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plasters, &c., is equally sweeping. As for compression, which he bas employed in the treatment of cancer of the breast, “ with a hearty and sincere desire of finding it efficacious,” he merely found that
" It may flatten or depress the tumours in the midst of the tissues, or into the intercostal spaces, and thus in some measure mask their existence, which no doubt has imposed on some persons, but it never leads to their resolution." (p. 460.) Compression may induce absorption of effused fluid and of fat, and thus determine diminution of the swelling, but can exercise no material influence on the disease. The notion of its favouring the disintegration of the cancer cells, leading to their re-entrance into the blood, and their subsequent excretion through the emunctories, is simply a pathological chimera.
Under the head of surgical measures, the author manifests the utmost reluctance to admit that cancer is an affection primitively constitutional, or depending on a pre-existing diathesis. We would willingly, for the sake of humanity, that an opposite doctrine could be substantiated. M. Velpeau adduces, in corroboration of the above view, the results of cases in which he had performed amputation of limbs for tumours seemingly malignant, and where no recurrence of the disease followed the operation ; but these, as Mr. Henry points out, belonged, in all probability, to the class of myeloid or myelocystic tumours. He further refers to cases of genuine cancer, in which a considerable length of time has elapsed since the removal; but these cannot be accepted as instances of definite cure, for we know that many years may in some instances intervene between the date of the operation and the reappearance of cancerous disease in its former seat.
We agree with Velpeau that statistics are of very little value ; and, upon his own showing, it is evident that his grounds for forming any valid opinion as to ultimate results are imperfect. He says :
“I have certainly seen more than a thousand cases of tumours of the breast. It is certain, however, that I have only been able to trace a very small number to the end. There is a large proportion of them, both public and private, which were seen only on one or two occasions. ..... The same difficulty existed in those cases in which I have had to perform an operation. When once the tumour has been removed, and the wound has cicatrized, the surgeon and patient readily lose sight of each other. Many of mine came from the country for the operation, and returned when it was completed. Some, in fact, did not reside or remain in France, and those who lived in Paris it was not always easy to see again."*
M. Velpeau lays it down as a rule, that scirrhus in plates, whether scattered or in one mass, should never be submitted to operation; the like applies to tubercular pustular cancer, whether discrete or confluent. Stony scirrhus en masse, and diffused lardaceous scirrhus, stand in precisely the same position.
“Whenever the scirrhous mass and the skin are confounded together in a diffused form, when the scirrhus is rather protuberant than depressed, and the tegumentary degeneration has no appreciable limit, and the whole mamma is
* Sydenham Society's edition, p. 489.
more or less thickened, there is also nothing to be hoped for from the operation.” (p. 497.) He points out other varieties where the use of the knife is inadmissible.
With respect to the risk of danger, M. Velpeau has had 32 deaths in 167 operations—that is, about one in six. It may, we think, be laid down as a safe rule, that where the tumour is circumscribed, making slow progress—where the lymphatic glands in the neighbourhood are unaffected—and the general health of the patient good resort may be had to the operation. We thus, in the majority of cases, procure the patient respite from pain, remove a source of continued anxiety of mind, so as, at all events, for a term of years, to enable her to enjoy a fair share of health and spirits. The withdrawal of the morbid mass, moreover, may, in a great measure, prevent a painful, a loathsome, and a lingering death.
Velpeau advocates early operation. So soon as the tumour declares itself, and he recognises the characters of genuine cancer, he ceases to attempt its resolution, and recommends its removalmin other words, does not believe that we are justified in submitting tumours of the breast to curative treatment, from the moment we can with certainty discriminate their cancerous nature. Some ten pages are occupied with details of the operative proceedings. Among the untoward results which occasionally ensue, are death from inexplicable causes-pleurisy, phlebitis and purulent infection, cancerous infection, erysipelas. The last is unquestionably the most common accident after the removal of tumours of the breast-a dangerous malady, which, besides favouring pleuritic effusions, may give rise to peritonitis.
The author is disposed to view the employment of congelation in a favourable light. Anaplasty he denounces as wholly valueless.
The question of caustics is duly considered. He thinks that they preserve the lymphatic glands from secondary cancer more than extirpation. At all events, he noticed this on two occasions. After pointing out some of their disadvantages, he says it cannot be denied that they possess some advantages.
