sary muscle-making material were it not for the child's astonishing capacity for consuming its own weight of such food in a comparatively short time. The adult in attempting to live exclusively upon bread and butter would find that he could not eat sufficient to sustain him. And hence it is that children will thrive under the same conditions that infallibly conduce to scurvy in the adult. It is remarkable that the many different authors writing upon this subject should not have observed this.

The great desideratum, then, in catering for the mercantile marine, with a view to prevent the occurrence of scurvy, should be that the sailor be provided with good flesh-food; and since salt meat must of necessity always form the basis of his dietary, every care should be taken that it be of recent pickle, bad salt meat being too commonly the cause of the disorder. Nothing would tend more to stamp out scurvy from our seas than Government making it compulsory on ship-owners not to ship their meat-supply as salt meat, but compel them to take it in as fresh meat, and thus ensure its being laid down in the brine within a week of the vessel's sailing. This plan could not fail to secure to the sailor a supply of wholesome meat, whereas as the law stands, he may have palmed upon him the vilest trash, the pickle-tub being made the receptacle of all that is loathsome. The carcase once in the brine, there is an end to all history as to its mode of death; neither do we know how long it may have been "sepulchred below;" and consequently many a ship is sent to sea with scurvy in the tab.Lancet, March 27, 1869, p. 424.

12.-ON THE TREATMENT OF CANCER BY ARSENICAL MUCILAGE.

By Dr. ALEXANDER MARSDEN, Surgeon to the Cancer Hospital, London and Brompton, and to the Royal Free Hospital.

The arsenical mucilage mode of treatment is applicable to all forms of cancer, except the cystic or colloid, provided they have not exceeded certain limits, viz., four square inches, and then not more than a fourth must be attacked at once. When a cancer has exceeded this limit, I know of no means that ought to be used to extirpate it but the knife; and it must not be supposed because I so strongly recommend the arsenical mucil-· age, that I would discard the use of this instrument altogether; for in some cases it is our only hope.

The paste may be applied to cancers situated on any part of the body except inside the mouth or nose, parts, in fact, where the use of the curative agent would be dangerous. I do not

recommend its use when the disease is deeply seated, but for many cancers on or near the surface, this mucilage is the least painful and the most certain remedy I know. During the last seventeen years I have fully tried every known caustic, and now firmly believe that this is the best.

The application of arsenious acid is not new; it has been used in various ways and compounds, but hitherto such success has not attended its use, as to make it appreciated as it ought to be. The mode I adopt is as follows. A thick paste of arsenic is made according to the following formula

Arsenious acid, 3 ij.

Mucilage of gum acacia, 3j.

To be well mixed together, and made into a thick paste. The patient's health having been attended to, the whole of the cancerous surface is to be spread over with this paste, provided it is not more than a square inch, and it must be sufficiently thick not to run; a piece of dry lint is then pressed on to it, overlapping the paste half an inch all round; this must be left for a short period, say ten minutes, by which time any superabundant paste will have been taken up by the extra lint, which is then to be carefully cut away with a sharp pair of scissors; in an hour, or at most two, the lint covering the paste will have become dry and hard, and it will adhere closely and firmly to the cancer. In the course of twenty-four hours the surrounding parts will commence to swell, become red, and to a certain extent inflamed, and the patient will experience a drawing pain. In general this is by no means severe, and does not last more than one or two days. At the expiration of frotn forty-eight hours to three days, according to circumstances, bread-and-water poultices are to be constantly applied and changed every two or three hours; the pain, redness, and swelling will by this time have subsided, and a distinct line of demarcation be seen extending entirely around the cancerous inass; the skin ulcerates, and a fissure is formed, separating the slough from the healthy tissues; the fissure continues to deepen, until the entire cancer comes away, leaving a healthy cup-like depression, varying in size and depth according to the mass removed. Healthy granulation will now commence and it will be well to continue the poultices for some time; indeed it often happens that no other application need be used. Of course we must be guided by circumstances, for granulation proceeding too rapidly, too slowly, or in any abnormal manner, must be treated according to the known rules of surgery. Great diversity will be found as to the time of the slough coming away, in cases of small extent and not extending deeply into the tissues, the periods will vary from six to fifteen days, but in those of greater size, from twelve to thirty. In some instances only one application of the

paste will be necessary, but it will in general be found advisable to apply it every second or third morning, till the desired effect is produced; no rules can be laid down as to how often this must be done; the experience of the surgeon and the progress made must decide. When it is intended to re-apply the paste, the former piece of lint must be carefully soaked for some time with warm (not hot) water, and after it has come away, the mucilage be used as before, recollecting that until the last application that is intended has been made, poultices as a rule are not to be used, unless under special circumstances; and that after a decided line of demarcation has been formed, no more paste is to be applied. In general it will be found that after the slough has come away, the whole of the disease has been removed; but sometimes this will not be the case, and then the mucilage must again be had recourse to; in others it will be found desirable to remove a portion of the dead cancer before another application of the paste. This, however, is only necessary when the cancer becomes hard and callous, and will not allow it to penetrate. I have also used this remedy in some cases after operation by other means. For example, not very long ago, a gentleman applied to me; he was suffering from a pedunculated epithelial cancer, situated below and a little behind the right ear, quite of a mushroom shape. The broad flat part was four inches and a half in circumference, half an inch thick, and grew on a stem less than three quarters of an inch in diameter. It was removed in a moment with a noose of silver wire. but the root still remained; one application of the paste brought this perfectly away in eight days, and a fortnight after the patient was well. Neither the knife or ecraseur could, I think, have accomplished this, and no other caustic would have performed the task so cleanly and satisfactorily. One of the most pleasing and wonderful phenomenon connected with the mucilage is the extraordinary power of election it appears to possess; for if put on with only ordinary care, the cancer alone is attacked, the healthy structures remaining untouched, and the disease ultimately rolling out of a perfectly healthy wound.

