les maladies des Enfans, 8vo. Paris, 1825.-Ibid., Alterations pathologiques deverses trouvées sur des enfans nouveaux-nés. See notice of report made on this memoir to the Acad. R. de Méd., April 26, 1825, and the discussion, in Arch. Gen. de Méd., viii., 129, and in Ferrussac's Bulletin des Sc. Med., v., 271.-Prosper (S. D.), Recherches de Anat. et de Physiol. pathologique sur plusieurs maladies des enfans nouveaux-nés. Paris, 1826.-Hufeland, Die Krankheiten der Engebornen und die Vorsorge, &c., in Journ. der Prakt. Heilk. Berlin, 1827. See Journal Complémentaire. Paris, 1827, and Med. Chirurg. Rev., Feb. 1828, p. 507.Meissner, Kinderkrankheiten. Leipzig, 1828.-Hardegg, De morbis fœtus humani. Tubingen, 1828.-Billard, Traité des maladies des Enfans nouveaux-nés et a la mammelle. Paris, 1828. Translated by Stewart, New-York, 1839.Bergk, De morbis fœtus humani. Lipsie, 1829.-Cruveilhier, Anat. Path. du corps humain. Paris, 1829.-Otto (A. W.), A Compendium of human and comparative Pathological Anatomy. Translated by J. F. South, London, 1831. Zurmeyer, De morbis fœtus. Bonna, 1832.-Duges (ANT.), Art. Fatus, in Dict. de Méd. et de Chirurg. Pratique, tom. xviii. Paris, 1832.-Gratzer, Die Krankheiten des fœtus. Breslau, 1837.-Simpson (J. Y.), Cases illustrative of the spontaneous amputation of the Limbs of the Fatus in Utero, with Remarks, in Dublin Journal of Med. Sci., November, 1836-Montgmery (W. F.), Art. Foetus, in the Cyclopedia of Anat. and Phys. London, 1837.-Simpson (J.Y.), Contributions to intra-uterine Pathology. Pt. I. Notices of cases of Peritonitis in the Fatus in utero, in Edinburgh Med. and Surg. Journ., Oct., 1838.—Ibid., Pt. II, On the Inflammatory origin of some varieties of Hernia and Malformation of the Fatus, in same Journal for July, 1839.-Darling, in New-York Journ. Med. and Col. Sci., vol. iii.] FUNGOID DISEASE.-SYN. Hæmato-cerebri

form Disease; Milt-like Tumour, Monro. Soft Cancer, Auct. var. Spongoid Inflammation, Burns. Medullary Sarcoma, Abernethy. Carcinoma spongiosum, Young. Fungus Hamatodes, Hey, Wardrop. Fungoid Disease, A. Cooper. Fungus Medullaris, Maunoir. Matière cérébriforme, Auct. Gall. Carcinome mou et Spongieux, Roux. Tumeur Encéphaloide, Laennec. Fongus Médullaire, Lobstein. Carcinus Spongiosus, M. Good. Carcinome Sanglante, Cancer mou, Fr. Der Blutschswamm, Germ. Bleeding Fungus.

CLASSIF.-3. Class, Sanguineous Diseases; 4. Order, Cachexies (Good). IV. CLASS, IV. ORDER (Author, in Preface). 1. DEFIN.-A tumour, or tumours, consisting of a whitish, pulpy, brain-like substance; generally soft, circumscribed, elastic, or obscurely fluctuating; giving rise to large vascular growths, which bleed profusely: always connected with constitutional vice, contaminating the frame, and terminating fatally.

consistence, the cerebral pulp. Hence the name, encephaloid, given it by the French pathologists. It softens after exposure for a short time to the atmosphere; and when the softer part is washed away, or when the mass is compressed, a filamentous or fine cellular tissue remains.

3. B. The consistence of the hæmatoid tumour varies in different cases, and sometimes in different parts of the same mass, being sometimes more dense than the firmest brain, at other times as soft as the brain of a fœtus, as the milt of a fish, or even not much firmer than custard. According to M. LOBSTEIN, the different degrees of softening is owing to the progress of the disease; and this appears to be generally the case. In the first stage, or that of crudity, the melanoid tumour has the consistence of a firm brain, or of the conglobate glands; in the second, the consistence is less, being that of the foetal brain; in the third, it approaches that of milt or custard to these may be added a fourth, when the tumour is situated externally, or near the surface of an organ or part, viz., that at tended with ulceration and the rapid production of bleeding fungi from the ulcerated part.

