10. Observation XL. Melanic cancer of cheek-excised Dec. 1845. No return in 1848.

11. Observation XLIV.

Cancerous tumour on the finger and toe

amputation May 1848. No return at the end of the year.

12. Observation LII. Colloid cancer of mamma-excised March 15th, 1847. No return when the appendix was written.

13. Observation LIII. Colloid cancer of mamma-excised Sept. 1847. No return up to June 1848.

14. Observation LIV. Encysted, sanguineous, colloid tumour of the back. No cancer cells to be found-excised June 1848. Patient not afterwards heard of.

Now, out of the whole of these cases, there is only one in which an unequivocal cure can be said to have occurred, and this is one of the cases of carcinomatous testicle, which was excised in 1842. And even this case may be considered to have been an unusually favorable one for the operation, as the tumour resulted from, or followed, a local injury; this being precisely the form which all systematic writers have considered as most likely to be benefited by operation. We cannot conceive how from these cases Dr. Bennett can draw any valid argument for the operation, much less can we conceive what right he has to assume so confident and encouraging a tone, in opposition to most of the writers who have investigated this subject on a large scale. His cases would not even enable us to affirm that life had been prolonged by the operation, so few are they, and so recently have the majority of them been operated upon. We do not find in Dr. Bennett's other arguments anything which can compensate for this want of direct evidence in favour of the operation. We are disposed, however, to agree with Dr. Bennett, that repeated extirpation might possibly be of service in warding off the terrible constitutional cachexia, which ulcerated cancer often so rapidly induces. This is another question from that of the curative power of operation, and at present we have absolutely no data to lead to any conclusion, as the plan has not, as far as we know, been carried out to any extent.

With regard to the destruction of a cancerous tumour by chemical agents. Dr. Bennett speaks very doubtfully, on account of the impossibility of applying such remedies to the whole extent of the morbid growth.

The means of prevention reccommended by Dr. Bennett are rather hypothetical. After stating that all sorts of alteratives and tonics, mercuryiodine, arsenic, gold, copper, chloride of barium, have been ineffectually used as prophylactic agents, he proceeds to draw a possible indication from the observed antagonism of tubercle and cancer. In tubercle, he says, there is a deficiency of fat; the animal oils are indicated to increase the nutritive power. On the other hand, in cancer, fat-elements abound; spareness of frame is here the thing to be sought for, and " the circumstances which diminish obesity, would seem," he says, " à priori, to be opposed to the cancerous tendency." We shall only say in reference to such a suggestion, that it is based on the most speculative and hypothetical ground. Moreover, it has absolutely been fully tried and found wanting. Persons have been half starved, but their cancers have unfortunately grown with as much vigour as ever.

We have occupied so much space with the consideration of that portion of Dr. Bennett's book which refers to cancerous growths, that we must

pass very lightly over the "cancroid tumours." Here also is much well worthy of more space than we can accord to it.

Dr. Bennett describes a new growth, the "fibro-nucleated cancroid growth." It consists of filaments infiltrated with oval nucleated nuclei, but destitute of cells; sometimes the growth, to the naked eye, exactly resembles scirrhus, at other times encephaloma. The peculiarity of this humour is that free nuclei exist before any softening or liquefaction of cells could have occurred to set them free, consequently they must be considered to be an original formation, and what is singular, they do not at any time become surrounded with cell-walls, at least Dr. Bennett's observations go to show that cells are never found in this variety of growth.

The different kinds of epithelial growths are well described; the following gives good description of a form of disease of which we believe we have ourselves seen a characteristic example, which commenced as an induration at the base of the tongue, was attended by glandular enlargement, and was followed by corroding ulceration before which a great part of the lower jaw disappeared, a cancerous hue of the surface, and the general symptoms of true cancer.

"Another form of epithelial cancroid is one which frequently commences almost at the first as an ulcer, although sometimes it is preceded by slight induration of, or a wart on, the part affected. It is common in the under lip, in the tongue, and in the cervix uteri. In the lip there may often be early observed a furrow or groove in the indurated spot, or wart, in which the ulceration commences. This slowly extends, with indurated, thickened, and raised margins, is circular and cupshaped, its surface sometimes covered with a white cheesy matter, at others with a thick crust or scab. It slowly extends until it involves a greater or less portion of the lip or neighboring parts, pouring forth a foul ichorous discharge. In the tongue the disease follows a similar course; the base of the sore, however, is generally more fungoid or papillated on the surface, and exceedingly dense, owing to the close impaction and compression together of laminæ of epithelium. When examined microscopically, these forms of cancroid ulcers present on the surface masses of epithelial cells in all stages of their development, some sphercial, nucleated, about the 1-50th of a millimeter in diameter, others much larger, both often resembling cancer-cells when viewed alone, but associated with flattened scales, varying in shape and size, sometimes occurring in groups adhering at their edges, at others mingled together in a confused mass; many of the cells and scales often reach an enormous size, and as they become old split up into fibres. These elements are commonly associated with numerous molecules and granules, naked nuclei, fibro-plastic, fusiform, and pus-cells." (p. 181.)