This treatment I have used with equal success in cancer on the lip, face, head, arm, hand, abdomen, breast, penis, testicle, labium, scrotum, and foot. I have never seen any bad results from its use, except in one case, and in this the evil was temporary only, and occurred in one of our earlier cases, some years since. At the same time I must caution those who are inexperienced in its use, that it is a dangerous remedy in unskilful hands, and requires constant watching; neither can it be used, as I before stated, to cancerons surfaces of greater extent than four square inches, and then only a small portion must be attacked.

Many cases of scirrhus and medullary cancer are amenable to this treatment, particularly at an early stage, but to the epithelial it is peculiarly adapted. It is true that this form of cancer is frequently found to attack the tongue; and that except in the earlier stages of the disease, carcinoma of this organ presents to the surgeon a truly difficult task; but on other parts of the body we have this variety under very great control. I may say that a patient suffering from epithelial cancer, coming under treatment at anything like a reasonable time from the first attack, may, in nine cases out of ten, feel sure of a perfect restoration to health; such was not the case ten years ago. This reassuring fact becomes more valuable when we consider that of all the forms of cancer, about one in four is epithelial.-Marsden on Cancer, p. 60.

13.-ON THE PATHOLOGY OF FATTY DEGENERATION. By Dr. EDWARD LATHAM ORMEROD.

The pathology of fatty degeneration may be summed up in a few lines. And, as a preliminary, I must confess that a very attentive study of fatty degeneration continued through many years has much diminished, in my eyes, the importance of the specific character from which the process takes its name. Grave as are the diseases with which it is connected and on which it ensues, the fatty change itself is comparatively of little moment, and quite secondary to the degeneration, in date as well as in importance.

It is an infiltration of fatty matter which is derived immediately from the passing blood, or is made on the spot under its influence. And, as far as concerns the human subject, it is not the physiological form of fat, margarine, which is thus infiltrated, but oleine.

The structures which are infiltrated in this manner must be previously disorganised, the infiltration being a consequence, not a cause, of the disorganisation. Structures in healthy vital activity either do not admit of such infiltration; or, where their physiological constitution allows of this, they have the power of clearing themselves of the oil. They must be disorganised, but they must not be dead, as far as death implies liability to chemical decomposition or disconnection with the current of the circulation. For, experiments show that, under such circumstances, fatty degeneration, as expressed by the formal replacement of healthy structure by fatty matter, never ensues. -St. Bartholomew's Hospital Reports, Vol. IV., 1868, p. 67.

DISEASES OF THE NERVOUS SYSTEM.

14.-ON HYSTERIA.

By DR. SAMUEL WILKS, Physician to, and Lecturer on the Practice of Medicine at, Guy's Hospital.

As in hysteria the nervous system is deranged, so every part of the body may suffer-the function of every organ may be disturbed, as well as the nerves themselves disordered in all possible manners. Let us look to some of these irregularities. First, the nervous system proper may suffer.

The motor system may be depressed or excited; thus paralysis is a very common hysterical symptom, affecting more especially the lower limbs. A leg cannot be moved, or both legs are the subject of paraplegia. As, in such cases, the cause is want of nervous energy, so you will perceive the peculiarity of these cases that rousing of the will is often sufficient to put fresh vigour into the system and cure the complaint. A sudden alarm has often cured the patient who has been considered as hopelessly paralysed, and this gives us an insight into the correct treatment. I need not dwell further on this subject, as I have already on more than one occasion shown you the importance of the moral treatment of hysteria. A young lady has a complaint of an imaginary kind, and you visit her daily, and treat it as if it were a reality; the consequence is that it is perpetuated, and you have assisted in making it a perpetuity. You understand the real seat of the complaint-you attack that, and cure your patient. When I have had under my care here cases of paraplegia of years' duration, most assiduously treated by medicine, and at length cured by moral means, I cannot speak too highly of the method. These cases are not often difficult to diagnose, since in a real paraplegia the patient grows thin, bedsores appear, paralysis of the bladder and rectum may be present, and the patient feels ill, whilst in the case of hysterical paraplegia the patient remains plump; there is no trouble with the bladder, or if any, it is retention of urine; the abdomen is tympanitic, bowels confined. The physiognomy of the patient and her surroundings sufficiently indicate the nature of the case. She has taken to her bed as if for the remainder of her days, and all is arranged accordingly-the stitching, the embroidery, the religious books where they can be comfortably reached, and she generally receives more sympathy from the clergyman and the lady visitors than do cases of real illness. The fact is that there are no painful and loathsome circumstances attending her case, and, from her conversation and industry with her hands, it is regarded as an "interesting" one.