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XIII.-OXIDE OF COPPER OINTMENT AS A DISCUTIENT.-Professor Hoppe, of Basle, attaches very great importance to an ointment made with the black oxide of copper, as a discutient application. He uses it in the following cases :
1st. In opacities of the cornea (half a grain to 3j of axunge, increased to 5-10 grs.), a small quantity introduced into the eye twice or thrice daily, causes them to disappear.
2d. In diseases of the eyes, especially in inflammation of the lachrymal gland, of the cellular tissue of the orbit, and of the palpebral mucous membrane, he says, it produces excellent effects when it is rubbed on the temples instead of Ung, Hydrarg. He used, in such cases, an ointment made with aj to Jij of oxide, added to twice its weight of axunge, and combined with narcotics.
3d. In tumefaction of the external meatus of the ear, occasioned by chronic inflammation of its cellular tissue.
4th. In induration of the salivary glands, which in a few days yields to its influence.
5th. In enlargements and indurations of the glands of the neck, it is peculiarly serviceable, causing lymphatic glands which have become sarcomatous, to soften and disappear better than any other remedy. He says, he has seen obstinate, hard, and voluminous swellings yield to a single application.
6th. In goîtres of the ordinary kind it is very useful, although it is inefficacious in the hard, fibroid, sarcomatous tumours of the neck.
7th. Engorgements of the mammary glands, whether recent, or of old standing, are speedily discussed by it.
In many other maladies, as orchitis, glandular swellings of the groin and axilla, hypertrophies of the liver, spleen, etc., Professor Hoppe believes it to be efficacious. Its employment produces no deleterious effects on the economy, but it may easily produce papular eruptions, which may go on to ulceration. Its employment should be suspended whenever the skin becomes irritated, and an ointment of zinc may then be substituted. Hoppe uses it in proportions, varying from 15 to 30 grains to the ounce, of axunge. As contact with the ointment is rather unpleasant, the parts to which it is applied should be kept covered by lint and a bandage.-Deutsche Klinik. 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 69.) M. Ferrus (author of the article “ Cancer” in the Dictionnaire de Medicine) shortly addressed the Academy. In two cases of cancer only, out of fifty which he had observed, had he found evidence of hereditary taint to be wanting. The extent of the cancerous cachexia was not always in proportion to the severity of the local manifestations of the disease ; thus, a formidable cachexia might exist with but a trifling cancer, and there was often very little cachexia present in women, in whom the whole uterus and vagina were disorganised by the malady. The influence of the nervous system had been alluded to as often causing cancer by mental perturbation. He might state, as apropos to the question, that among the fifty cases he had alluded to, the temperament was observed to be lymphatic in two-thirds of the whole ; it was bilious and sanguine in a smaller number; and it was nervous in a still smaller proportion.
Dec. 5, 1854.-M. BOUILLAUD next spoke, and entered at some length into a eulogium of the Parisian school of medicine. He paid a very high tribute to the speech of M. Velpeau, and expressed his firm adherence to all the views of that surgeon as to the diagnosis and curability of cancer. “The micrographers,” said he, “ who believe that the cancer-cell is pathognomonic of cancer, have met a terrible adversary in M. Velpeau. His second speech was a cellulicidal discourse (discours cellulicide).” He enjoined upon the microscopists the
necessity of redoubled efforts, and of firm unanimity among themselves. He stated very truly :-“I do not doubt that the microscope always gives the same results ; I affirm that it never deceives, but I hold that the microscopists are not infallible. Let us not lay upon the instrument the errors and imperfections of the many who use it. It is no easy task to observe, discriminate, and interpret well. It is a very difficult thing to manage the microscope properly. I have assisted M. Broca in microscopical observations, and all those who were then engaged with him saw the same objects, and made the same designs of them. Errors and discrepancies can only arise from one source, viz., from observing different objects, and believing them to belong to the same substance. But I cannot admit that experienced microscopists can ever be at variance about the result of such simple observations.”
