weak, to which it gave milk, and which grew up healthy and strong. The young mother gave more than milk enough for its kid, grew up to full size and strength, and twice afterwards had kids.

Processes following the Discharge of Ora; formation of Corpora Lutea. Dr. Dubini has carefully examined the ovaries in the bodies of many women, and has found-1. That in those who have never menstruated the ovaries have never shown any trace of cicatrices; but in those who have menstruated, cicatrices were never absent. 2. That in a few cases the ovaries of women who had been recently [but how recently?] delivered presented no corpus luteum. 3. That the number of the so-called old corpora lutea, i. e. of vesicles with thick opaque white walls, and deeply wrinkled, which are found in the ovaries of different women, bears no relation to the number of children they have borne.

M. Raciborski† states that in regard to the formation of these bodies, which he supposes to consist in the "concentric hypertrophy" of the internal or granular membrane of the Graafian vesicle, there are characteristic differences between the females of the human species and of other mammalia. In the cow, ewe, doe, &c., the corpora lutea begin to be formed directly after the expulsion of ova, and they are just the same, whether the ova are impregnated or not; they are always genuine true corpora lutea. But in women, if the ovum expelled at any menstrual period is not impregnated, the hypertrophy of the internal layer of the vesicle is soon arrested, and it remains a thin yellow membrane in contact with the more or less altered clot of blood. If it is impregnated, the consequent process is different, but in degree only, not in kind; in this case the hypertrophy goes on, till very shortly the cavity of the vesicle is almost completely filled by the accumulated substance. And in this admission of the differences between the corpora lutea, according as the ova are impregnated or not, Berthold ‡ agrees; holding, I think, that the purpose of the development of the true corpus luteum is that a process may be going on in the ovary which may exclude the ordinary maturation and discharge of ova during gestation.

Some elucidation of what is thus roughly, though correctly, described as hypertrophy of the inner membrane of the Graafian vesicle, is afforded by the inaugural dissertation of Dr. Zwicky,§ who has minutely examined the formation of corpora lutea in cows and sows. The general results of his investigations may be thus briefly stated:-at the period of heat, when the ova are about to be discharged, the Graafian vesicle becomes more vascular and enlarges; serum is more abundantly secreted into it, and its membranes thicken. The cells also, part of which form the granular membrane of the Graafian vesicle, while part float in its fluid, are changed before the exit of the ovum. Flocculi appear in the fluid, and vascular folds and villi on the inner surface of the vesicle, which all consist of the altered cells. Some of the cells are changed by elongation into small narrow fibrous cells, which at last become fibres of imperfect fibro-cellular tissue; and others are changed into larger round or ovate cells, which also, unless they burst, are ultimately changed into similar fibres. And again, some other cells become four, or five, or even ten times as large as they were, and very finely granular; their nuclei also become larger and clearer, and their nucleoli more evident. Their enlargement appears to depend on the accumulation of the little fat-granules which the Graafian vesicles always contain. As they increase they pass from the round or ovate, into the oblong or acuminated form. The fat-granules and other fatty particles are those in which the yellow colour of the corpus luteum, when it exists, is contained.

When the ovum is discharged through the ruptured Graafian vesicle, blood is

• Annali Univ. di Medicina, Febbr., 1845, p. 277.

+ Report from the Acad. des Sciences; Gazette Médicale, 23 Nov. 1844. Ueber das Gesetz des Schwangerschaftsdauer; Göttingen, 1844, p. 17.

De Coporuin Luteorum origine atque transformatione; Turici, 1844, 8vo.

effused into the cavity, in the sow, but not, according to Zwicky, in the cow. The blood about half fills the enlarged cavity, After it has coagulated, it becomes gradually more solid, being compressed by the wall of the vesicle, which is both growing thicker and contracting. Thus compressed, and encroached on by the increasing and enlarging cells of the interior wall of the vesicle, the clot at last disappears, having, it would seem, contributed little to the formation of the corpus luteum.

