low the age of thirty, before which time they present the appearance of advancing age.

CAUSES.-Cretinism, like goitre, depends for its origin on endemic causes. In the deep, narrow, damp, malarious valleys of the Alps, the people reside in small filthy houses built up under the ledges of the rocks; in those which are most filthy, hot and close in the narrow ravines of the Valais, one of the Swiss cantons, where the air is stagnant, and the rays of the sun are intercepted or reflected from the mountains, cretinism and goitre appear in their most intense forms. "As we ascend the neighboring mountains cretinism disappears and only goitre is seen. When we reach a certain altitude, or above 3000 feet, both maladies vanish." The principal cooperating agencies which aid in producing the disease are: poverty, bad food, drunkenness, indolence sensuality and low debauchery of the parents, which naturally result in the infirmity of their children. The water in regions where cretinism prevails, contain calcareous and other mineral substances in solution; and cretinism, as well as goitre are to a considerable extent pathogenetic effects, or drug diseases produced by these agents long-used.

TREATMENT.-The first remedial measure in the treatment of cretinism is the removal of the patient from the influence of local causes which have originated the disease. The experiment has been made on a satisfactory scale by Dr. Juggenbuhl, who has established a hospital for cretin children in a high and healthy region on the Abendberg in the Bernese Alps. By devoting his whole attention to the recovery of these most hopeless objects of philanthropic compassion he has succeeded in restoring about one-third of all that came under his care to health and the exercise of reason, and greatly improved all others. Cretinism generally makes its appearance in the second year, and from three to six are necessary to effect a cure; though at an early stage it is effected in one or two. This institution gave to the world the first example of the power of education and health-promoting influences in removing the physical evils which accompany idiocy; and it has been imitated in this country and elsewhere in the numerous asylums for idiots.

The influence of a proper physical training is no where better shown than in the cure of idiocy and cretinism. Dr. Odet, a physician of Switzerland, who was himself a cretin, chose cretinism as the subject of his thesis, when examined at Montpellier, for the degree of M. D. In his dissertation he says, "it was by following these curative means that a learned physician, whom I am proud to own as a near relation, has been enabled to replace me in the rank of a man." "It was also by fortifying the physical system that we were enabled to develop, little by little, the intelligence of my youngest brother, who while still an infant, was separated from his mother by order of his physician. Cretinism seized upon his intellectual faculties under the mask of some of

the maladies incident to childhood. In the second stage the treatment was commenced, but time and patience were necessary. At the age of eight years he began to make himself understood, at nine he articulated some entire phrases, and at eleven he was fitted to enter an academy."

Case by Dr. Juggenbuhl.-M. D. of Fribourg, was five years old on his entrance. His parents were healthy, but they inhabited the lower part of the town, which was subject to cretinism; one of his brothers was also a cretin. M. was slow in learning to hold up his head, to stand and to walk. The glands of the neck were swollen. He had strabismus, a thick tongue and the rudiments of goitre. He soon learned the letters of the alphabet and to pronounce little phrases; but his memory was so feeble that he would often forget on one day that which he had learned the day previous. An exercise much prolonged could alone remedy this evil. But his physical strength progressed gradually with his moral powers. His complexion is now animated and has the tint of health; his step is firm and his body robust; thanks to gymnastic exercises and good air. He can already read a little and distinguish colors. Remedies.-See Scrofula and Goitre, p. 276.

GENUS VI.-CARCINUS.-CANCER.

DISEASES CHARACTERIZED BY VITIATED OR DISEASED CELL DEVELOPMENT.

The difference, says Williams, between a primitive cell and a mass of organized structure, is not simply one of magnitude. The primitive cell, though not strictly an organized body is infinitely less complex than the mass, and constitutes the ultimate limit of organized structure. When the formative blastema assumes the attributes of organization, a cell is the first visible form under which it presents itself; it is an atom of organic matter; so that the ultimate cells of organs are the iminediate agents of the organic processes; the elaboration of nutrient matter, in all its stages and disintegrations for the purpose of secretion and elimination, are essentially cell-phenomena.

Organic laws to which the cells, in common with larger masses, are subjected.-1. A definite scale of development is assigned to the primary organic cells proper to the various structures of the body. These cells pass through prescribed gradations of growth, the duration of their life period being equally pre-limited. The typical elements of a primary cell are three only; first an external sac (cell membrane); then a smaller vesicle (nucleus), which contains a smaller (nucleolus). Apply this description to the ovum; first is the vitelline capsule-thủ second the germinal vesicle, enclosing the third, the germinal spot.

Mr. Budge, the German micrographer, reduced a frog to a state of emaciation and then laid bare a small muscle of the leg, and under the aid of a microscope counted with precision the number of its elementary fibres. By proper feeding he now restored the animal to health, and when its size was fully restored, he counted with the same minuteness the elementary fibres of the same muscle. He found that the fibres were considerably increased, as well in number as enlarged in bulk.

Primary cells propagate themselves by the reproduction of others like themselves. When the malignant tendency has been once established in a part by the organization of a cancerous primary cell, in virtue of this power inherent in the cell of multiplying its kind, the continuance of the destructive process in the part is certain and inevitable.

Diseased Manifestation of Cell-Development.-Morbid tissue is generated within the economy in strict conformity with the laws that preside over foetal development. But, as we have already seen, both nervous influence and catalytical agency, give rise to a variety of diseases when they are swayed by disease-causing influences from their natural course. Thus also in some cases the power of histological evolution may create positive disorder in the system. An immense and uninterrupted movement takes place within the organs of which the body is composed, for the purpose of supplying new tissue in the place of those which are no longer fit to accomplish the functions devolving upon them; let this unceasing activity be diverted from its proper channel, and the production of tubercle, cancer, and all kinds of morbid deposits will be the immediate consequence.

