for bone; but true bone, as pointed out by Dr. Walshe, never occurs independently of the presence of natural osseous tissue, from which, however, osteophytes, piercing into cancerous tumours, often spring. In addition to these two forms of decay, Dr. Bennett describes a third, in which the cells break down because they have arrived at the natural term of their existence, and are not supplied with the necessary blastema to enable them to originate another generation. But we do not see that he has brought forward any evidence to show that this would not occur in the usual way, viz. by development of granules between the cell-wall and nucleus, leading to the destruction of both.

While, however, there is no doubt that cancer often undergoes this degeneration, in part or wholly, it is certainly uncommon for a cure to happen in this way; a temporary suspension of symptoms may occur, but generally decay at one point is more than compensated by rapid increase at another. Nevertheless, occasionally a cancerous tumour will undergo unequivocal cure.

Before passing on to Dr. Bennett's chapter on treatment, we must briefly allude to his few remarks on statistics. He denies that, at present, we have a sufficient number of cases to enable us to make a numerical analysis, although "he anticipates the most important results by applying the principle of statistics to cancer." He asserts, however, that at present we have not more than 526 observations on tumours of all kinds, which can be depended upon; and he rejects as quite worthless the 9118 cases collected by Tanchou from the Parisian registers. We are disposed to agree with Dr. Bennett's anxiety to have his items as correct as possible, although we think he has underrated the accuracy of Tanchou's tables. Individual experience is daily confirming the main facts deducible from them.

3. What is the best treatment of cancer?

We have no intention of doing more than giving our readers Dr. Bennett's views on this point. They are, like many other parts of his book, original, ingenious, but rather doubtful. He divides our remedial measures into three sections: (a) means of retardation and resolution; (b) means of extirpation; (c) means of prevention.

(a) The means of retardation are those which are considered hostile to the growth of organized matter. Cold and pressure seem the two chief agents. Pressure is best applied by Dr. Neil Arnott's ingenious apparatus, which is figured by Dr. Walshe. Dr. Bennett also thinks that if the supply of nourishing blastema could be cut off in any way, the growth would necessarily decay. These agents of course attack only the local disease; the general constitutional state is left untouched by them.

(b) The means of extirpation are by operation and chemical erodents. Dr. Bennett alludes, under the head of excision, to the celebrated discussion before the French Academy in 1844, in which Cruveilhier alleged that fibrous tumours of the mamma were frequently and erroneously cut out for cancer. Dr. Bennett remarks that, at the commencement, no diagnosis can be made between a fibrous and a cancerous tumour, and that, moreover, into a true fibrous tumour cancerous blastema may at any time be poured; he seems inclined then to authorise ablation, whenever the tumour shows unequivocal signs of increase. He believes, indeed, that the results of operation are much more favorable than are generally sup

posed. On the other hand, Dr. Walshe's inquiries, as is well known, give a very unfavorable picture of the result of ablation.

Dr. Bennett's opinion, to be of any value, must be founded upon his experience of the operation. On examining therefore into his cases, we find the following results of his 33 cases of cancer, we find that operations were performed in 14. These cases are the following:

1. Observation I. This is headed "cancerous tumour of the breastexcision-cure." In this case we find a patient admitted in February 1847, under Mr. Syme, who cut out a cancer of the mamma which had commenced in the previous December. On the 18th of March the wound had healed, and the patient was dismissed in good health. The case is therefore headed "cure," but of course this is quite gratuitous; almost all operations do well for some time; it is idle to call anything a cure until the patient has passed years without a return. In the appendix accordingly we find that the tumour did return in November 1847, and in November 1848, it was of the size of a large foetal head, it had ulcerated, and was attended with extreme constitutional cachexia. This case then proves nothing for the operation, or rather speaks against it.

2. Observation II. In May 1847, a tumour, supposed to be fibrous, but really cancerous, was cut out from the neck. When the appendix was written, we presume at the close of 1848, it had not returned. Eighteen months, however, can hardly be considered a sufficient time, as cancerous growths often return two or three or even more years after extirpation.

3. Observation IV. Cancer of breast, cut out August 16th (we presume 1848, but it is not so stated) by Mr. Syme. When the appendix was written, the patient had not been heard of. But here the time is too short, whether the date be 1847 or 1848, even if the patient had been heard of.

4. Observation V.

Cancer of breast, removed by Mr. Fergusson

When

on 13th April, 1847. Up to October there had been no return. the appendix was written, Mr. Fergusson had not seen the patient again. Here, again, the case is worthless, as the time is much too short to enable us to say that the operation has not been followed by return of disease.

5. Observation VI. Cancer of breast-excised-returned-re-excisedre-returned.

This case is no argument for the operation. The second tumour appeared two years after the removal of the first.

6. Observation VIII. Cancer of cheek-excision-cure. Operation May 7th (1847 or 1848?), wound healed May 25. No return in November 1848. The period of probation here is only 6 or 18 months according to the date of the operation, which is not given.

7. Observation X. Cancer of testicle-excision-cure. Operation Sept. 1842. In 1848 no return. This was a case of cancerous growth from local injury.

8. Observation XI. Cancer of testicle-excision Sept. 1847. No return at the end of 1848.

9. Observation XXXV.

Cancer of mouth-excision some years ago— return soon afterwards-re-excision June 1848. No return when the

appendix was written.

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

11. Observation XLIV. Cancerous tumour on the finger and toeamputation 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 recommended by Dr. Bennett are rather hypothetical. After stating that all sorts of alteratives and tonics, mercury, iodine, 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 nucleolated 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 a 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 small 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 neighbouring 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 lamina 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 spherical, 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 Müller, 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