formation, which made no part in the original structure of the body, is divided by Mr. Abernethy into two orders; first, sarcomatous tumours, or those which have a firm and fleshy feel; and secondly, encysted tumours, or those which consist merely of a cyst or capsule with a fluid deposited in it.

The first order is subdivided into numerous species. The first is termed common vascular or organized sarcoma, and is composed of lymph, rendered more or less vascular by the growth of vessels through it. This appears to be the most simple form of tumour, and is only dangerous from its growth and size, when, inflammation being the effect of the distention and pressure and the tumour possessing but slight powers to sustain disease, it sloughs and falls out. The second species is the adipose sarcoma, which consists of a fatty or lardaceous substance, contained in a thin but distinct capsule; it generally forms in the midst of cellular or adipose substance, and is often lobulated in its appearance. These tumours have appeared to us to consist of fat deposited in a cellular structure, probably the common reticular membrane, which naturally contains a serous fluid. The whole is then contained in a slender cyst, which does not appear to partake of the diseased action, for if the included substance be removed the cyst will adhere and so swell. They are very loosely connected with their capsules, and hence their removal is easily effected, since the latter do not regenerate the disease. The third species is denominated pancreatic, from its resemblance to the structure of the pancreas. It occurs generally in the neighbourhood of salivary glands, or such as are of a similar structure. It is of slow formation and generally very indolent in its nature; at other times, however, it will excite pain and inflammation, which confound it with schirrus.

Cystic sarcoma is the fourth species; it consists of a number of cysts containing a serous fluid, and resembles the section of a healthy ovary in appearance: it generally forms in the ovary and testicle, and in the latter often contains a caseous matter. Mammary sarcoma, the fifth species, is white, VOL. V. No. 17.

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firm, and homogeneous in its appearance, like the gland from whence it is named; it possesses no cyst, extends considerably into the surrounding parts, and appears very intractable in its nature. The sixth species, the tuberculated sarcoma, is very horrible in its progress and effects; " it consists of an aggregation of small firm tubercles of different sizes and colours, connected by a kind of cellular substance; the size of the tubercles is from that of a pea to that of a horse bean, or sometimes larger; the colour of a brownish red, and some are of a yellowish tint." The primary tumour generally forms in the neighbourhood of lymphatic glands, but innumerable smaller ones afterwards grow on the surface of the skin and are extremely hard and painful. At length a foul ulceration supervenes, very similar to the cancerous, with thick inverted edges and an ichorous discharge. The tumours in some parts are confluent, and here ulceration generally commences. We have recently met with them, not only on the surface of the body, but also in the liver and on the peritoneum, in the same subject; it is extremely malignant and destructive.

The sarcoma next described, the seventh species, has been by some called the soft cancer, and by others it has been included in the comprehensive name, fungus hæmatodes. It differs, however, in many respects from cancer, and we conceive can only be regarded as one of the varieties of fungus hæmatodes. The chief characteristic of the disease is its anatomical structure, which very nearly resembles that of the brain. The primary tumour has generally its situation near the surface of the body, and very frequently in the testicle, and glands about the neck and head. The disease spreads in all directions, and the glands secondarily affected, are generally converted into a structure resembling the primary tumour, but of a much softer consistence and apparently less vascular. They often contain a creamy fluid, which is deposited in a flocculent tissue resembling, after maceration, an unravelled testicle. The primary tumour will frequently ulcerate and throw forth a bleeding fungus, but we have never met with this

result in the secondary appearance of the disease, in which the skin generally ulcerates from distention, the tumour sloughs and is discharged. It appears to be propagated in a peculiar manner and independent of absorption; for we meet with the secondary tumour in a part which has no possible connection by absorbe nts with the one primarily affected. Thus we have known the eye the seat of the primary disease and the lungs secondarily affected; the testicle is its most frequent seat, and the liver will exhibit the next scene of its ravages. The parts secondarily affected differ very much in appearance from the primary tumour; the latter is often much firmer in consistence, and will contain cysts or cavities filled with a glutinous fluid, whilst the former are converted into a medullary substance, in many parts of a consistence not much thicker than cream. Thus, like cancer, the glands secondarily affected do not always possess the characters of the primary tumour. On a former occasion we mentioned those circumstances in which it differs from cancer,* and endeavoured to point out those dissimilarities which exist between it and other diseases which have been confounded with it under the term fungus hæmatodes. This name has been applied to an immense variety of diseases, which agree in a few leading points, and it appears as if the subject was likely only to be cleared by detaching the more conspicuous varieties, and marking their peculiar characters. For this reason we should prefer calling the present, medullary sarcoma to fungus hæmatodes, since the former appellation very accurately expresses the common appearance of the tumour.