He believed that the microscope had rendered very important services to science, and to the study of Cancer, because it had been able to establish a satisfactory classification of tumours into epithelial, fibro-plastic, and cancerous. He again maintained that the microscope should not be made responsible for the errors of the microscopists. When it happened that these observers were disagreed among themselves about an object, their difference of opinion was generally attributable either to the inexperience of some of them, or to the circumstance of their not having all examined the same substance. He had no doubt that, instead of morbid tissues, they had often unwittingly examined those which were normal, sometimes cellular, and at other times muscular, vascular, or simply hypertrophied tissues, and chance might have made it occasionally happen that in tumours of a complex nature, one of the elements had been examined by one histologist, a second element by another, and so on.
He concluded by proposing that the Academy should appoint a committee who should investigate the subject of cancerous tumours, either by themselves, or aided by experienced microscopists, as often as they might consider this assistance necessary.
M. Rostan observed that the Academy had, in some measure, anticipated M. Bouillaud's suggestions; and that the question under debate was to be given out to competition for one of the Academy's prizes.
Jan. 2, 1855.-M. Robert expressed his dissent from what had been stated by M. Delafond, that the cancer-cell was not characteristic or specific in its appearance and shape. M. Delafond had asserted that the form of this cell was not constant in its form : that it was spherical or ovoid when it was not compressed by the surrounding tissues, and that it was elongated or fusiform when it existed under opposite conditions. These plausible statements were not borne out by facts, for he had often seen ovoid and spherical cells in the densest schirrus, as well as elongated cells in softened encephaloma; and moreover, fusiform bodies were common in subcutaneous fibro-plastic tumours, which were quite exempt from compression. M. Delafond had stated that the volume of the cells varied according to the phase of their development, but this was quite unproven. M. Robert exhibited a series of drawings illustrative of the appearance of the cancerous, fibro-plastic, and epithelial elements, and also of pus globules, and he showed that, although occasionally they might present somewhat abnormal aspects, there could be no difficulty, in the great majority of instances, in recognising them, and distinguishing them from one another."
Another objection raised against the specific nature of the cancer-cell was, that in several of the normal tissues of the body we found cells which presented a very great analogy, if not a perfect similitude, to those of cancer. This view originated with Virchow, and for a time was popular in Germany. According to that pathologist, the pavement epithelium of the mucous membrane of the ureters, the bladder, the lungs, and the conjunctivæ, resembled
very much the cells of cancer ; and scarcely a year ago M. Michel, of Stras- bourg, had traced the same analogy in the cells of the medulla of the bones of young children. M. Robert had examined all these structures, assisted by able microscopists, in order to ascertain the truth of the statements; and after repeatedly examining and comparing together the tissues mentioned above and the elements of cancerous growths, he never experienced any difficulty in distinguishing the different structures. It might be asked, Why have distinguished histologists in other countries arrived at different results? Might it not be due to differences in the power of the microscopes used ? A microscope of high powers revealed structural appearances which were invisible to any one using an instrument of lower powers. Cancerous elements appeared very differently when viewed under powers of 300 and 500 diameters. He thought, therefore, that the objections raised against the specific character of the cancer element were more specious than real, and he maintained that an experienced eye could always distinguish them from other structures, whether normal or pathological.
M. Velpeau had principally contested the specific nature of the cancer elements in a pathological and clinical point of view; and he alleged that he had found cancer-cells in non-cancerous tumours, which were extirpated without the occurrence of any relapse. But M. Robert held that, if M. Velpeau admitted the curability of true cancer by operation, the non-recurrence of the tumours in question did not prove them to have been non-malignant. M. Velpeau said he did not found his diagnosis on the non-recurrence of tumours, but on the general appearance of the patient But among all the admitted clinical signs of cancer, there was not a single pathognomonic unmistakeable symptom, when the cachexia was absent, and generalisation of the disease was not yet manifested. Modern histology was daily showing us that the symptoms reputed to be characteristic of cancer could not be relied upon as such, since they were being constantly met with in morbid productions of a totally different nature. For example, it had been held, from time immemorial, that retraction of the nipple, occurring in tumours of the breast, was a pathognomonic sign of schirrus. But M. Robin had lately described a form of mammary hypertrophy, in which this retraction of the nipple was very well marked, and which consisted simply in a hypertrophy of the glandular culs de sac, and in atrophy of the excretory ducts, which give to the breast the aspect of schirrus. Two cases of this, which had recently been witnessed within a very short time, led him to believe that this affection was by no means rare.