The wall of the vesicle, after the exit of the ovum, is from half a line to two thirds of a line in thickness, and it continues to increase inwards by a continuance of the same process of multiplication and enlargement of its cells as preceded the discharge of the ovum, till, at length, the cavity of the follicle is completely filled. While it is thus increasing also, one portion of its fibrous cells are combined in fasciculi of connective or fibro-cellular tissue, which, traversing the whole mass, hold it together, and support the blood-vessels which run through it; and another portion are placed promiscuously between and among the large round cells. As soon as by this growth of the inner membrane of the Graafian vesicle its cavity is filled, its period of involution or degeneration begins; it grows smaller, more solid, and dries. In this change, some of its large round or ovate cells become narrow, and assume the appearance of fibres; and the longest, which are not thus changed, burst, and probably are absorbed with their contents.

The corpus luteum in this process of involution consists of only fibrous cells in various stages of development, and a large abundance of fatty matter. The fibrous cells become narrower, and their nuclei being drawn out, the whole gradually puts on the appearance of uniform slender cylindrical fibres, like those of immature fibro-cellular tissue. By these the walls of the Graafian vesicle are thickened, or else, as in cows, the fibres after a time coalesce with the stroma of the ovary, and can no longer be separated from it. And the end of the corpus luteum is, not that it is absorbed, but that it is lost sight of when this transformation of its component cells into fibrous tissue, like that of the stroma of the ovary, is complete.

Gestation. Dr. Berthold estimates that parturition after healthy gestation takes place when the ovary, having omitted during pregnancy the maturation of nine menstrual ova, is preparing for the maturation and discharge of what, in the unimpregnated state, would have been the tenth. The proper period of gestation+ will thus be equal to the interval comprised between the beginnings of ten menstruations, minus from ten to fourteen days. The above-named interval will not be always the same, while in different women, and in the same, under different circumstances, the intervals between the successive menstruations vary; but it may be estimated as equal to the number of days which intervened between the beginnings of the ten menstruations before the pregnancy. On an average this period will be between 290 and 300 days; the ordinary period of gestation will therefore be between 280 and 290 days; but it may be as short as 273, or as long as 291 days, in those whose habitual periods are shorter or longer than usual. In those whose menstrual periods are very short, parturition may take place at the eleventh instead of the tenth period.

Dr. Berthold's evidence for his mode of calculation is, 1st,-in a few cases in which it has proved true; 2d, in an apparent analogy in the case of cows and

⚫ Ueber das Gesetz der Geschwangerschaftsdauer; Göttingen, 1844.

This expression is not correct, because gestation is not begun till impregnation has taken place. The calculations are here made as if gestation began on the first day of a menstruation; but impregnation may take place some days (probably not less than twelve) after that day, or perhaps a short time before it. If, however, this mode of calculation is so correct, that the knowledge of the day of impregnation is unimportant, we must certainly admit Dr. Berthold's theory, that parturition is determined, not by the age or state of the child, or by the state of the uterus, but by that of the ovary, when it is reassuming its periodical action after its inaction of nine of its ordinary periods; a theory supported by the fact that, in pregnant animals, removal of the ovaries always produces abortion, but great injury of the tubes has no such effect.

sheep, in whom parturition occurs a little before the day on which the tenth heatperiod would have fallen, if they had not been impregnated; 3d, in more distant analogies of some other periodic processes, such as the shedding of teeth and horns; 4th, the possibility of impregnation taking place in both women and animals within a few days after delivery; the ovum thus impregnated being probably that for the maturing of which the ovary was in preparation when parturition ensued; 5th, the apparently similar condition of the ovary shortly after delivery and shortly before the time of heat or menstruation.

Lactation. M. Dumas* has observed a constant difference between the milks of the truly carnivorous and the herbivorous animals, in that in the former the sugar of milk is either absent or exists in quantity too small to be extracted. But as soon as carnivorous animals (as bitches) are fed with bread or other amylaceous food, sugar is formed in the milk: and it disappears when their food is again made exclusively of animal principles. The casein of the milk of bitches is similar to that from the herbivora.