"As they do not give the idea of an operation, they are less terrifying to the patients, and their application will be permitted much more cheerfully, and with infinitely less effort, than the knife. As they destroy the tissues bit by bit, they occasion no loss of blood, and they disturb the system less than operation properly so called. Patients who submit to this treatment are not compelled to keep their beds, or to consider themselves ill. The after-dressings require less care, and do not absolutely call for the assistance of the surgeon. The wound generally becomes cleansed rapidly, after which cicatrization proceeds without delay. Without also obviating erysipelas, pblebitis, or purulent infection, as has been stated by some surgeons, there is nevertheless reason to believe that they are somewhat less liable to these unfortunate complications than cutting operations.” (p. 549.)
Caustics he deems preferable to the knife, when the cancer is ulcerated in patches, and is rather sprouting than narrowed; when, even with the knife, it would be impossible to preserve a portion of the integuments of the part invaded by the tumour; in all cases in which the cancer is fungous, circumscribed, and the patient dreads the knife; in
all ulcerated, cavernous, and disseminated scirrhus; and in ulcerated cancers, which are adherent to the summit of the axilla, or to the clavicle, or extend to the neighbourhood of the bones.
The caustics principally in vogue are arsenic and the chloride of zino; sulphate of zinc, lately recommended by Dr. Simpson, constitutes, according to Mr. Spencer Wells,* the active ingredient of a nostrum employed for the cure of cancer by a Dr. Pattison. Arsenic has been largely used by cancer-curers, but the great risk of danger from absorption, and which has occasionally led to the death of the individual, has caused surgeons to be very chary in employing so potent a poison. We have certainly found it useful in small canceronis sores upon the face, applied according to the formula of M. Manec. Chloride of zinc is a caustic which has rapidly acquired a certain reputation. It was employed by Hancke of Breslau, by Canquoin of Paris, and extensively in this country by Mr. Ure, who published a series of researches on it, several years ago, in the seventeenth and eighteenth volumes of the · Medical Gazette. Mr. Ure used it mixed, in various proportions, with anhydrous sulphate of lime. He says,
"The superiority of this phagedænic paste (for so the preparation may be justly named) over every other caustic, consists in its susceptibility of being applied over very extensive surfaces without any risk of injury from absorption, and in its being available wherever the surgeon's hand can reach. The depth to which it will corrode the morbid texture can always be estimated beforehand ; its action is unfailing; the separation of the eschar is prompt; and it imparts an excellent character to the sore, and soundness to the suppuration. The favourable modification of the tissues, the rapidity with which cicatrization follows, and the mildness of the general phenomena that accompany its action, are additional recommendations.”+
We have introduced the above quotation, because this caustic has lately gained considerable notoriety on account of its forming the basis of a remedy, till lately secret, employed in this metropolis by a Dr. Fell of New York. The secret, which was oozing out, has at length been divulged by the Doctor, in what he calls a Treatise on Cancer and its Treatment;' the object of which is to bring before the medical profession a new, and what he believes to be “an entirely original mode of treating the disease of cancer in all its various forms." (Preface.) We learn from the same source, that Dr. Fell received a communication from the Board of Governors of the Middlesex Hospital, respecting his making a trial of his method of treatment in the cancer wards of that charity on the following terms:
“1st. That Dr. Fell should, in confidence, communicate to the surgical staff the nature of the remedies employed by him, the method of their preparation, and the mode of using them. 2nd. That twenty-five cases should be subjected by him to treatment during a period of eight months. 3rd. That Dr. Fell should pledge himself to publish the full particulars of his system of treatment within a period of six months; and that in case of his failing to do so, that duty should be undertaken by themselves.” (p. ix.)
Now the gentlemen forming the surgical staff allow that Dr. Feli * Medical Times and Gazette, July 11th, 1857.
† Lib. cit., p. 392.
has fulfilled the obligation contracted by him, frankly and without reserve. After some commendatory observations on the plan of treatment, and its immediate results, these gentlemen conclude their report as follows:
“That the undersigned have not as yet had time to ascertain the average duration of the benefit conferred by the treatment, nor have they any means of knowing whether, in the event of a return of the disease, there be any difference observable from what is known to take place after excision."