Fibrous tumours are divided into the sarcomatous, dermoid, chondroid, and neuromatous. A good description is given of each of these. In the subsequent pages, Dr. Bennett alludes to fatty cancroid growths, tumours, from effused blood (which Dr. Walshe, in the article on Adventitious Products, has also elaborately described under the title of "Hæmatoma"), and various other growths or morbid products which by possibility, may resemble cancer. Among these he mentions the "typhous" deposit, as furnishing cells approaching in appearance to true cancer-cells.

In bringing this review to a conclusion we may congratulate the British school of Pathology on the fact, that it has furnished such men as Walshe and Bennett, as worthy fellow-labourers in the same field with Muller, Bruch, Lebert, and Hannover. We do not hesitate indeed to claim for our countrymen even the first rank among these distinguished men, as

authorities on Cancer. Dr. Walshe's work is the most elaborate and complete; but if we cannot assign to Dr. Bennett the praise of having brought together such extensive materials, or of having so philosophically arranged them, we must accord to him the credit of being an excellent and indefatigable observer, who has added much to our knowledge of cancer, and has done still more to clear the path for the observers who will succeed him.

ART. XII.

General Board of Health: Report on Quarantine. Presented to both Houses of Parliament by Command of Her Majesty.-London, 1849. 8vo, pp. 172.

WE Consider the subject of this Report of so great national importance, that, although we have received it very late in the quarter, and in order to comment upon it have been compelled to defer much valuable matter to a future Number, we feel it our duty to point out the numerous errors it contains, before the practical conclusions to which these errors would lead can receive the sanction of the Legislature. We are compelled, however, to dispense for the present with any analysis of its most valuable portion, that relating to the effects of overcrowding, impure air, and diet, as causes of disease in ships at sea or in harbour,-and restrict our observations closely to the subject of Quarantine. But we may state, before passing on to our task, that the remarks upon the sanitary regulations of ships and their condition in various ports; upon the defects in marine registration; upon the relative mortality of seamen and landsmen from zymotic diseases, and the general mortality at sea compared with that in the metropolis; upon the increase of zymotic disease in unhealthy districts; upon the prevalence of scurvy in merchant ships; upon the condition of emigrant vessels and passenger-ships; above all, upon the practical utility of ventilation, and the simple means of ventilating ships, proposed by Dr. Arnott, and so successfully adopted by Dr. Millar, to prevent the excessive fatality sometimes observed in transport and emigrant ships-all these we consider most admirable. We cannot express too strongly our perfect concurrence with this portion of the Report, or recommend with sufficient earnestness its immediate study by all medical men, especially by those attached to our navy or mercantile marine.

When we pass on, however, to the strict subject of the Report, we find, with extreme regret, that the portion relating directly to Quarantine is as faulty as that to which we have just directed attention is excellent. It is our duty, therefore, to consider closely the portions which are likely to mislead those, who, deriving their sole information on this subject from the Report before them, would receive what they find stated there without that previous information from other sources, which might enable them to judge of its correctness, and prepare them to discover its fallacies. This examination is peculiarly necessary in the present instance. The subject is not one likely to be practically known to a large proportion of our readers, very few of whom would take the trouble of examining the documents from which the Board of Health have made extracts, or of considering how far these extracts represented the general conclusions of the 7-IV.

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documents in question, or how far they constituted purely ex parte evidence, contradicted by more convincing testimony on the opposite side of the controversy, from the same pages. That general readers are not the only class who require to be guarded in their reception of the evidence afforded by this Report, is very clearly shown by the almost indiscriminate laudation with which it has been received by the press, medical and nonmedical. As far as we have seen, with but two exceptions, it has been praised by writers who evidently knew nothing more of the subject than they had learned from the book they were reviewing, and who received with the most child-like and unsuspecting confidence all they found stated under the imposing guise of an official "blue-book."

Let us commence by examining the opinions of the reporters with regard to the true object of Quarantine. They state that,

"The object of quarantine is to prevent the introduction of epidemic diseases from one country into another, and its regulations are based on the assumption of the contagiousness of the diseases with which it deals; it being supposed that such diseases are propagated by contact, direct or indirect, of the unaffected with the affected. In accordance with this view, the preventive means adopted by quarantine consist of the isolation of the sick or suspected, with whom it interdicts all communication, whether by person or by articles deemed capable of transmitting contagion." (p. 4.)

