Recent Literature A Monograph on Diseases of the Breast, their Pathology and Treatment, with Special Reference to Cancer . By W. Roger Williams, F.R.C.S., late Surgeon Western General Dispensary, and Surgical Registrar, Middlesex Hospital. With 76 figures. London: John Bale & Sons. 1894
Boston Medical and Surgical Journal
among healthy people as among the insane. Another factor, which bears out what I said before, is that wheu we speak of an insane heredity we entirely ignore the form of insanity in the relatives ; aud we are very apt to ignore the closeness of the relation. We must bear iu mind that in the case where insanity occurs in a grandparent, for example, the individual in question has iu his veins, on an average, only onefourth of the blood of that grandparent. Then, again, if we find a case of
... d a case of insanity in the relatives of our patient, it makes a very great difference whether that insanity is general paralysis, which, in all probability was due to syphilis acquired by that relative at some period iu his life, or whether it was a traumatic insanity due to some injury he had received, or alcoholic insanity, or some form of insanity which pointed more clearly to degeneration such as paranoia. The figures which I cited, which Dr. Stedman has criticised, were figures of old date and given simply as an illustration. Dr. Lane : The gentlemen who have discussed the paper seem to be aware of the obstacles I met in compiling this paper. I spent several hours in digesting statistics that I did not dare to bring before you because they were unreliable, and the means of studying the subject further were so imperfect, I fouud I could not bring anything of value. The matter of diagnosis of insanity is our most urgent need for the further study of the subject. Scarcely two men in this State would agree on a table of diagnosis of insanity. Until our State Board of Lunacy and Charity has a preponderance of men interested in the subject, I do not think we can get correct statistics. The State board is the only authority which can compel the asylums to classify their cases according to a fixed nosology. Speaking of the faulty statistics and decades, it is a point I ran across in getting hold of these figures, aud getting the ages of the insane. It is curious the irregularity with which the ages are given. In giving the ages it seems to be a custom to approximate the even numbers, and the even numbers are onefourth to one-fifth larger than the odd numbers, so that the only way to do is to take a decade. The statistics of 1890 show 73 per cent, more insane in our institutions than in 1880. The more hospital accommodations there are, the more willingly do people send their insane into the hospital. specimens. Dr. Homans showed a beautiful specimen of adeno-carcinoma of the uterus, removed by vaginal hysterectomy ; an ovarian tumor ; and also a hairy mole, or birth-mark, about two and one-half inches in diameter, removed from the face of a girl of eight. The mother was said to have been frightened by a dog while pregnant, aud this spot with a reddish-brown base aud covered with black hair resembling fur was found on the region between the malar bone and the left ear, and a portion of it was hypertrophied and filled with sebaceous glands. The affected skin was dissected out and so much of the cavity as could not be covered by approximation was covered with a Thiersch graft taken from the thigh. This book is essentially a scholarly one. The first chapters of the monograph are devoted to the Ontogeny, Phylogeny, Morphology, Anomalies and Histology of the Breast. Then the author takes up the various conditions governing the growth, disseminations and life-history of cancer in the male and female. The differential diagnosis is carefully considered, and the treatment of cancer is also fully set forth. The author evidently believes in a thorough operation, and strongly emphasizes the necessity for the complete removal of all cancerous growth. We personally believe that Halsted's method of operating for cancers of the breast, while extreme, is preferable to that advocated by the author. The author is evidently a believer in antiseptic surgery. The growing custom among American surgeons is to do this class of surgery aseptically and not antiseptically, and the results attained are eminently satisfactory. The work ends with a reference to axillary tumors, inflammation and suppuration, tuberculosis and syphilis of the breast. The latest statistics as to whether life is prolonged or not by operation are not included in this work, Gross's statistics of March, 1888, being the last reported. In many respects this is a book that we can recommend as a careful analysis of the facts relating to diseases of the breast. The strictly scientific part of the work is extremely well done. The practical conclusions, including treatment, are commonplace. The book is well written, printed and bound, and fairly well illustrated. address, reprinted in this convenient form, is, like everything he writes, full of interest and of stimulating thought. He puts before his hearers the problem " Whence and how is motion produced by the muscles, and whence is the mysterious nerve force derived that excites the muscles to contraction ? " He discusses the problems of latent chemical energy, and in the energy of the universe he sees nothing but perpetual motion, aud that all stimuli are but forms of motion. This motion can be clearly demonstrated in muscular energy, but the nature of nerve force is still unknown. One fact only is certain, it is capable of propagation along a nerve fibre. The hypothesis that the source of nerve force is latent chemical energy, conceived as minute motion liberated and released by added motion is not improbable. Of the relation of this energy to life itself, however, nothing is to be said, nothing is to be discerned, and he can see no promise that the future has anything in store for us. In his whole address he points out the relation of the doctrine of the conservation of force to the problems of the dynamics of life, in a way that is full of suggestion to every thoughtful mind.