not produce more than its natural proportion of cardiac disease. And if the proportion of cardiac disease natural to acute rheumatism is at all like what occurred in the non-alkaline cases, we must believe that alkalies reduce the proportion of cardiac disease which belongs to unmedicated acute rheumatism. With this conclusion I should myself be most unwilling to withhold the use of alkalies in any suitable case. Those cases may be regarded as suitable where there is free generation of acid.

A few words of practical suggestion may form a not unwelcome conclusion. In order to obtain the best results from the alkaline treatment of rheumatism, it is necessary that it should be regulated with a watchful care. In the beginning of the disease, when there is rapid production of acid, the alkalies should be given freely, and, above all, frequently. Taking the urine as a guide, it should be made alkaline as soon as possible, and kept so with no intervals of acidity. To do this, the salts must be given at first in considerable doses, and at short intervals; three or four scruples every two or three hours, as ordinary treatment for an adult. As the disease progresses, and the acid tendencies of the patient diminish, it is necessary to lessen the strength and the frequency of the medicine in a gradual manner, with continual reference to the urine, guarding against excess of alkali towards the end of the disease as carefully as against deficiency at the beginning.

It appears to matter little whether potass or soda, vegetable salts or carbonates, are used. Citrate of potass may be given alone, or with acetate or bicarbonate. Nitre and acetate of ammonia are, at St. George's, not unfrequently used as adjuncts. The form of prescription may be safely varied according to the circumstances of each case and the fancy of the practitioner. Perhaps a simple solution of citrate of potass in water is as effective and as little objectionable as anything. This salt, or its equivalent, may be given in the general quantity of about an ounce in the twenty-four hours; rather more at the beginning of the disease, less towards the close. In most cases quinine or bark may with advantage be added as the active symptoms wane.-Lancet, Feb. 20, 1869, p. 254,

11.-ON THE CAUSE OF SCURVY, AND THE ACTION OF THE DIFFERENT SO-CALLED ANTISCORBUTICS.

By Dr. ARCHER FARE.

There have been many speculations with regard to the cause of scurvy; one authority affirming that it is owing to the absence of vegetables in the food taken; another maintaining that a deficiency of the salts of potash is the cause; while a third gives it as his opinion that it results from bad ventilation, deficient water-supply, wet seats, &c.,-all of which fail to explain the real cause of the disease. That scurvy is not owing to a deficiency of the salts of potash in the food of the sailor, and that salt meat contains all the elements necessary for nutrition, have been proved beyond doubt; while that the belief that fresh succulent vegetables or lime-juice are indispensably necessary to the cure of the disorder is an error, is proved by the fact that beef-tea and milk will effect a cure in the absence of both. If salt meat contains all the elements required for nutrition, how does it produce scurvy? Purely by its hard and indigestible nature as food, and its inability, from its resistance to peptic change, to supply for any length of time all the conditions necessary for proper digestion. Added to this is man's natural aversion to the continued use of one, and only one kind of food for any length of time. Physiology teaches us that the gastric fluid is secreted only in the presence of food; but that it ceases to be secreted, although food be present in the stomach, as soon as the wants of the system are satisfied. Now, what takes place during digestion where the only food employed consists of salt meat-sometimes of the consistence of buckhorn-and dry biscuit? The food remains in the stomach probably five or six hours, while the wants of

