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spaces; yet there appears to occur here also metamorphosis and increase of the osseous corpuscles. The same holds true of the myeloid tumours, which are only distinguished from the sarcomatous tumours by the occurrence of the great myeloid cells, which also arise from the areolar-tissue cells. Even so is it with scirrhus and encephaloid; at least, I have seen the development of these from the areolar tissue, as well in the neurilemma and sarcolemma, as also from the so-called muscle-nuclei themselves, in several scirrhous and encephaloid tumours. . . . . The most interesting transformation is that which the areolar-tissue cells exhibit in the origin of epithelial cancer or cancroid. . . This can be particularly finely followed in cancroid of the lip; and here the areolar-tissue running among the muscle gives the best opportunity for observation. I have figured the gradual transformation of the areolar-tissue-corpuscles from cleavage, and also sometimes from endogenous generation, to great heaps of cells with epithelial character, and with an acinose arrangement. From the pressure of these the muscular substance is gradually destroyed, just as in suppuration. In the same way occurs the development of epithelial cancer in the bones; and I have now before me plates, delineated in the year 1855, which show this development out of the areolar tissue of the Haversian canals.
We see, therefore, that in most new formations the areolar-tissue cells take the part of brood-places. Why, in the one case, the product should be a rapidly evanescent one-as the pus corpuscles; in another, a spindle-formed cell, or a like-figured nucleus-as in the fibroid and sarcoma; in the third, a round many-nucleated cell or large pale clear nuclei-as in scirrhus and encephaloid; or, lastly, in another case, a cell of epithelial characters, with proportionably thick consistent cell wall; that is a question that we are not at present in a condition to decide."*
Billroth, in his last interesting work, has arrived at opinions nearly similar. At the end of his essay on tumours he concludes:
"That the source of all cell formation excited by pathological processes (whether the cell-formation leads to the formation of solid or fluid tissues), is found principally in the areolar tissue, and indeed in the cells and nuclei of these; and the nuclei and cells of the other tissues partake of this either not at all, or in a slight and secondary measure."†
And in another place, Billroth remarks on the similarity and dissimilarity of chronic inflammation and formation of tumours, in these terms:
"However close in many relations chronic inflammation and tumour-formation stand, they are clinically easily distinguished; for chronic inflammation at last becomes extinct, the cell-formation ceases, retrocession occurs, and the process can so heal. But in tumour-formation, the cell and tissue formation is unlimited, it goes on relatively ad infinitum; here and there local retrocessions occur, yet the process never perfectly heals, unless the tumour is thrown off by gangrene."
It is apparent that these opinions are in fact a wide generalization, approaching to each other a great number of formations, and simplifying exceedingly our mode of regarding them. But what, then, our readers may say, becomes of malignancy and benignancy as characters of tumours? Why, at present Virchow is disposed to look upon malignant tumours as possessing a kind of contagious property; that is to say, in the neighbourhood of a malignant tumour the cells are * Archiv für path. Anat., Band xv. p. 525. 1859.
↑ Beiträge zur path. Histol., p. 79. 1858.
Billroth, p. 65.
irritated (perhaps by the passage into them of the fluid formed by the diseased cells, percolating into them, or attracted by them, and then taking on the same formative activity. And indeed Van der Kolk long ago showed for how great a distance round a cancer the germs of the disease were spread, so that tissues apparently healthy to the eye were in reality profoundly diseased. In favour of Virchow's view is the fact that the tumours with most juice are most malignant; and dry, fluid-free tumours are generally harmless. A cancer then grows in this way, and also by conveyance of its irritating fluid or corpuscular germs to a distance by lymphatics and veins (in some cases).
As an almost necessary consequence of these opinions, Virchow entirely disowns the doctrine of the constitutional origin of tumours. He does not believe in a mysterious general cancerous dyscrasia, for example, which manifests itself by the formation first of one and then of another tumour. No, first of all is supposed to occur in all these cases the local affection (i.e., irritation of a cell, increased attraction of healthy plasma, increased growth), and then propagation from infection or from transportation of the fluid and germs, and contamination of the blood by the absorption of products from the local lesion. The dyscrasia, or constitutional disease, is in all cases, according to Virchow, entirely secondary. "Every dyscrasia is dependent on a permanent supply from certain parts of hurtful ingredients." (p. 119.) And this is the case with tubercle* as with cancer, with scurvy as with leukæmia.
