is a comparatively rare form of disease, as is also melanosis. Epithelioma is most common after the age of forty, but now and then we encounter a case at a comparatively early period.

After these affections have continued for an indefinite or variable period, they all manifest a disposition to softening, disintegration, and ulceration. Sooner or later, they break down, just precisely as tubercles of the lungs during the progress of pulmonary consumption. The period at which this disintegration occurs varies in different cases and under different circumstances. Encephaloid cancer manifests this disposition more rapidly than any of the other formations. We find that a patient affected in such a manner rarely survives twelve, fifteen, or eighteen months; ulceration of the skin takes place, a fungus protrudes, followed by a more or less copious hæmorrhage, gradually undermining the health, and eventually destroying the life of the individual. Scirrhus frequently lasts considerably longer; it is slower in taking on ulcerative action, but this is sure to supervene and destroy the patient. So, likewise, with epithelioma, melanosis, and colloid. Colloid, perhaps, is slower in taking on this action than any other of the formations under consideration; it often destroys the life of the patient without taking on ulcerative action, by its mechanical pressure upon surrounding and perhaps important structures, wearing the patient out by hectic irritation.

occasionally, but rarely, under the skin, in connection with the subcutaneous inter-muscular and cellular tissue. The disease usually begins in the form of a little tubercle, not larger than the size of a small pea when attention is first attracted to it. This goes on gradually increasing in volume, until at length it may acquire the bulk of the fist, or of a large orange, or some other object of this kind; it is rarely that a scirrhous tumor, properly so called, attains any very great bulk; small size is one of its characteristic features, in which it diffe s remarkably from encephaloid and colloid, and even melanosis. Hardness, even in the earlier stages of the affection, is one of the distinguishing signs of a growth of this kind, and this hardness continues during the whole progress of the disease. We often find a tumor of apparently large growth in the mammary gland; but after extirpation, on clearing away all the adventitious structures the scirrhous formation is always comparatively small.

The tumor is found to consist of a stroma and of cells. The cells are of different shapes-some ovoidal, some elongated, and some caudate, with nuclei and nucleoli, some in large numbers, thus showing great vital activity. Wherever this deposit occurs it replaces the natural structure, as in the manimary gland, an example under which it is best studied. You will find that the mammary gland is entire'y destroyed during the progress of the affection; that the glandular tissue During the progress of these growths, disease of a of which it naturally consists is replaced entirely by this similar kind is liable to occur in the neighboring parts, new formation, this stroma and these cancer cells, so that especially in the lymphatic ganglions; not to the same in the advanced stages you will not, even under the miextent in colloid as in the other format ons. This ten-croscope, be able to recognize any of the natural structure. dency to contamination of the surrounding structures There are blood-vessels, as well as nerves, and absorbmanifests itself at a variable period, generally not until ents in such a growth. The arteries and veins are proba certain amount of development has occurred in the ably nothing but the vessels which naturally existed in main mass; this is either in consequence of the absorp- the mammary gland, compressed in their structure, as tion of some of this substance, and its extension along well as in position, by the deposit. These vessels have a the lymphatic vessels, the lymphatic ganglions becom- diminished circulation, otherwise the tumor would be ing contaminated; or else in consequence of sym- capable of acquiring a much larger bulk than it does. pathetic irritation." The coats of the vessels are changed in their character, and frequently during the progress of the affection become exceedingly brittle, so as to give rise during the progress of ulceration to more or less bleeding, though this is seldom very copious. We infer the existence of nerves, rather than profess to be able to demonstrate them; there is always a pain of a peculiar character, denotive of the existence of nerves. We infer Scirrhus, or hard cancer, is so called because the sub-the existence of absorbents from the fact that if we stance of which it is composed is harder than any of the natural tissues, with the exception of bone and cartilage. Scirrhus is most liable to occur after the age of forty-five; it rarely takes place at an earlier period. The youngest subject in which I have seen it was a child, a little boy, three months of age, who died under my care, and upon a post-mortem examination I found several tubercles of this character in the liver, all as distinctly marked as the cancerous tubercles in the case presented before you a few days ago. This was the only case in which I have seen scirrhus at so early an age; I do not know that there is on record an instance in which it has appeared earlier. Now and then we observe scirrhus in the mammary gland at the age of twenty-six or seven, at thirty, thirty-five, and forty, but seldom under the age of forty-five.

All these tumors, formations, or growths have a disposition, after extirpation, or after their destruction by any process whatever, to return sooner or later. This recurrence may take place within a few weeks or a few months after extirpation; or it may be delayed for a number of years.

