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Scirrhus of the BreastAuthor(s): Clement HawkinsSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 13, No. 23 (Nov. 14, 1849), pp.642-643Published by: BMJStable URL: http://www.jstor.org/stable/25501039 .

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642 SCIRRHUS OF THE BREAST.

brought, and slid out of court with a non-suit against

me, on the legal informality he had himself committed.

Your readers may see the case ably treated in the

last number of the Medical Gazette. There is also a

detailed account in the Medical Times; either will be a

sufficient antidote to the wilful, and, may I say, malig nant perversion of the truth, which the Lancet has

adopted. Obstinate as this journal has represented me

to be as a "contumacious witness," and wrong in

treatment, or unprincipled in some secret remedy as

the coroner affected to suspect me of being, the whole

of that treatment was publicly and cheerfully recorded

by me at the General Board of Health, near forty-eight hours before the inquest was held.

It may suffice that I have thus drawn attention to

the subject, and protested against the garbled statement

and unworthy imputations of the Lancet and its Coroner

Editor. Consolitary is the recollection, that the Presi

dent of the Association, Dr. Hastings, declared lately at Worcester, that the great objects of the said Society

were the cultivation of the social sentiments, and the

degradation of all that is sordid. I may have erred in

a matter of law touching a coroner's power to force a

physician or surgeon to state his treatment to gratify the idle vagary or love of power in coroner or jury. I certainly did err in considering a deputy coroner

would be bound by his word, attested by credible wit

nesses, or I should not have commenced an action which

I knew was liable to a non-suit on defective legal

formality. Let all this pass. Our members in the provinces

may have less cause for vigilance than those in Middlesex, who are threatened with Newgate under alleged con

tumacy. You, Sir, and the members of the Provincial

Association, will, I am sure, let the public interest be

protected in every becoming way, and cause class

interest to be subservient to the general good of society. You will lend your influence to make the coroner's

powers to be clearly ascertained-if needful, revised

also, and clearly defined, and then by all of us let them

be rigorously obeyed. The medical profession, in every relation of life,

should be as ready to succour suffering humanity, and

assist the cause of weakened justice, as to resent

aggressions upon their own social feelings, lawful rights, and sense of honour, come these indignities from private

individuals, from congregated bodies, or coroners. " Fiat justitia ruat cltum."

I have the honour to be, Mr. Editor, Your very obedient servant,

CHARLES F. J. LORD.

Hampstead, October 26, 1849.

FUNGOID GROWTHS IN CHOLERA.

To the Editor of the Provincial Medical and Surgical Journal.

SIR,-My attention has been attracted by Dr.

Branson's hypothesis to account for the presence of

fungoid growths in cholera evacuations. I am not

about to enter upon any consideration of the generIa

subject, which I think likely to be set at rest by the

investigations of my friends Drs. Baly, Gull, Jenner,

and Mr. Marshall; I merely wish to make a remark

on the existence of torulce in saccharine fluids con

firmatory of the quotations in Dr. Branson's letter.

It has been said that the smallest quantity of sugar in

urine is sufficient to determine the growth of torulae, but I doubt if this statement is generally appreciated at its full value. Torulae may occur abundantly in

urine when sugar cannot be detected by Trommer's

test-that which I have been in the habit of employing at the bedside. I do not say that it is absent in these

instances, because it is in oxalic urine that I have

mostly observed this fact, but it is well worthy of being

kept in mind that it may be so minute in amount, that

it may escape observation, owing merely to the fallacies

to which the extemporaneous search for it in a nitro

genous fluid is exposed. This may serve as a hint to

inquirers, that they must not rest satisfied as to the

absence of sugar in choleraic evacuations where torulae

may be found, until a more delicate analysis has been

made. I have found them in urine where not only was the quantity of sugar so trifling as to leave no

influence upon the specific gravity of the liquid, but

principally where the density was actually lower than the customary healthy standard. (See a paper by

myself, on " Oxalic Urine," in the Provincial Medical

and Surgical Journal for September 8th, 1847.) I remain, Sir,

Your obedient servant, EDWARD BALLARD, M.D.

East Retford, November 6, 1849.

P.S. I may add, now that I am upon the subject of

vegetable growths, that I have five times met with

globular bodies in the urine which I have not seen

elsewhere described: twice in a case of chronic rheu

matism, and three times in a case of eczema of the

scalp. They varied in size from that of a mucous

corpuscle, and smaller, to four times that size; the

smaller ones had a smooth outline, and were distinctly

granular internally; the larger were dark brown, and

not only contained granular matter, but were irregularly covered by granular elevations, more or less minute, over their surface. Some I have seen burst. In one

instance I saw two or three small ones attached in a

row to one of the large bodies. In both of the above

cases oxalate of lime occurred in the urine, and I have

never seen them where this salt was absent. In four

out of the five observations the urine presented an

excess of phosphates, and in three of these there were

prisms of triple phosphate visible in more or less

abundance. In only one out of the five did the urine

exhibit normal acidity, and in two it was alkaline to

test paper.