We have now, as far as possible in Virchow's own words, given an outline of his cellular theory, and if we have been successful in our description, it will be seen that all parts of this theory hang well together. The common origin of every growth, of every cell is a preexisting cell, and originating in this common way, we are able to connect physiological and pathological growth, and to more or less clearly explain where and why several processes diverge. As so great importance is given to the cells, and as both vessels and nerves are ranked as quite secondary agents in the phenomena of inflammation, of the formation of pus, and of the growth of tumours, we recognise the propriety of the term Cellular Pathology.
If it shall turn out that these views are supported, there is no doubt that Virchow has made a vast step forward, and that a very simple and grand expression of morbid phenomena has been given. But many of the statements are not only novel, but are based on propositions still greatly controverted, as, for example, the existence of areolar-tissue corpuscles. Other statements evidently embrace only part of a subject. If, for example, there are no general dyscratic diseases, in the usual sense of the term, but if there is in every case a local origin, what is the local origin of small-pox, which sometimes kills before a pustule is seen? or of the other diseases of the class which begin with general symptoms, and then at a certain stage show local phenomena in a
For Virchow's opinions on tubercle, which we have not space to describe here, we may refer to Dr. Jenner's review in this Journal, in Jan. 1853.
particular part. Again, in the case of cancer, is there really nothing in all those arguments which only a few years ago were supposed to prove indubitably that every local manifestation in cancer is but the topical sign of a general constitutional state? And are the opinions on phthisis to undergo so radical a change that we are to look upon it entirely as a local disease, until by continued absorption of hurtful substances the blood and other parts are contaminated? Certainly not without grave consideration ought we to abandon views formed after full inquiry and no little careful experience. In medicine, as in all other things, we must give way to facts, but we are not called on at once to admit the truth of opinions which go against our accepted doctrines.
Now, Virchow's statements of the local origin of dyscrasia are given so briefly and with so little or no reference to clinical facts, that they can scarcely be looked on as more than hypotheses. That there is truth in the local production and absorption of hurtful substances, from chronic inflammation and from many tumours, we have no doubt. That is a doctrine by no means new, but that it expresses all the phenomena of cancer, for example, is most certainly "not proven."
And as in the doctrine of inflammation we seemed to see that with much real truth Virchow has mixed up hypothetical explanation, and to make his view consistent has thrown into the background such important phenomena of inflammation as hyperemia and nerve-implication, so in his statements on tumour it seems to us that he has been too anxious to break entirely with old doctrines, and to look at everything from the point of view which he has chosen.
We have hitherto selected for comments those parts of this book which seem to us most essential and fundamental in the doctrine of the "cellular pathology." But the work is not limited to these subjects— it glances at the whole of pathology, and discusses with great ingenuity almost all morbid processes. We have not seen in any of Virchow's writings so good a description of Embolie, Thrombus, Pyæmia, Melanæmia, Leukemia, Rickets, Atheroma, &c. So also the histological account of the tissues is extremely simple and good. We could have wished to have discussed many of these subjects, but this article is already too long, and we can only hope that our readers will study the work for themselves. We can assure them they will have some real enjoyment, and when they disagree, will disagree with respect and admiration for the author.
1. Lettsomian Lectures on Syphilis. By VICTOR DE MERIC, Esq., Surgeon to the Royal Free Hospital, and to the German Hospital, Dalston.-1858.
2. Lectures on Chancre. Delivered by M. RICORD, Surgeon to the Hôpital du Midi; published by FOURNIER, with Notes and Cases; and translated from the French by C. F. MAUNDER, Demonstrator of Anatomy at Guy's Hospital.-1859. pp. 244.
3. A Treatise on Syphilis in New-born Children and Infants at the Breast. By R. DIDAY, Surgeon to the Hôpital de l'Antiquaille, Lyons; translated by G. WHITLEY, M.D. (The New Sydenham Society.)-London, 1859. pp. 272.