SCIRRHUS.

The structures most liable to scirrhus are the mammary gland and the uterus. It occurs here more frequently than in all the other parts of the body together, provided we exclude epithelioma, which I regard as but another form of scirrhus, The liver is not an uncommon seat. We find it in the prostate gland, in the kidneys, in the spleen, in the lungs, in the salivary glands, in the brain, and in connection with the bone;

place upon an ulcer of this kind arsenic, belladonna, morphia, etc., these substances will manifest their effects upon the system at large, nearly as rapidly and effectually as when taken into the stomach, or administered by the rectum, or hypodermically, in the form of injection.

The scirrhous tumor is usually devoid of any thing like a distinct capsule or covering; the cellular tissue around it, however, is generally more or less condensed, precisely as in the case of the benign formations. Therefore, it is impossible to enucleate such a tumor when we come to extirpate it, unless it is very brittle, as occasionally happens when of long duration.

The progress of the scirrhous tumor is comparatively slow. As it proceeds, we find that the mass increases in every direction, and that it tends ultimately to the surface, to which, as well as to the deeper and surrounding structures, it contracts adhesions. The surrounding tissues are in a state of irritation in consequence of the pressure exerted by the morbid mass, and the irritation thus excited leads to the deposition of plasma, lymph, or fibrin, giving rise to adhesions, so that while a tumor of this kind is, in its earlier stages, perfectly movable from absence of adhesions, after several months we find that it is comparatively immovable on account of them.

Clinical Department.

UNIVERSITY MEDICAL COLLEGE OF NEW
YORK.

OPHTHALMIC AND AURAL CLINIC, CONDUCTED

BY PROFESSOR ROOSA.

CASE I.-NEPHRITIO NEURO-RETINITIS.

As it advances to the surface, the skin becomes firmly adherent at several portions of its extent. Originally the skin is entirely free from discoloration, and without enlargement of the subcutaneous veins; after a while it becomes discolored and tender, with a disposition to ulceration, which finally occurs, leaving a characteristic sore. The ulcer of scirrhus, as presented to you very often in the mammary gland, has everted edges, more or less ragged and irregular; sometimes they are steep at one part, everted at another, and perhaps undermined at a REPORTED BY W. J. H. BELLAMY, FEBRUARY 14, 1868. third portion of their extent; but, generally speaking, we say that the edges are everted, and they are very hard and very irregular. The surface of the ulcer has the appearance as if it had been made by a punch or some similar instrument, scooped out as it were, excavated; and it is always incrusted with aplastic, cacoplastic, or spoiled lymph-lymph which is not convertible into granulations; hence an ulcer of this kind is usually free from granulations, or, if there are any, they are unhealthy, imperfectly developed, not tending to reparation. The discharge from such an ulcer is thin, sanious, ichorous, or sanguinolent-not natural, healthy, or laudable pus; it varies in quantity, is frequently very profuse, and at the same time excessively offensive; it will tarnish a silver probe, showing that it contains what is supposed to be sulphuretted hydrogen. Occasionally a vessel at the seat of the ulcer is laid open, and, in consequence, there is hæmorrhage more or less copious, but usually comparatively small in quantity; it may amount to a few ounces, or even half a pint in rare cases, but is never copious, as is so liable to happen in encephaloid.

During the progress of the disease, the surrounding lymphatic ganglions always become involved, sometimes before the establishment of ulceration, but generally not until it is about to take place or after it has actually occurred. Proceeding still further, the constitution suffers in a marked degree; the countenance gradually assumes a peculiar cadaverous appearance, often denotive of the cancerous cachexia; the eyes gradually sink in their sockets; the features become shrunk and contracted; rapid emaciation takes place, followed by hectic, loss of appetite, disorder of the secretions and of the digestive apparatus; and sooner or later the death of the patient is the inevitable result.

In some cases we find secondary developments. Thus, for example, in cancer of the mammary gland nothing is more common, during the progress of the case, than the development of little cancerous tubercles in the skin around the original seat of the disease, or even in remote portions of the body. Thus I have seen these secondary formations upon the top of the shoulder, between the shoulder and the vertebral column, sometimes in the extremities; I have seen them in the lower extremities in a case of cancer of the maxillary sinus. Sometimes they occur in the lungs, in the liver, the kidneys, the spleen, the pleura, the latter even as a sequence of cancer in the mammary gland. The blood becomes impoverished in a marked degree, the patient is rendered næmic, and there is lesion of the skeleton, so that some of the long bones are liable to give way on the slightest

exertion.