SCIRRHUS OF THE BREAST.

To the Editor of the Provincial Medical and Surgical Journal.

SIR,-May I beg the favour of your inserting the

following questions in the Provincial Medical and

Surgical Journal, in the hope of eliciting a reply from some practical and experienced surgeons (members

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MEDICAL INTELLIGENCE. 643

of our Association,) on a point of vital importance and

interest to society. I have endeavoured to inform

myself on the subject of scirrhus of the female breast

by reading the published writings of many of our dis

tinguished countrymen, and I regret to say I have been

dissatisfied with the result of my reading, and have

been unable to form any definite opinion, for in many

respects there is a wide difference of opinion on the

nature, as well as of the treatment, of this "cruel

scourge of humanity." I have taken every opportunity of asking many

surgeons of experience (some who have retired from

practice) what has been the result of their operations for scirrhus of the mammary gland. The answer I have

almost invariably received has been,-the less you inter

fere the better. During the last few years I have been

made acquainted with cases in which both eminent

London and provincial surgeons have been consulted,

and the opinions given the anxious patient and her

friends have been discordant indeed. In more than

one instance, under the advice of "great men," the

whole gland has been extirpated, when, to all appear

ances, the operation promised success; yet the result

has been far different; the wound has nearly healed,

but instead of cicatrizing, the edges have become dark

and shining, and carcinomatous ulceration and miserable

death has ensued.

The question has arisen in my mind, was not the

fatal termination hastened by the operation. We know

that a scirrhus tumour of the female breast, if left to

itself, usually ulcerates, and the patient dies from its

effects. Every surgeon who witnesses the progress and ter

mination of these cases would gladly avail himself of

a doubtful remedy, in the hope of being instrumental

in arresting this state of things. The only remedy we

have is the knife, and of the propriety of operating I

am desirous of being made acquainted; and I hope the members of the Provincial Association, who have

leisure, will give me their opinions through the medium of the Journal. I will not trespass longer on your

patience. I am, Sir, your obedient servant,

CLEMENT HAWKINS.

Cheltenham, November 5, 1849.

Questions. 1. Is scirrhus of the female breast ever a local

disease ?

2. Is the removal of it by the knife advisable when it is in an indolent state ?

3. When the operation has been performed under such circumstances, has the disease been observed to take on a more active form, and proceed more rapidly to a fatal termination ?

N.B.-Any other practical information on this subject.

MEDICAL BENEVOLENT FUND.

To the Editor of the Provincial Medical and Surgical Journal.

MR. EDITOR,-Will you allow me to suggest t6 each

one of your readers, that the day appointed for public

thanksgiving,-viz., next Thursday, would be a pecu

liarly favourable opportunity for contributing a special

thank-offering to Almighty God, in the shape of a

donation to the Medical Benevolent Fund, as a token

of grateful acknowledgement of that mercy which has

protected himself and his family from the destroying

pestilence, from the effects of which several have become

claimants upon our fund, and many more are suffering from the direst calamity ?

A small sum from each would amount to a consider

able aggregate, and might be appropriated to the relief

of sufferers from cholera.

I am, Mr. Editor, faithfully yours, WILLIAM NEWNHAM.

Secretary. Farnham, Nov. 9, 1849.

...Acalt- .ntt.lignt. THE CHOLERA SUB-COMMITTEE OF THE

COLLEGE OF PHYSICIANS, ON THE CHO

LERA FUNGI.

The following are the principal conclusions and

results arrived at by this committee on the nature and

import of certain bodies examined microscopically in

relation to cholera:

" 1. Bodies presenting the characteristic forms of

the so-called cholera fungi are not to be detected in the

air, and, as far as our experiments have gone, not in the

drinking-water of infected places. "2. It is established that, under the term 'annular

bodies' and ' cholera cells, or fungi,' there have been

confounded many objects of various and totally distinct

natures.

"3. A large number of these have been traced to

substances taken as food or medicine.

"4. The origin of others is still doubtful, but these

are clearly not fungi. "5. All the more remarkable forms are to be de

tected in the intestinal evacuations of persons labouring under diseases totally different in their nature from

cholera.

" Lastly. We draw from these premises the general conclusion that the bodies found and described by

Iessrs. Brittan and Swayne are not the cause of

cholera, and have no exclusive connexion with that

disease; or in other words, that the whole theory of

the disease which has recently been propounded, is

erroneous, as far as it is based on the existence of the

bodies in question. WILLIAM BALY, M.D. Cholera Sub WILLIAM W. GULL, M.D. Committee.

QUALIFICATION OF MEDICAL OFFICERS FOR PAROCHIAL APPOINTMENTS.

An interesting discussion took place in the St.

Pancras vestry, on the appointment of a medical officer

for one of the districts of that extensive parish. The

directors of the poor having advertised for a medical

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