According to Dr. John Davy,† the coagulability by heat of the colostrum of the cow is due, not to its containing albumen, but to a peculiar modification of ca. sein in it. Its nutritive matter is more concentrated, it is more easily coagulated by rennet, and it is less readily changed by the action of atmospheric air than the later milk is. The human colostrum (according to the examination of a few specimens) is not peculiarly rich in nutritive matter, neither does it coagulate on being heated.

* Report from the Acad. des Sciences, Gazette Médicale, 4 Oct. 1845; and in the Ann. des Sciences Naturelles, Sept. 1845.

+ Medical Gazette, April, 18, 1845; and Medico-Chirurgical Transactions, vol. xxviii, 1845.

BOOKS RECEIVED FOR REVIEW.

1. Memoranda on Different Subjects in Anatomy, Surgery, and Pathology. By M. N. Bowen, Surgeon. Second Edition. London, 1846. 24mo, pp. 259. 3s. 6d.

2. A Practical Manual, containing a Description of the general Chemical and Microscopical Characters of the Blood, or Secretions of the Human Body. Part II. By J. W. Griffith, M.D., F.L.S. London, 1846. 8vo, pp. 164. 5s.

3. Remarks on the Dysentery and Hepatitis of India. By E. A. Parkes, M.B. London, 1846. 8vo, pp. 271.

4. Remarks upon Medical Organization and Reform, Foreign and English. By E. Lee. London, 1846. 8vo, pp. 121. 4s. 6d.

5. The Mineral Waters of Kreutznach. By J. E. P. Prieger, M.D. Lond. 1846. 8vo, pp. 92. 3s. 6. Notes and Recollections of a Professional Life. By the late W. Fergusson, M.D. Edited by his son, James Fergusson. London, 1846. 8vo, pp. 248.

7. Flora Capensis. Contributions to the Botany and Topography of Gibraltar. By E. F. Kelaart, F.L.S., F.G.S. Lond. 1846. 8vo, pp. 219.

8. Moral Philosophy; or, the Duties of Man considered in his Individual, Domestic, and Social Qualities. By George Combe. Third Edition. Edinburgh, 1846. Royal 8vo, pp. 116. Double columns, 2s.

9. Outlines of the Course of Qualitative Analysis followed in the Giessen Laboratory. By H. Will. London, 1846. 8vo, pp. 103.

10. Bericht über die durch den Gebrauch des Microscopes in dem Studium der Anatomie und Physiologie erhaltenen Resultate, den Ursprung und die Verrichtungen der Zellen. Von Jakob Paget und Dr. W. B. Carpenter. Aus dem Englischen übersetzt von Dr. Raimond Melzer. Augsburg. 1845. 8vo, pp. 160.

11. Bericht über die Fortschritte der Menschlichen Anatomie und Physiologie im den Jahren 1843-4. Von Jakob Paget. Aus dem Englischen von Dr. Raimond Melzer. Augsburg, 1846. 8vo, pp. 174.

12. Commentary on the Hindu System of Medicine. By T. A. Wise, M.D. Calcutta, 1845. 8vo, pp. 431.

13. Clinical Illustrations of the Diseases of India, as exhibited in the Medical History of a Body of European Troops, for a series of years from their arrival in that country. By William Geddes, M.D. London, 1846. 8vo, pp. 492.

14. Elements of the Theory and Practice of Medicine, designed for the use of Students and Junior Practitioners. By George Gregory, M.D. Sixth Edition. London, 1846. 8vo, pp. 799. 16s.

15. Phrenology considered in a Religious Light. By Mr. John Pugh. London, 1846. 8vo, pp. 2

208.

THE

BRITISH AND FOREIGN

MEDICAL REVIEW,

FOR OCTOBER, 1846.

PART FIRST.

Analytical and Critical Reviews.

ART. I.

The Nature and Treatment of Cancer. By W. H. WALSHE, M.D., Professor of Pathological Anatomy in University College, Physician to University College Hospital, and to the Hospital for Consumption and Diseases of the Chest.-London, 1845. 8vo, pp. 590.

WE proceed with our analysis of the second division of this valuable work, in which the disease is described as it affects various organs, tissues, and parts.