We here find, as in other cases, an evident connection between the phenomena of health and disease,-between physiological activity and pathological influence. It is in this light that we are led by the researches of Virchow to look at this subject.

General View of Cell-Formation.-1. Some diseases result in the first place from total absence or considerable deficiency of normal evolution on a given point. The mucous membrane of the intestinal canal affords a fine example of incessant development. New layers of epithelium are continually being secreted to line its inner surface; but the living medium, or blastem, is necessary to their production, and whenever this blastem itself happens to be altered in its essential properties-the modification which always occurs in inflammation, the epithelium disappears, and is no longer regenerated. (See Vol. I., p. 646, and Vol. II., p. 181.)

Cholera also exhibits an example of this; for it has been incontestibly proved that in this disease the vessels that ramify in the internal surface of the intestines are completely laid bare.

1. CANCER.-CARCINOMA.

The name was given by the Greeks, and derived from Kaрkivos, a crab, from the large blue veins, resembling the crabs-claws, which appear upon its surface. A painful scirrhous tumor, which terminates in a fatal ulcer. (Cullen.)

Conditions Essential to the Production of Cancer.-1. Constitutional causes which lead to the development of the cancerous element in the blood by deranging the functions which preserve this fluid in a healthy state: 2. Local causes which separate the morbid material and transform it into cancerous deposit, which may replace the proper textures of the part or become incorporated with them. The cancerous element must first exist in the general circulating fluid before the local injury, or perverted nutrition from some other cause can produce cancer. When these proper conditions exist, any organized structure may be involved by the disease.

Progress and Development of Cancer.-Its earliest condition is that of a blastema, or fluid. It is described as a firm, compact, amorphous substance, resembling coagulated fibrine, sometimes con. taining molecular granules of modified protein or fat. In this blastema, cells are developed which are supposed to be of a specific nature, presenting appearances different from the cells of the ordinary healthy tissues; the cell-wall and its nucleoli, and granules are generally larger, more varied in form, as round, oval, caudate; the cell-wall is also extremely thin and pale; and the action of acetic acid renders it so transparent as to display the neucleus and its nucleoli distinctly. Some of the granules, nucleoli, and nuclei, are without any distinct cell-wall; they all progress to the stage of parent-cells; each possesses amazing reproductive power, and is supposed to produce a second. In some cases a fibrous tissue is developed from the blastema, most probably from the cells; and when formed it resembles the condensed or indurated tissue of other parts; but it is regarded as a new formation, and forms the chief portion of scirrhus, the most common variety of cancerous growth. (Southam, Virchow, Vogel. See Brit. Med. Jour. Jan. 1858, p. 5.)

Though the specific character of cancer-cells may be suspected, it has not been demonstrated; and efforts to diagnose the ultimate nature of cancerous growth by the microscope have led some observers into errors. (Nelaton, Clin. Surg., Phila. 1855, p. 457. See Velpeau, Lebert, Robin, Mandl.) The cells found in cancerous growths may then be regarded as the same as those found in ordinary healthy growths; but, the blastema derived from the blood being in a diseased state, the cells are developed under a specific influence. The cancerous blastema being more highly organized, that of tubercle may be

transformed into the caudate or fibro-plastic cells with their nuclei and granules; and these may reproduce others like themselves, or may go beyond this and form fibrous tissues of imperfect organization; and these have only a brief duration.

In the ordinary effused lymph of inflammation or of healthy granulations, the cell is endowed with the power of progressive development, from the fibro-plastic cell, into filamentous tissue, and then, into the healthy permanent structures. (Southam, Brit. Med. Jour. Braithw. Retrosp. July, 1858, p. 28.)

DIAGNOSIS.-When the cancerous action commences in a tumor which has long been inactive, it is attended with frequent shooting pains; the skin that covers it becomes discolored, and, at length ulcerated. Pearson says, Pearson says, "when a malignant scirrhus or watery excrescence has proceeded to a period of ulceration, attended with a constant sense of ardent and, occasionally shooting pains, is irregular in its figure, and presents an unequal surface; if it discharges sordid, sanious, fetid matter; if the edges of the sore be thick, indurated, and often exquisitely painful, sometimes inverted, at others retorted, and exhibit a serrated appearance; and should the ulcer in its progress be frequently attended with hæmorrhage, in consequence of the erosion of blood-vessels; there will be little hazard of mistake in calling it a cancerous ulcer." When a cancerous tumor of the breast is ready to break open, it generally becomes prominent in some minute point, attended with an increase of the peculiar kind of burning shooting pain already felt in a slighter degree; a corroding ichor transudes through the skin forming an ulcer. Ulcers of the cancerous nature discharge a thin, acrid sanies which corrodes the parts; the lips are thick, dark colored, retorted; and fungous excrescences often grow from them, attended with excruciating, pungent, lancinating, burning pains, and sometimes with bleeding. Though every hard tumor of the female breast is not a cancer, all such as occur after the cessation of the menses may be regarded with suspicion.

PATHOLOGY.-Thus far the microscope has only shown that the primary elements of morbid growths do not materially differ from those of the normal tissues; and that these constituents vary in the degree of their development, their mode of arrangement and in their relative proportion to each other. In innocent tumors the difference is slight; but in malignant growths there is a general want of order in the distribution of all the elements and structures that enter into their composition. The following division of the varieties of cancerous growths is based on the microscopic disclosures of their minute structure:

1. Gelatiniform or colloid cancer; marked by an excess of blastema. 2. Cephaloma, medullary, or soft cancer; characterized by an excess of cells.