Be it remembered, the first applications were made to patients in the hospital on the 22nd of January last, and the Report bears the date of the 18th of March, so that the period of trial did not extend to nine weeks. We took up the work with avidity, but great was our disappointment to find the preliminary portion a mere réchauffé from the writings of Walshe, Paget, and others. At length we arrived at the plan of treatment thus magnanimously disclosed to the surgical staff of a metropolitan hospital, our expectations being raised to a high pitch by the astute remark of the Doctor: "any man who, at the present day, can believe that because a cancer is removed it is cured, is worse than simple.” (p. 56.) Assuming this to be Dr. Fell's creed, let us briefly inquire into his curative means. There is a plant, he tells us, whose large white blossoms and snow-white flowers enamel the wild forests and plains of the Far West, and whose bruised stem exudes a red blood-like juice, recalling Virgil's account of the myrtle by the tomb of Polydorus, “ huic atro liquuntur sanguine guttæ." It is called by botanists Sanguinaria Canadensis, by the Indians puccoon. The Doctor found this plant capable of removing tumours and effecting a cure, but requiring months of continued application. He therefore deemed it expedient to quicken its action by the addition of chloride of zinc, employing a considerable dash of this powerful escharotic, as may be gathered from the subjoined formula. * As a preliminary step in cases of non-ulcerated tumours, he destroys the cutis by nitric acid, and then applies the paste; but finding the eschar produced by each application so thin as to require a long time to get rid of a large tumour, he resorts to incisions through the eschar about half an inch apart, avoiding the living tissues, and into these inserts daily the paste spread on strips of linen. He asserts,
“That although the action of the puccoon was much hastened by the addition of the zinc, yet it was slow enough to allow its complete absorption, thereby enabling it to exert its peculiar constitutional effects, and at the same time removing the diseased mass in a few weeks.“ (p. 59.)
In certain anses he employs an ointment containing sulphate of zinc, alternated with one containing jodide of lead. He exhibits internally iodidle of arsenic, as suggested by the late Dr. A. T. Thomson.
We maintain that the whole efficacy of Dr. Fell's treatment is due to the chloride of wine; the only originality consists in scoring the eschar, and thus allowing the liquefied chloride to percolate through to subjacent morbid textures. We consider the pucooon to have no
" Sangamaria Canadensisjs vel ; chlor. zinci, js vel 3ü: aquæ, yü; pulv, sum, tritie Mid. H. & Mix, and form a paste the consistence of treacle." (p. 59.)
more virtue, as far as cancer is concerned, than so much liquorice powder. Not being imported into this country from the " Far West," it served the Doctor as a convenient vehicle for blinding some of his credulous visitors.
Those of our readers who desire further information respecting cancer-ourers, past and present, we would refer to Mr. Spencer Wells' ingenious and interesting Lecture, already quoted.
M. Velpeau, in a few pages at the end of his work, treats of diseases of the male breast. He expresses a belief that the extirpation or destruction, by caustics, of cancer in the mamma, affords a better chance of success in the male than in the female.
Erfahrungeu von JOHANN LUDWIG CASPER. Thanatologischer
1857. 8vo. pp. xxxi. 860. Practical Manual of Forensic Medicine. From Personal Observation
by JOHANN LUDWIG CASPER. Necroscopic Division. With Atlas
of nine coloured Plates. The name of Dr. Casper has been long familiar in the literature of medicine. It is now more than twenty years* since, in speaking of of his Weekly Journal of Medical Science,' we accounted for the value of that periodical by referring, as a leading cause, to the great talents and respectability of its chief editor. Then already extensively, and by no means newly, appreciated for his successful efforts for the advancement of science, Dr. Casper has never since relaxed in his exertions; and he has remained too conspicuous among the strenuous cultivators of medicine in his own country not to have frequently occupied a place in our pages. For an extensive series of years, it has been chiefly to points of statistical inquiry, or still more in relation to medico-legal topics of investigation, that he has directed his attention : while, with reference to the latter especially, it has been the advantage of his position, through the strict organization of the criminal code of Prussia, to have enjoyed peculiarly ample opportunities for observation, sustained, wherever necessary, by the most efficient co-operation on all points of more exclusively technical inquiry on the one hand, and constrained into careful elaboration by a system of organized checks and revision on the other; and thus singularly favourable, because admitting the greatest possible scope for the due application of the existing resources of science, while presenting the greatest devisable resistance to the ingress or the persistence of error.
It becomes daily more and more a matter of duty and necessity, to examine closely into the position of those who venture to proffer instruction to us, in a science so vital in its interests as that of medicine; because the easy opportunities, now presented everywhere by a
* Brit, and For. Medical Review, vol. iii. p. 461,