CANCER OF THE DIGESTIVE ORGANS AND APPENDAGES.

1. Lips. Labial cancer, without being very common, is of tolerable frequency. There is some variety in its mode of origin and progress. It may commence by infiltration of scirrhus in a limited portion of the lip, underneath the skin, at its junction with the mucous membrane. After a time one of these tissues gives way, leaving a fissure which discharges a thin acrid fluid that dries into a scab. When this falls, or is torn off, it is reproduced, until, as the ulceration advances, no more regular scabs are produced, but fungous granulations spring up from the scirrhous basis. In some cases, the first symptom is said to be a fissure, which resists all treatment. It has been known to commence as a cutaneous warty excrescence, or, as described by Dr. Warren, as a pustule; and it is most certain that venereal ulcerations of this part sometimes become cancerous, though the frequency of such an event has been much exaggerated. But, however commencing, as the disease advances, the skin, mucous membranes, and labial glands form a prominent mass, which, combined with the fungous productions from the sore, produce an abundant slaver that constantly escapes over the lip, and irritates or excoriates the neighbouring skin. The ulceration may spread over the entire cheek, and even part of the external ear. It may affect the maxilla, and has even been known to reach the sternum. The salivary and lymphatic glands become enlarged

and painful, and, especially the latter, may partake of the diseased action. General contamination of the system is comparatively rare. Scirrhus is the usual form of cancer in this part; encephaloid has rarely, if ever, been observed. It is excessively rare in females; and is almost invariably seated in the lower lip. The only affection with which it is likely to be confounded is venereal ulceration with indurated base; in many cases the history is the only diagnostic guide.

When the ulceration is superficial, it may sometimes be successfully treated by caustics, the acid nitrate of mercury and the chloride of zinc being the best. It is generally supposed that excision is more successful here than in other parts; but there has been much exaggeration on this point.

2. Gums. The term epulis is applied to all solid growths from the gingival membrane of either jaw. Cancerous epulis is generally of the scirrhous species. It is more common in the lower than the upper jaw, and usually appears at the reflexion of the membrane on the alveolus, towards the last incisor or bicuspid teeth. It commences by infiltration; but a tuberculated nodule, sometimes with very deep anfractuosities, soon results. It generally varies in size between that of a pea and a nut, but has been said to attain the bulk of a walnut. Ulceration eventually takes place, the sore fungates and sometimes bleeds, and the discharge is peculiarly fetid. The disease destroys the soft parts, and may, but rarely, affect the bone. It is most common in advanced age and in males. There is usually lancinating pain. It is distinguished from the flabby, fungous granulations which sometimes form in the gums, near carious teeth, by its density, its tuberculated shape, and pale colour; and from erectile epulis, by the pulsating characters of the latter. From simple epulis it can scarcely be known, excepting from the result of operation.

3. Tongue. Lingual cancer is tolerably frequent. Out of 8289 fatal cases of cancer, reported in the Paris registers, in 36 the main disease was seated in the tongue. Scirrhus is the usual form; but the fungous excrescences sometimes exhibit the encephaloid character. It may commence as a small, somewhat knotty, and irregular tumour, which is generally seated in the anterior part of the organ, midway between the raphe and the edge, and rarely extends beyond the middle line; or the first appearance is a small excrescence, which in some instances is said to become pedunculated. In a few rare cases simple ulcers become cancerous; and still more rarely the morbid matter is deposited in erectile tumours. In either case the surface ulcerates, and the glands become affected in the usual way. Distant organs are not commonly implicated. Acute pain is not a constant symptom; but there is generally an aching sensation, with occasional sharp pangs, darting towards the ear. One of the most distressing concomitants is the necessity for incessant sputation. There are, of course, pain and difficulty in speaking, mastication, and deglutition. These increase with the progress of the disease, until the performance of these functions becomes impossible. The cachexia is frequently intensely marked, and the sufferer is commonly cut off by its progress. According to Mr. Travers, strong and healthy males, æt. 40 and upwards, are the most usual subjects; but the disease is not unfrequently observed in females, and much younger persons.