the system continue unsatisfied. All this time the stomach is being excited to secretion, while the gastric juice, from this exhausting secretory action, becomes deteriorated in quality, or in the end, perhaps deficient in quantity; and the result is that the whole digestive process is brought to a standstill. Scurvy, therefore, is the result of mal-nutrition. But we know that if limejuice or vegetables be added to the staple fare of salt meat and biscuit, scurvy may be prevented. And the prophylactic power of the lime-juice does not, as is generally supposed, depend upon its having any direct action upon the blood, but upon its immediate action on the contents of the stomach, by serving as the agent by which these hard ingesta become reduced and rendered fit for absorption-in fact, by taking the place of the gastric fluid. Now, what facts have we to strengthen this hypothesis? In the first place, that the solvent powers of the gastric fluid depends, for the most part, upon the acid it contains, it having been found to yield, on analysis, hydrochloric, acetic, lactic, malic, and phosphoric acids; one being capable of taking the place of the other. Hence it is that the acid wines and vinegar become antiscorbutics. Secondly, that the solvent effects of the different acids upon the fibrin of meat is well known, and is taken advantage of in making analysis of the contents of the different viscera in medico-legal investigations. We learn by experience that saur-kraut, spruce-beer, oranges, lemons, and their juices, and all kinds of esculent fruits and vegetables, possess more or less so-called antiscorbutic properties; also, that the acid wines, vinegar, brandy, molasses, pickles, and sauces tend greatly to prevent the occurrence of scurvy-indeed, it would be difficult to name anything contained in the category of eatables and drinkables which does not possess, to a greater or less degree, some antiscorbutic value. Now, it must be patent to all who possess the smallest knowledge of chemistry, that if vinegar and brandy serve at all to prevent the disease, it cannot be owing to the salts of potash they contain; while it is equally certain that they must operate in a manner quite different from that in whieh potatoes and green vegetables effect a cure. The juice of the lime and lemon, acid wines, beer and vinegar, act by virtue of their solvent effect upon the food contained in the stomach; whereas alcohol can only act through the medium of the circulatory system. The secret of vegetables and fruits being so potent as antiscorbutics is this: -The alimentary canal may be very appropriately termed a double organ, inasmuch as the animal food is digested by the stomach, and the vegetables by the intestines. Hence man has two distinct appetites, one for each kind of food-the animal and vegetable. He may eat to repletion of the one kind, and then partake heartily of the other. Is it not fair to assume, then, that, in the case of the scorbutic patient whose stomach digestion has been most imperfect, the intestines, which for weeks have been almost wholly unemployed, should, upon the accession of vegetable food, play an active part in supplying the necessary nutritive material to the system? Scurvy is to be prevented, then, in two ways: either by employing the stomach better, or by giving the intestines more to do.

Food should be so constituted as to contain within it the materials from which may be drawn all the primary elements of the blood; and no one kind of food is so rich in these as flesh, the fibrinous portions being the most essential. It is true that wherever scurvy has happened, whether on land or sea, it has always been in the absence of vegetable food; but what other condition is there that strikes one? That the fibrinous and albuminous portions have always been deficient in the materia alimentaria supplied, or they have been presented in such a form as not to admit of their being, for any length of time, properly and effectually reduced; the latter being the case where salt meat has been the cause, and the former where bread, tea, coffee, bacon, cheese, &c., have formed the diet under which an outbreak of scurvy has taken place. We have sufficient proof that the fibrinous and albuminous principles play a most important part in eradicating scurvy in the fact that vegetables will sooner effect a cure when combined with salt meat than when administered alone, and still quicker conduce to such result when taken in conjunction with fresh meat. And again, a healthy, growing youth with

craving appetite, whose stomach is equal to any emergency in the way of food, will outlive a much longer voyage on salt meat and biscuit than the man in middle life with fastidious stomach; although in the case of the youth the demands of the system for food are greater, in order to supply the wants of a growing frame. What stronger arguments can be adduced in favour of my theory? What greater proof can we have, in opposition to the prevailing opinion, that vegetables are chemically antiscorbutic-that they supply a something which meat does not possess, and which the body requires? The four varieties of food necessary for the maintenance of nutrition are represented in bread and butter, and how commonly do we see well-nourished, blooming children living almost exclusively upon it. But the fibrinous and albuminous principles contained therein being proportionately very small, it would fail to supply the necessary 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 tub.-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 mucilage, 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 from 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 mass; 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 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 only with 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 cancerous 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 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, experi ments 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.

15.-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