ARSENIOUS ACID IN CEREBRAL CONGESTION AND HALLUCINATION. Dr. Lisle states that insane persons often present symptoms of cerebral congestion. Patients who suffer from hallucination always do; but 67 per cent. of these were cured, and 29 in 193 permanently improved. Arsenious acid is an infallible specific in cerebral fever. The dose varies from to of a grain thrice during the day, before meals.-Am. Jour. Med. Sciences.

W. L., aged 18, a pale-faced, intelligent-looking boy. He is a clerk in one of the large houses of the city. About a year ago, he began to suffer from occasional attacks of what was called "sick headache." This headache was severe, compelling the patient to quit work for the time, and it was usually accompanied by vomiting. This state of affairs continued until about four weeks ago, when he began to observe that his sight failed him. Two days ago he presented himself to Dr. Roosa, who brings him before the class to-day. His vision, as tested by Snellen's test types, showed that it was about one-third the normal amount, that is, he could only read letters in the types at ten feet which he should be able to discern at thirty feet. Smaller type, ordinary reading matter, he cannot read at all. On examination with the ophthalmoscope, it is found that there is no appearance of the optic nerve entrance, except that the vessels may be seen emerging at the porus opticus, the veins tortuous and distended, while the normal appearance of a white disc is not recognized at all. There do not seem to be any exudations or hæmorrhages in the retina. The urine was examined by heat and nitric acid, and found heavily loaded with albumen.

A

Remarks.-This is undoubtedly a case of nephritic neuro-retinitis, so called. The primary disease is in the kidney of course, and is what is known as Bright's disease. The changes in the retina are secondary, just as we may have changes in the vascular system in various parts of the body, consequent upon weakness of structure. short time since a medical man died in this city from rupture of the heart, or the aorta, whose retina of one eye I had the opportunity to examine some few months before his death, and which I found affected as is this young man's. The affection of the eye generally, although not always, occurs in the later stages of the disease; at least it is very apt to be unnoticed until then.

I would advise this boy to go into a hospital, and be there treated as only hospitals can treat this class of unfortunates. He needs tonics, the most nourishing food, and vapor baths, to excite the action of the skin, which is now doing scarcely any of its work. He should Pediluvia be wrapped in flannel from head to foot. may be frequently used.

As to his eyes, we need only put on a pair of blue glasses to protect them from excessive light, there being a slight amount of photophobia. He will take the muriated tincture of iron, and as his mother refuses to send him to a hospital, we shall endeavor to see that the requirements of treatment are answered at home. I should remark, that there are none of the peculiar patches in the retina which characterize nephritic neuro-retinitis, because the disease has not advanced far enough. The ophthalmoscopic symptoms are those of the first stages of nephritic neuro-retinitis. The prognosis is, of course, very grave, both as to the general condition and as to the vision. His youth is of favorable import as far as it goes.

CASE II.-SUPPURATIVE KERATITIS.

Ellen D., aged thirty, a poorly nourished subject.

should be covered with a piece of soft plaster for a day regular descent of the child. When the child is deor two, and a perforated plaster of buff leather or ama-scending, one may feel, by introducing a finger into the dou subsequently worn to keep off pressure from the vagina, that the movements take place simultaneously centre of the growth. The removal of a corn may be with the compressions produced externally, and if any very considerably aided by the use of the compound parts of the child project from the genitals the operator tincture of iodine painted on the swelling. When the can perceive the visible results of the pressure. The corn is painful, this application subdues the sensibility, pain caused by the manipulation is not generally more and renders the corn dry and pliable, and easy of removal severe than the pains of labor; with multiparæ when by means of a file. Soap and water, so useful to the skin the abdominal walls are lax, and in twin-birth, after in many ways, are especially serviceable to feet afflicted one child has been expelled, this method succeeds the with corns, and particularly when they are soft corns. best. On the other hand, when the integument of the Daily washing with soap, and the subsequent interposi- abdomen is distended and thick, it is much more diffition of a piece of cotton wool between the toes, may cult, although, if the patient be narcotized, it may be be considered as a cure for soft corns. And in these practised with success. cases the skin may be hardened by sponging with spirits of camphor after the washing. The cotton wool should be removed at night, and this is a good time for the use of the camphorated spirit."

LOCAL ANESTHESIA IN OTALGIA.-Dr. C. C. Shoyer (American Journal of Medical Science) has found the following means effectual in promptly relieving the pain in ear-ache: He draws into the smallest size India-rubber syringe about one-half a drachm of chloroform, and slightly elevating the nozzle to prevent slipping, introduces it into the ear. The effect, he says, is magical, stopping the pain almost immediately.