How can we explain the discordance of opinion which exists on the subject of syphilis! Is the disease as seen in the London hospitals different from that which prevails in France? Do modern syphilographers understand in a peculiar sense the terms hardness and softness? Are constitutional symptoms influenced by national habits or temperature? We confess to a feeling of surprise at reading controversial works, and listening to dogmata which unite only in one point of view-namely, in putting the whole subject in lights which it never enjoyed before. But from this war of words a theory has sprung which, if true, simplifies-but, if untrue, tends to confuse; and it is to this subject that we shall in the first place chiefly confine our attention: we mean the teachings of that school of which M. Ricord is the founder and head.
A word upon the origin of the disease:
"It is perfectly certain," says Mr. De Meric, "that previous to the general spread of the disease in 1493-95, no ancient or medieval writer had given a description of the complaint, as seen and depicted by Joseph Grundbeck, Benedictus, and Leonicenus, who wrote in 1493-95; these authors being the first who published an account of the malady." (p. 3.)
No one, we add, is likely to witness the malady as Benedict has depicted it.
"I knew," wrote this trustworthy and learned man, "some honest and religious nuns, confined in the strictest manner, who unfortunately contracted the venereal disease from the peculiar state of the air, together with that of the putrid humours and the weakness of their habits of body."
From the profundity of the wisdom of the ancients, it was supposed that infection might be communicated by the use of holy water contaminated by a person suffering from the disease; that a "young lady of the period" might catch the pox by being sprinkled with the asperges" at the church door. "But," quietly sneered Fallopius, "the disease must have been contracted per unum asperges' ego scio."+ Heretofore we were content with squabbling as to whether the venereal disease first broke out at the siege of Naples, or whether it
Benedict V.: Tract. de Morbo Gallico, cap. 3.
† Ibid., cap. 13.
was imported with other western produce by Christopher Columbus from the New World. The vulgar view of the case, that whenever the laws of nature are offended, as by one female receiving the embraces of a number of men, disease is as sure to ensue as that typhus fever will follow overcrowding, is generally rejected as unscientific; and we plunge accordingly into the obscure legends of the past.
But of all stupendous assertions, unsupported by any argument or facts, is one of Van Helmont, revived by M. Ricord, which throws common medieval myth into the shade-namely, that syphilis is a modification of glanders, transmitted from the horse to man.
"Now it was not known," says M. De Meric, "at the period alluded to, that this latter disease was communicable from the horse to man; and it has since been suspected that some of the loose female characters, already labouring under simple ulceration, and hovering round armies, might have been infected by an individual suffering from glanders, or having about him some infectious secretion originating from a diseased horse. A mixture of the poison of glanders with the unhealthy and decomposing secretions of dissolute females, may have given rise to the dreadful malady which has for centuries undermined the health of generation after generation. Proof there is none; but a tolerable share of probability."*
We have thus, by way of simplifying the question of the origin of the disease, a portal opened to the whole range of veterinary surgery, in addition to that of archæological research; and we see no reason why speculation should not likewise be extended to the probable effects of the introduction of canine and bovine maladies into the human race, and thus avail ourselves of additional disquisitions calculated to afford delectation to those curious in startling assertions. But let us pass from this unprofitable subject. Cause and effects obey in the history of disease one fixed and immutable law; and we find that when ancient writers confine themselves to describing facts as they saw them, the phenomena which they record differ in no essential manner from those witnessed under similar circumstances in the present day.
Now we read a great deal about the enormous host before Naples, assembled by Charles VIII., King of France; of the length of the siege; of the many causes of disease generated in the camp. What are the facts? That monarch marched into Italy in the month of August, 1494; he had to make his way through Etruria and the Papal States; and he marched out again in October, 1495, leaving behind the Duke de Montpensier, with six thousand men. Why, the whole campaign lasted but little more than one year! It was carried on in a cultivated country, and during the greater part of the time the troops must have been in movement, and therefore more healthily employed than in lying listlessly before a beleaguered place. How comes it that if the tremendous malady of which Gilinus and Leonicenus and others wrote, sprang from this "puddle in a storm," similar results have not been witnessed in the vast assemblages which have characterized the warfare of modern times?
*De Meric: Lettsomian Lectures, p. 4.