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4. C. The colour of this production varies sometimes in the same mass. It is commonly of the colour of the brain; occasionally portions of it are redder, and exhibit more of a fleshy appearance; and in other cases, parts of it resemble a clot of blood. When the hæmatoid mass is encysted, it is readily detached from its capsule; and, in the early stage, is often divided into several lobes, placed closely together, and separated by an extremely fine cellular tissue, which seems to convey the vessels for its nutrition. In the advanced stages, the division into lobes disappears. The nonencysted form is, however, more common, particularly in the viscera. The masses constituting this formation vary from the size of a pea to that of the head of a fœtus at the full time.

parts resemble slightly-softened glue; others have earthy particles mixed with the pulpy cerebriform matter; many present insulated portions of the colour and consistence of boiled yolk of egg. As the tumour increases, the softening and disorganization characterizing the successive stages of its growth take place. Disorganization generally commences in the central parts: cavities now form in it, chiefly containing blood; and, when the blood is washed away, and the tumour is placed in water, numerous membranous shreds and filaments are seen floating in these cavities.

5. D. The medullary structure, although the general, is not the only form observed in the primarily diseased mass. Some of the fungoid productions are composed of distinct parts, provided with cellular capsules, and differing in 2. i. DESCRIPTION.-This is the most malig-size, colour, and consistence. Some of these nant formation to which the body is liable. When it appears covered only by the integuments, and has not yet acquired considerable bulk, the surface of the tumour which it forms is smooth, generally equal, and not discoloured; it is commonly soft and elastic, and communicates to the touch an obscure sense of fluctuation. When removed from the body, the hæmatoid tumour is generally circumscribed, and more or less rounded it frequently possesses a capsule of condensed cellular membrane.-A. M. LAENNEC has divided the disease into, 1st, the encysted; 2dly, the irregular and non-encysted; to which he has added, 3dly, the interstitial impregnation of organs by the cerebriform substance. This last is not mentioned by Mr. WARDROP, who has described this disease with great accuracy. M. LAENNEC has never met with it in the lungs. It may be, therefore, considered as a rare form of the disease. When divided, the substance soils the knife, and is composed of an opaque, whitish, homogeneous matter, resembling, in colour and

6. If the fungoid mass is situated near the surface of any internal viscus, discoloration of, and adhesion to the part covering it, followed by ulceration, take place. But the ulcerative process, instead of giving rise to loss of substance, produces a fungous growth, and, as well as when the tumour forms exteriorly, the increase of bulk, which had hitherto been slow, now becomes rapid. The fungus which thus forms is soft, easily torn, of a dark red or pur

of the diseased mass appearing first in one of the lower extremities, the subsequent occur. rence of it may not be in the glands above the originally affected part, but in some distant or internal organ, as in the lungs, liver, in an upper extremity, &c. This was well evinced in a most remarkable specimen of the disease which came before me several years since in a lad of about fifteen, who presented in all the extremities, upper and lower, in the parietes of the thorax and abdomen, in his neck and

ple colour, of an irregular shape, and bleeds | propagated through this medium; for, in case profusely when slightly injured; and differs from the firm, dense structure of the cancerous fungus. It resembles, when small, the softer kinds of polypous vegetations which form on mucous surfaces. When the primary hæmatoid tumours are situated towards the surface of the body, they increase in size more rapidly than when seated internally. They generally soon lose their uniform round and smooth appearance; they project very considerably, and at last become irregular at their surface. Their consistence diminishes, partic-head, a number of those tumours, certainly not ularly in the projecting portions, where the soft under fifty. They varied from the size of a etasticity passes into obscure fluctuation. The walnut to that of a large orange; many of veins running over or from the diseased mass them were of simultaneous origin, and those assume a varicose appearance; an erysipela- which were the latest in appearing did not octous-like redness of the prominent parts super-cur in the seat of the glands of the absorbents venes, followed by lividity, adhesion of the in-leading from the primary tumours. A some teguments to the tumour, ulceration, and soft, what similar, and still more remarkable case, reddish fungous excrescences. The growth in respect of the great extent and number of of the tumour is now remarkably rapid. The the tumours, both internal and external, I had surface of the fungi exudes a thin fetid sanies, lately an opportunity of seeing frequently with often with blood, which is sometimes discharged Mr. BUSHELL. in great quantity; hence arose the name fungus hæmatodes, which applies only to the advanced stage of the malady. When the fungus is very large, its more prominent parts often lose their vitality, and separate in most offensive sloughs.