INHALATION OF BROMIDE OF POTASSIUM IN HOOPING

COUGH.-Dr. Helmke, of Jena (Ranking's Abstract), advises the inhalation of a solution of bromide of potassum for hooping-cough. He uses it with the strength of two grains of the salt to an ounce of water.

TREATMENT OF MALARIAL FEVERS BY THE SUBCUTANEOUS USE OF QUININE.-This method seems first to have been used by Dr. Chasseaud, of Smyrna, in 1862. It was first tried in the N. Y. Hospital in 1866, in a case of congestive remittent fever, and is now a part of the regular practice of the house. A solution of quinine is used, of which thirty-five minims are equal to four grains of the salt. It was soon discovered that abscesses were sometimes caused by the undissolved crystals of quinine, and by particles of dust which had dropped into the solution. An excess of acid removed this source of danger, and but slightly increased the pain of administration. After some experiments, it was observed that four grains of the salt were needed to break an attack of tertian fever, and fully eight a quotidian. In cases of congestive fever the amount varied with the symptoms present, and was given upon the estimate that one grain subcutaneously equalled four by the mouth. The injections were first given, and the rule is still observed, two hours before the expected paroxysm. Where two injections were required, if there was time, four grains were given, and the other dose two hours before the expected chill, and if the time was too short, both were given at once. Three cases are cited as examples of many in which this general plan of treatment was carried out. In many cases no quinia was given after the last chill, except on the anniversary days. In some small doses were administered to guard against a return of the chill. By the hypodermic method of administration, a great saving in the use of the medicine may be made, not more being employed in the entire course of many cases than were formerly needed to avoid a single paroxysm. In the remittent fever, the experience is not very satisfactory. -E. C. SEGUIN, in the N. Y. Medical Journal.

NEW METHOD OF DELIVERY BY THE PRACTICE OF ExTERNAL MANIPULATION BY DR. KRISTELLER (Berlin, Klin. Wochenschr.) (Ranking's Abstract).-After the very favorable results that have been derived on the one hand from external manipulation, as recommended by Wiegand, in the better position of the foetus, and also in the preparatory stages of the labor, and on the other hand from Crede's practice of removing the placenta to complete delivery, Kristeller inquires whether it be not possible to regulate, by external manipulation, the course of a labor which is progressing abnormally, and thus to restrict the indications for manual or instrumental extraction. With weak, irregular, or faulty pains, and in cases where an abridgment of the labor is desirable, the following method of delivery has been followed by Kristeller for some time, with the best results. Standing on one side of the woman, who is placed on her back, he attempts to isolate the uterus from the coils of the intestine, and to carry it in the axis of the pelvis. He then grasps it with the hands in such a way that the little finger is directed toward the pelvis, and the palm of the hand clasps the fundus of the uterus, or its sides at the upper part, with the thumb placed upon the anterior, and the slightly stretched fingers upon the posterior surface, of the organ. Kristeller next commences to move the integument of the abdomen gently over the uterus, and then proceeds, keeping the hands in the same position, to exert upon the organ a pressure at first slight, but later gradually ELECTRICITY IN PULMONARY CONSUMPTION.-Dr. Elsincreased in amount. A pause is soon made in the berg, in a communication to the Philadelphia Reporter, compression, which varies from one-half to three min- on the subject of electricity in pulmonary consumption, utes, according to the gravity of the case, the stage of claims the following advantages in the employment of delivery, and the sensibility of the woman; after which electricity: 1st. It can be applied directly to any muscle the pressure is again exerted, though not at the exact or set of muscles which the physician desires to bring place as before. The compressions are thus repeated, under its influence. 2d. It can be carried out daily, at ten, twenty, or forty times, and toward the end of de- all hours and seasons. 3d. It does not fatigue or exlivery are continued with short intermissions. Some- haust the patient. 4th. It can be employed at all ages, times a few compressions suffice to bring a slow labor to and in every condition of debility. 5th. It can be ema favorable conclusion. When no signs of any results ployed in the patient's house, in bed, etc. 6th. Even are observed after twenty or thirty compressions, this when absolute rest is requisite, such as in pulmonary method is given up. The compressions act in the first hæmorrhage, it may be employed. 7th. The injurious place by increasing the power of the uterus, and by ex-influences of the weather, and other inconveniences inciting pains; and in the second place by removing spasmodic strictures, by producing complete dilatation of he os uteri, and favoring the onward movements and

separable from other kinds of exercise or muscular gymnastics, are avoided. 8th. It acts more powerfully, and in less time, than any other gymnastics.