more conclusive. It is equally difficult to see how this evidence of cancer being not merely a local disease, can be resisted. The only way in which it can be resisted, or shown to be not conclusive, must surely be by doubting whether inheritance has anything whatever to do with the matter; or, and this is a less reasonable alternative, by assuming that the instances of cancer, similiar in the offspring to that in the parent, are cases of true inheritance; and that those of cancer, unlike in parent and child, are simply coincidences, and nothing more. As the latter alternative, indeed, is almost a reductio ad absurdum in the presence of the histories of cases of multiple cancers in families, such as may be found recorded in treatises on this subject, it will be unnecessary to consider it. It may be well, however, to inquire whether there is any reason for thinking that all supposed cases of inheritance of cancer may be only coincidences of disease in the same family. The percentage, before quoted, of cancerous patients who were aware of the occurence of the disease in other members of their family, seems by itself almost conclusive; but the supposition of coincidence is rendered still more untenable by the observation made some time ago by Mr. Page, Med. Times and Gazette, Aug. 22, 1857), that among a large number of patients with innocent tumours, neither cancerous nor recurring, only 6.8 per cent. were aware of any relative having cancer; while 22.4 per cent. of the cancerous had one or more relatives with the same dis ease. If, then, we may believe on the present evidence, that cancer is really inherited in a large number of cases, and that in the transmission of the disease in this way, it happens, as often as not, that a different organ suffers in the offspring from that affected in the parent, how can the theory be maintained that cancer is a local malady? The fact that, among inherited cases, cancer is so frequently in the same organ in both parent and offspring is no evidence for its merely local nature. The occurrence of tuberculous disease in the lung, and of gout in the great toe in successive generations may be fairly taken to prove for what parts these diseases have a special liking, but is scarcely a sign either of their local nature, or of their transmission by inheritance as local diseases. And it is not easy to understand why, under analogous circumstances, cancer, and not gout or phthisis, should be considered a local disease. Moreover, on reference to the statistics, it will be seen that it is only in instances of cancer in those organs, especially the breast and uterus, for which it has a very great liking, that we see any special tendency to a repetition of disease in the same part in two members of successive gene rations. And that cancer of the breast or uterus, when transmitted to offspring, should be repeated in the breast or uterus respectively is surely not, on any theory, to be wondered at, when it is remembered how likely it is that, under any circumstances, cancer in the female will be found in one or other of these organs. But again, the proportion of cases in which cancer occurs in a different organ in parent and offspring is of comparatively little moment. If it be allowed that cancer is ever transmitted to a different organ in the child from that which was affected in the parent, then it is practically allowed that cancer is not merely a local disease. For such an admission in any individual case, must of necessity be the same thing as granting that in this special instance the disease was not merely a local one. And before those which occur in the same organs in parent and offspring can be supposed to be merely local, surely some difference must be shown plainly to exist between the cancer which occurs in the two groups of cases (those in the same and those in different organs). For, while there is every reason to believe that a constitutional disease will always be found to prefer certain organs as its site before others, there is no reason for believing that a disease, not traceable to external influences, can spring up at one time as a local and at another as a constitutional disease. If the number of cases in which there occurred unlike cases in successive generations was very small in proportion to the number of those in which the disease was, under the same circumstances, alike, there would be, of course, an increased chance that the exceptions might be only coincidences. But, if it be granted or proved that such cases as those referred to really occur, then one such case would weigh more in the decision than a hundred or a thousand on the other side, and for the reasons just given. But the case is not reduced to such straits. Under all circumstances, the occurrence in question seems to be as frequent as the reverse; and, if we except the cases of cancer in those organs towards which it always has a very strong tendency, there really seems to be comparatively little chance of an inherited cancer attacking the same organ in the child with that which it affected in the parent. At least, if we except cancer of the breast and uterus, such an event happened in Mr. Paget's forty-five cases of direct inheritance (from parent to child) not once, and in Mr. Moore's eight cases only once.-British Medical Journal. FAVOURABLE TERMINATION OF A CASE OF OVARIAN DROPSY WITH- The following case is so pregnant with instruction to the Medical Pro. fession at large, that were I to withhold giving it publicity I should not be doing my duty as one of it members : Mrs. H., aged 64, the subject of the following remarks, and the mother of a large family, had always enjoyed good health till about three years ago. At that time she observed a slight swelling taking place in the lower part of her abdomen, on the right side. Having caused her no pain, the only inconvenience arose from its bulk and occasional gastric disorder; consequently she gave it no attention for two years, till I was called in about twelve months ago. The swelling had rapidly increased for some months previously, and had now become very painful. I examined her and found her very much enlarged, resembling a person about the seventh or eighth month of utero-gestion; but, as she had ceased to menstruate for twenty years, it left no doubt in my mind as to the disease being any other than ovarian. The tumour occupied very much the middle line, and fluctuation was distinctly felt. Great pain was complained of at a point about two inches to the right of umbilicus, and the skin at that place was much inflamed, and apparently adhered to the structures beneath. As a means of relieving this pain I ordered hot linseed-meal poultices to be constantly applied, at the same time giving her a mixture of infusion of digitalis, acetate of potash, and iodide of potassium, there being a con siderable amount of oedematous swelling in the lower extremities. The pain was immediately relieved, and also the swelling in the legs. The tumour did not perceptibly increase for the next three or four weeks, but as she was chiefly in bed she could not judge so well of its size as when she was walking about. At the end of this time a small