Again, when a mammary tumour was extensively ulcerated, when its edges were fungous, sprouting (vegetans), and its base was greyish, sanious, discharging fætid pus in great abundance; and when this was accompanied by hemorrhage and exhaustion, we said that we had to deal with a serious case of cancer. But, to M. Robert's own knowledge, a combination of all these alarming symptoms had occurred in two cases of simple hypertrophic tumours. In one of these cases he himself had operated with complete success, and the patient had for five years enjoyed perfect health. The other case was similarly successful in the hands of a celebrated surgeon in Paris.
But M. Velpeau had further asserted that the specific cancerous elements had been found absent in truly cancerous tumours. He had searched M, Velpeau's book in vain to find proofs of this.
M. Velpeau had also stated that tumours which at first contained no cancercells, had been known to recur, having these cells in the secondary tumours ; and he had cited several cases of this nature ; but in all these cases the primary tumours had not been microscopically examined, and therefore there was no proof of their non-cancerous nature.
As to the benignity or malignity of the tumours, he thought that it was better to direct our attention to their prognosis and manner of evolution than to their anatomical structure. All tumours were relatively benign or malignant. A true schirrus, which had existed eight or ten years, without implicating the glands, or causing pain or cachexia, and which, after its removal, did not recur, or did so only after the lapse of a few years, was extremely benign when compared to an encephaloma, which ran through all its phases, and killed the patient in less than a year. The same was true of epithelial, fibro.
plastic, and other tumours not so well known, which recurred after ablation. A noli me tangere of the cheek, or ala nasi, was a hundred times more benign than an epithelioma of the under lip, of the rectum, or of the cervix uteri. And farther, such a schirrus as he had described was much more malignant than a simple adenoid tumour, of large size, which was ulcerated, and discharging fetid pus profusely. If, therefore, in the majority of cases, structural characters were constant and easily demonstrated, nothing could be more variable and uncertain than the prognosis and diagnosis we might base simply upon the evolution of morbid products.
We had then two problems to solve; that of structure, and that of prognosis. The solutions of these were not antagonistic, and we ought not to seek only to solve one of the questions. But the science of the present must precede that of the future, and anatomical diagnosis must precede prognosis.
This view appeared to him to be a scientific and practical one. What had been done respectively by the anatomical and clinical men, at the bedsides of the patients ? The former had divided tumours into cancerous, epithelial, fibro-plastic, vascular, glandular, etc. By long and patient study they had become acquainted with the delicate characters of the tumours, which were long passed by unobserved ; and they had tried to discover in what particular lesions particular elements were found, and thus they had frequently been successful in establishing a correct diagnosis. They knew that one tumour might remain for a long time unremoved, without serious injury to the system; that another could not heal spontaneously; and that the former was more benign than the latter, etc. They thus formed a mental estimate of the patients' history, weighed their good and bad chances, and finally were able to say in what cases it was right to operate, and in what other cases it was prudent to leave the disease undisturbed.
But what had the purely clinical men done? Was their judgment, based on traditions of doubtful value and on pure empiricism, better than the more complete and exact views of the anatomical school? When one of them was called to treat a tumour, if he found that the patient had a bad aspect, and a sinister physiognomy, he removed the growth, like an anatomist. But while the latter, in such circumstances, strove first to confirm, by means of the scalpel and the microscope, his first impressions as to the nature of the disease, in order to strengthen his practice if he was in the right, and to modify his first opinions if he had been deceived, the former, limiting the circle of his researches, made an uncertain diagnosis and a doubtful prognosis.