9. Often, however, when the original mass is advancing through the changes I have de scribed, the absorbent glands become affected by the disease, and the internal viscera, and the whole constitution, are contaminated; or, perhaps, it would be more correct to say that 7. In some cases the voluntary nerves have the original contamination is thereby so far been connected with the diseased mass, and heightened as to occasion a more general forhave participated in the change of structure; mation of this diseased structure. When the but they have not been found changed beyond absorbent system is affected, Mr. WARDROP the limits of the tumour. In the eye, the optic states that usually one or more glands swell nerve is always changed in structure; and in in the vicinity of the primary tumour, and that a case referred to by Mr. WARDROP, the ante- this takes place sometimes at an early period rior crura nerve passed into the centre of the of the disease, and occasionally not until the diseased mass, and was so completely lost in primary tumour is far advanced. In some ca it that it was impossible to distinguish between ses the diseased glands grow to a great size, the two structures. This appearance being while in others they are but slightly enlarged. general whenever large nerves enter into the Occasionally the primary affection makes little hæmatoid tumour, has led M. MAUNOIR to infer progress, while the disease of the glands adthat the cerebriform matter composing it is vances rapidly. The structure of the glands nothing else than a morbid accumulation of the thus secondarily affected is entirely converted nervous pulp. This opinion is combated by M. into the cerebriform matter, exhibits a homoLOBSTEIN, who avers that he has met with ca- geneous pulpy mass, and is contained in a cel ses in which, particularly in early stages of the lular capsule. Mr. WARDROP has never observ disease, the nerves passed through the tumoured a fungus arise from the diseased gland. without experiencing any change. I am, however, disposed to doubt this, at least as respects the fully developed disease: if they pass through, I believe, from the dissection of a case which occurred to me, that they are always changed, and identified with the morbid mass: if they merely pass by it, or between insulated portions of it, no change will be observed.

8. The most remarkable characteristics of this disease are, 1st. The frequently simultaneous occurrence of a number of the tumours constituting it in different parts of the body; the least connected with each other, either by structure or function; and, 2d. That when an apparently isolated mass of the disease is met with in an extremity and extirpated, it always soon afterward manifests itself in some distant part, either externally or internally, the subsequent disease being even more rapid in its progress than that preceding it. The simultaneous appearance of the hæmatoid tumours, or their successive manifestation, although sometimes observed to take place in the course of the absorbent system, seem not to be always

10. This morbid production may appear one part only, or in several at the same time, or in distant parts successively. The tumours which first appear may be called primary; those which occur afterward, either in the absorbent glands, or in remote parts, may be named con secutive. But the disease may terminate fatally without any more than a single mass being developed. Mr. LANGSTAFF has adduced an instance of this. The primary tumour may be small, and the subsequent productions most extensive, or the reverse.

11. There is scarcely any organ or part of the body exempt from this disease. The extremities, the mammæ, thyroid gland, the testes, ovaria, uterus, the lungs, the liver, pancreas, spleen, the stomach, the intestines, the urinary bladder, prostate gland, the mesentery, omentum, the eye, the brain, the spinal cord, the nerves, the glands, the heart, the muscular parts of the trunk, the bones, &c., have all been found affected with this malignant disease. It seems to commence in the cellular tissue; but as it is developed, the proper texture of parts to

which it extends is either converted into it, or | been brought into view by the able writers just is absorbed in proportion as it is increased.