Mr. Abernethy's account of carcinoma, the last species in his arrangement, is the most valuable part of the essay, containing the most succinct yet comprehensive history of the disease we possess. Indeed the essay seems to have been undertaken with a view to establish the characters of this disease, by separating from it a few which agree with it only in

London Medical Review, Vol. iii. p. 109.

external appearances, and others, which although equally destructive and intractable, are nevertheless perfectly different, and require to be discriminated before any progress can be made in this difficult part of medical science. Some of these, being less destructive than cancer, do not require the same active remedies, which renders a knowledge of the characteristic signs of the latter the more important, that we may know it at an early period, and when the disease is in a small compass, and the operation on that account less formidable. We would gladly transcribe his history of carcinoma, but we are compelled to pass on to his instructive description of the schirrous structure:

"It is difficult to convey correct ideas of the structure of carcinoma by words or even by drawings. In the generality of instances the diseased part is peculiarly hard, and there are intermixed with it, firm, whitish bands. There is indeed no other striking circumstance which can be mentioned as constantly claiming attention in the structure of this disease. These firm whitish bands sometimes extend in all directions from the middle towards the circumference of a carcinomatous tumour, like rays from a centre, having little intervening matter; sometimes they intersect it irregularly, having interposed between them a firm brownish substance, which may be scraped out with the finger. Sometimes they form cells, containing a pulpy matter of various colours and consistence; and sometimes these bands assume an arborescent arrangement, ramifying through the diseased substance."

We lament that no writer has attempted to analyze the peculiar schirrous structure; we mean, endeavoured to determine to which of the natural tissues that compose animal bodies it is peculiar, for we believe that the different organic alterations are referable to certain structures. The few continental writers who have attempted such investigations, have decided that cancer occurs in such a variety of organs, so different both in function and structure, that it is peculiar to none but involves the whole. There are however, peculiar tissues which

enter into the composition of all organs, such as vessels, nerves, cellular membrane, &c.; and the circumstance of this disease affecting all organs would seem to us to prove that it belongs to one of those structures which contribute to the formation of every part. If we were to hazard a conjecture on the subject, we should fancy it appropriate to that fibrous tissue which composes the cellular membrane, and that from the following circumstances. The appearance and disposition of those membranous bands, which are considered as the criterion of schirrous structure, are very similar to that of the fibrous tissue which composes the cellular membrane. They are firm, and white, and fibrous, divided by septa or forming distinct cells, having generally fat deposited in the interspaces. The appearance of a section of a schirrous tumour may not inaptly be compared to that of a lemon, the membranous bands gradually diverging like rays from a centre, until they are lost in the surrounding cellular substance. Again, schirrus generally commences in parts abounding in cellular membrane, as the surface of the body, and in glands, into the composition of which much of this substance enters. Thus we find it in the mammary gland, and those of a conglomerate structure in general, whilst it is not known in others of a more compact or conglobate form. It is never met with in the kidneys, very rarely in the testicle, and we doubt if ever true schirrus be found in the liver, for that morbid alteration which has been so denominated, differs very essentially from the characters of schirrus in other organs. When the disease attacks membranous or muscular parts, it commences in the cellular membrane that connects them. Thus the schirrous pylorus commences between the peritoneum and muscular coat, and the bands are seen to extend along the cellular membrane that connects the muscular fibres. If schirrus were an entirely new formation, we should expect that it would be contained in some cyst, since that is the case with most of the sarcomata; whereas schirrus is diffused and scattered into the surrounding parts: and lastly, the universality of cellular membrane will account