66

Blindly intent on accomplishing an impossible object, it overlooks the circumstances on which the existence and extension of disease really depend; and after the experience of centuries has shown the inutility of the securities it offers, it still proposes to go on reposing implicit confidence in them and in them only. Quarantine is based, as has been stated, on the assumption that epidemic diseases depend upon a specific contagion; but the question of contagion has no necessary connexion with that of quarantine. The real question is whether quarantine can prevent the extension of epidemic diseases, whatever may be their nature, whether contagious or not. (pp. 16, 17.)

"In like manner the discussion whether epidemic diseases arise and spread from contagion, or from common or specific poisons generated in the localities in which these pestilences first break out, has nothing whatever to do with quarantine." (p. 18.)

We shall see presently, that, by the term " epidemic diseases," the Board do not always imply diseases which can only be acquired by breathing the air of some locality in which such diseases are prevalent. In some places they appear to restrict the term to this signification. In others they include, as they do here, what are usually considered to be contagious epidemics. The principal object of Quarantine is to prevent the importation of such diseases as experience has shown may be communicated from one person to another by close approximation of the affected with the unaffected. And the preventive means adopted do not consist simply of isolation of the sick from the healthy and their congregation together, as stated at page 61, but of isolation, not only from the healthy, but in a very great measure from each other, a most important distinction to be borne in mind. We shall presently see, when we come to the practical applications of the doctrines of the Report, that the second paragraph is altogether. contradicted by the most positive evidence, and that quarantine can prevent, and has prevented, the importation of disease.

We must now make some remarks upon the accounts of the manner in which quarantine regulations are carried into effect. Here is the statement of the Board:

"If the great practical truth, taught by modern investigation and experience, be,

that the only real security against any kind and degree of epidemic disease is an abundant and constant supply of pure air, the prevention of overcrowding, and the dispersion of the sick; and if, as is generally agreed, confinement in a foul atmosphere can convert common fever into pestilence, and ventilation and dispersion can dissipate any contagion, then quarantine must be not only useless but pernicious, since the invariable effect of quarantine as hitherto practised in all countries has been the congregation and confinement of the sick and of those who, though not actually sick, are suspected to have in them the seeds of disease, requiring only a few days or hours for their development, the congregation and confinement of such persons in a limited space, often in a filthy ship and an unhealthy locality, and always under circumstances calculated to excite apprehension and alarm-conditions in the highest degree favorable to the generation and spread of disease it follows that quarantine, instead of guarding against and preventing disease, fosters and concentrates it, and places it under conditions the most favorable that can be devised for its general extension; and therefore must not only fail to accomplish its object, but tend to produce the very calamity which it endeavours to prevent." (p. 61.)

This is a most important paragraph, containing a singular mixture of established truths with the most inconceivable error and ignorance. The security to be obtained by ventilation is strongly stated; the advantages of dispersing the sick are alluded to without mentioning any of the necessary precautions which should accompany such dispersion; and then we have a description of the practice of quarantine "in all countries," which, after having visited the principal European lazarettos in the Mediterranean, we do not hesitate to state is totally and entirely contrary to the truth. In no lazaretto for many years past have patients been congregated or confined in a limited space. On the contrary, all suspicious cases of sickness which occur on board ship are removed on shore, are placed in separate and well-ventilated rooms, and attendants are placed there with them. This is the invariable custom; and therefore the conclusion that quarantine fosters and concentrates disease is unfounded and untrue We have been on three separate occasions in charge of smallpox patients in a lazaretto, for periods ranging from sixteen to twenty-one days. In every case the patients were removed from the ships as soon as they arrived, they were sent on shore to separate and well-ventilated rooms, and we, with nurses, were kept with them in quarantine until all danger of propagating the disease had passed off. Now, can any reasonable being doubt that in this way smallpox was prevented from spreading among other men on board the ships, or that if these precautions had not been taken, the seaman, and through them the whole neighbourhood, might have suffered severely for a long period. The ill effects of the neglect of these precautions was most strongly evinced in 1830, when the smallpox was distinctly proved to have spread from the Naval Hospital at Malta to the home of the person who washed the patient's linen, and then over the greater part of the island. It extended itself rapidly, and did not cease until the following year, 10,351 persons having been attacked, of whom 1503 died. It was proved to have been imported from Greece in H.M.S. Asia, there being no smallpox in the island before the arrival of this ship; and there can be little doubt that the subsequent immunity of the island has been secured by the quarantine regulations, which were neglected in this unfortunate instance with the effect of destroying and disfiguring so many unfortunate persons." * And yet we are nauseat* All the details of these facts may be found in Dr. Davy's work upon the Ionian Islands and Malta.