opening that would admit a common probe occurred on that part, which was inflamed and adhering to the structures beneath, when a considerable quantity of yellowish fluid was discharged from it, along with a number of very minute hydatids. This fluid continued gradually to escape for a number of weeks until the tumour was almost gone; indeed, the only indication left of its existence was a thickened doughy feeling in the right iliac region, extending to the opening where the fluid escaped. After she was up and apparently as well as ever, the small opening healed over, but the swelling slowly returned. A few more poultices were applied, and the fluid began to escape as before. I saw her a short time since, and she told me that when it stops discharging for a week or two, all she has to do is to apply more poultices, and the discharge is renewed. Several folds of cloth placed over the opening to dry up the discharge, which is now very trifling, and a bandage tightly applied to keep up a considerable degree of pressure, is all she is doing for it, and her health is now as good as ever—at least she has no inconvenience from it. From the facts of the case narrated above, it will be seen that the opening whereby the fluid was discharged took place spontaneously, that the cyst in all likelihood was unilocular, that adhesion of its walls must, to a certain extent, have taken place, that the opening has been nearly permanent, that it gives exit to the fluid as it is secreted within the cyst, that the disease is checked, the swelling removed, and the patient able to attend to her duties as before. Now, I am of opinion, when the distension is great and the fluctuation is more distinctly felt at one spot than at another, that if inflammation were induced, by pressure or otherwise, to insure adhesion of the abdominal wall to that of the cyst, and a small opening made, not with the view of emptying the cyst of its contents at once, but more with the intention of allowing it to drain by degrees, and at the same time a bandage be tightly applied to exert a considerable amount of pressure over the tumour, and the opening prevented from closing, many cases might be treated in this way, and the patients, if not entirely cured, might be much relieved, and be able to spend the remainder of their lives with more ease and comfort, and freed from the grave consequences of undergoing the operation of ovariotomy, which is at all times accompanied with so much hazard and danger to life, or the tumour be prevented from pressing on some vital organ, and destroying the patient in that way. Port Glasgow, Feb. 25.-Medical Times and Gazette, March 23. DEATH OF M. CIVIALE. This eminent surgeon died, almost suddenly, on the 13th inst., in the 75th year of his age. Seldom has a name been so thoroughly identified with an operation as that of Civiale; and all over the civilized world will everyone understand, when hearing of his death, that the inventor of lithotrity, an ingenious and persevering surgeon, a skilful operator, an eminent author, a teacher of several generations of lithotritists, a conscientious man, and a benefactor of humanity in his special branch of surgery, has departed this life. Čiviale died at an advanced age, in the possession of a very ample fortune, and in the enjoyment of the most enviable honours and distinctions. He was a member of learned societies of the first order, the head and leader of lithotrity, the author of several works on subjects connected with his department of practice, and sole surgeon of the wards set apart for crushing stone at the Necker Hospital at Paris; and so fully was he in possession of his faculties up to the end as to have just completed a magnificent museum of calculi for the above-named hospital, and corrected the proofs of an important work on Lithotrity, which will soon see the light. Seldom has a man succeeded in rendering greater services, and of a more signal kind, to the sufferers from a most distressing complaint; and all must rejoice to find that his efforts have been duly rewarded and magnificently acknowledged, both by the public at large and by the most eminent bodies of our profession. The general expression of regret at Civiale's demise contrasts in a striking manner with the unnoticed death of Heurteloup, who certainly worked with great activity and perseverence in the same path. And why? Civiale laid his practice, his inventions, his teachings open to the world; Heurteloup kept whatever improvement he might introduce egotistically to himself, afraid that others should reap any benefit from his mechanical skill. Civiale brought his methods of operating and his instruments with great alacrity before the learned societies of his country; Heurteloup's communications were all wrapped in mystery, full of supposed results, but silent on the means of obtaining them. Both are gone. one will be remembered with gratitude, the other forgotten. Civiale's position among the leading members of the medical profession and the learned societies of Paris may be looked upon as quite exceptional, and the distinctions he obtained as peculiarly gratifying, because our brethren of the French capital, particularly the most eminent, have a horror of specialism. Both Ricord and Civiale have had to contend against this feeling, and they have both succeeded in a most credible manner. The setting apart of special wards at the Necker Hospital for the exclusive treatment of calculous patients by Civiale was quite an event, the like of which had not been known before in any specialty, and has not occurred since. It is said that some remarks made by Marjolin at the Hôtel Dieu many years ago struck Civiale, then Dupuytren's pupil. After surmounting many difficulties and submitting to severe criticism and even ridicule, he succeeded in applying Marjolin's hint; and, by dint of persevering efforts, the deceased inaugurated and subsequently vastly improved a most important branch of practice. It may here be remarked that discoveries and inventions have of late years borne principally on the improvement of our means of diagnosis, as shown by the stethoscope, laryngoscope, opthalmoscope, sphygmograph, &c.; but therapeutics have not advanced in the same ratio. Civiale's is a splendid therapeutical discovery, which he has the glory of having made and carried, through a long series of years, to a high point of perfection. The best known British lithotritists will certainly learn with regret the demise of Civiale, for many, if not all, of them have been his pupils. We well recollect that one of them, Mr. Coulson, was the first to introduce the practice of lithotrity into this country. A series of English surgeons have since shed much lustre on lithotrity, and gratitude for Civiale's services must rise to a very high point, when it is recollected that his teaching spread extensively, as it included medical practitioners from the old and new world. He was buried in the neighbourhood of Paris with the greatest simplicity, in compliance with his wishes; but the news of his death will certainly cause the deepest regret among his friends, the medical profes ́sion, and the public at large.-London Lancet. |