12. ii. PROGRESS AND DURATION. -a. The progress of the disease may be divided into four stages. In the first, the tumour has the consistence of the conglobate glands; in the second, it is much softer; in the third, the softening is still greater, and amounts to a state of semi-liquefaction, and gives the sensation of fluctuation; in the fourth, ulceration or vascular fungi arise. Signs of general cachexy appear in the second or third stage, and are very decided in the fourth.-b. The duration of this malady is generally some months at least; and it may continue for two or three years. In the early stages, it is not usually attended by febrile action or much pain; and it may exist for a considerable time without occasioning emaciation; but there is always more or less debility. Acceleration of pulse and emaciation appear in the advanced stages, often accompanied with effusion into the adjoining cavities, particularly when an internal organ is the seat of the malady, as the liver, uterus, &c. In the third and fourth stages, the vital functions are very manifestly affected. The stomach loses its power, or rejects the ingesta. The patient experiences most severe pain; and the energies of life decline. The complexion often assumes a livid, earthy, or peculiar yellowish hue, or pale straw colour; the pulse becomes smaller and weaker; and at last the patient sinks, generally without either delirium or insensibility having existed for any considerable time before death.

mentioned, and as they deserve a fuller notice than I have bestowed on them in the sketch indicated above, I shall here state them more fully.-a. There is no relation between the hard, incompressible texture of scirrus, in which carcinoma commences, and the cerebriform, elastic, and soft substance constituting fungoid disease.-b. Carcinoma commences in scirrus, which confounds in one mass all the tissues which it invades, and often without much increase of bulk, although with augmented density; fungoid disease always consists of a more or less evident tumour, which seems to destroy every trace of any other structure.-c. Carcinoma, even in an advanced stage, when fungous projections sprout from its ulcerated parts, presents but little vascularity; whereas the fungoid disease possesses large vessels and vascular cavities, so that it derives one of its most common names from this circumstance.-d. Fungoid disease attacks organs in which true carcinoma has not hitherto been seen to originate, as the lungs, the liver, the brain, the spinal cord, and the nervous trunks. e. Cancer affects the aged, fungoid disease the young; and the former is attended with more pain at the commencement than the latter; and, f. as MM. MAUNOIR, LOBSTEIN, and VELPEAU have remarked, there is something peculiar in the cachexy attending carcinoma, that is not observed in the fungoid malady; for it is not unuusal to see persons labouring under this latter affection possessing their natural colour. This, I believe, occurs most frequently when some external part only is affected, or when the disease has not invaded the digestive or assimilating organs, or when absorption of the morbid matter has not taken place to a great amount. In a case now under my care, the healthy complexion is preserved, and yet neither the able practitioners who have seen it nor myself have any doubt as to its nature.

13. iii. DIAGNOSIS AND COMPLICATIONS.-This disease was confounded with cancer until the commencement of this century, when BURNS and HEY first remarked the difference between them. They are still considered by some Continental pathologists, and by Dr. CARSWELL, as varieties or modifications of the same constitutional malady; and there are several circumstances which both favour and militate against 15. M. LOBSTEIN asks, with reference to the this opinion. They both occur in similar hab- question of the identity of these two maladies, its of body and temperaments; they often arise whether, admitting that true cancer sometimes spontaneously, or without any manifest cause, gives rise to the fungoid formation, it therefore or are traced to the same exciting agents; follows that this latter is the same as cancer? they are both dependant upon constitutional May there not exist, simultaneously, tubercuvice, as well as upon perverted organic action lous degeneration of the lungs, fungoid disease and secretion in their seats; and they both un- of the liver, and fibrous tumours in the womb, dergo somewhat similar local changes, and oc- without inferring the identity of these three casion an increasing contamination of the flu-morbid formations? Fungoid disease, thereids and soft solids. Moreover, as I have stated in another place (see article DISEASE, 141 -144), and as Drs. KERR and CARSWELL have justly remarked, both may co-exist, or the carcinomatous may pass into the fungoid formation. Dr. CARSWELL observes that numerous examples might be given of scirrus, medullary sarcoma, and fungus hæmatodes, as they are commonly called, originating in the same morbid state, and passing successively from the one into the other in the order in which they have been named. