increased in size so much that nine weeks after its first appearance it was resolved to resort to the hazardous operation of removing it. It was found to contain two well formed fingers. A ligature was placed round it, and it was removed without much hemorrhage. The wound was perfectly cicatrised in a month after the operation.
Each of the fingers within the tumour contained three phalanges and a perfect nail, and they were articulated to a bony mass (produced probably by the union of the metacarpal bones), and also to some smaller semi-cartilagious pieces of bones. The greater portion of the tumour consisted of fatty matters, and of a cyst which contained a yellowish fluid, as well as blood-globules and the rudiments of epithelial tissues.-Virchow's Archiv. für. Pathol. und Physiol., Bd. vi., Hft. 4, 1854.
PORCHAT AND HESCHL ON DEVIATIONS OF THE UTERUS IN CHILDHOOD. M. Porchat is “ interne" to the Parisian Foundling Hospital, and has had many opportunities of examining the bodies of young female children dying in that institution. His observations were chiefly made upon children about two years old, and often younger. He found that anteflexion of the uterus existed in most cases ; and hence he concludes, with Boulard, that this is the normal direction of the organ in childhood. He has also observed the organ retroflected, which condition he considers due to an abnormal deviation of the rectum. He does not regard flexion of the uterus in children as depevdent upon intestinal distension from flatus, or upon any cadaveric alternations: but thinks that the tissue of the organ is so soft at this period of life, that il has an inherent disposition to become doubled upon itself.-Comptes Rendu! of Societé de Biologie. August 1854. And Gaz. Med. de Paris. Nov. 28, 1854.
At a meeting of the Viennese Imperial Academy of Medicine, held on the 3d February 1854, Dr Heschel said, that he had never seen deviation or dis