It was more philosophical and conformable to science to base our classifications of tumours on their anatomical composition and structure. If the microscope had dispelled many illusions as to the curability of true cancer, it had also revealed to us the possibility of curing diseases which often, but for it, were allowed to proceed to a fatal termination. The microscope could not, any more than pathological anatomy in general, decide emphatically in every case, the benignity or malignity of a morbid production, but it enabled us, better than mere clinical observation, to foresee the result of treatment. In certain cases it gave us caution, and in others boldness. By means of the microscope we had made great advances in the study of all accidental growths ; and if we became hereafter perfectly acquainted with the obscure question under consideration, much of the praise would be due to those who had brought so much ardour and laudable perseverance to these truly difficult researches.
Jan. 8, 1855.-M. DELAFOND discussed at great length the various celltheories, and quoted the opinions of a great many authors in support of the doctrine of cellular unity. Besides the authority of the German microscopists, Virchow, Schwann, Förster, Müller, he cited passages from the works of MM. Lebert and Broca themselves, which were favourable to his opinion. He terminated his address by enunciating the following conclusions, which he thought were proven :
NEW SERIES.--NO. II. FEBRUARY 1855.
1st. Independently of normal cells, there exist in the organism pathological cells, which cannot be distinguished by fixed and constant characters.
2d. In the origin of their formation, the three cancer cells—(the cancer-cell properly so-called, the epithelial, and the fibro-plastic cells), present no marked differences among one another.
3d. If, under certain circumstances, these cells, especially fibro-plastic cells, present differences of form and dimensions, these differences are only due to the varying densities of the tissues in which they are developed.
Ath. The chemical characters, by means of which it has been endeavoured to distinguish cancer-cells, are not sufficiently well-marked to constitute a trustworthy distinction.
5th. The effects of chemical reagents are equally inadequate to afford a sufficient ground of distinction.
6th. Numerous facts have proved that true cancers do not always contain the cells called cancer-cells, while these cells have been found in tumours and tissues which were not cancerous.
7th. Still more numerous facts prove that epithelial tumours, which are not considered to be true cancers, are capable of recurrence not only at the same place, but at a distance from it.
M. VELPEAU.—I have just published a work in which I affirm that cancer is sometimes curable, and that it can be very often diagnosed, without the aid of the microscope. M. Robert having disputed these propositions, I have tried to defend them. Firstly, I have endeavoured to prove that cancer can be diagnosed independently of the aid of the microscope ; but I have not meant by this to say that the microscope was useless, and that the works of microscopists were of no value, as has been imputed to me. Secondly, I have discussed the alleged existence of cancers having no cancer-cells. And Thirdly, the question whether or not cancer was curable. The first point has never been seriously contested, and the curability of cancer in certain cases does not appear to me to have been refuted. As regards the question of the specific nature of the cancer-cell, I am not competent to solve it in a microscopical point of view. I have only attacked it clinically. The recurrence of tumours containing no cancer-cells has convinced me that the cell is not the pathognomonic sign of cancer. M. Robert has contested my facts, and asked how I knew that it was a cancer by resting my opinion on its recurrence. Let me, once for all, answer the question.
Its non-recurrence is to me a proof that a tumour is not cancerous only when this fact is found existing in conjunction with other circumstances possessing an equal negative value. I have always founded my diagnosis on the combination of these negative characters. I admit that I may have been sometimes deceived, but how can I have been constantly deceived throughout the numerous series of cases ? M. Robert has spoken of the retraction of the nipple not being a pathognomonic sign of cancer, but on what grounds does he allege that M. Robin's two cases of mammary tumours were not cancers? You answer, On the absence of cancer-cells. But I knew both cases, one of which was my own, and in it the malady recurred two months and a half after the operation. How can this be said not to have been cancer, or how can confidence be placed on the absence of the cell as a diagnostic mark? No one has pretended that retraction of the nipple alone constituted a specific mark of cancer; for how can we diagnose a malady by a single character ?
After a few remarks on fibro-plastic tumours, M. Velpeau postponed the conclusion of his address till the next meeting.
CASES OF HYPERTROPHIED FINGERS AND TOES. Mr Adams, surgeon to the Richmond Hospital, Dublin, at a meeting of the Pathological Society, April 8, 1854, brought forward the case of a girl, æt. twelve years, who had been born with the index and middle fingers of her left hand in a state of hypertrophy. The subject of this observation was a native of the Isle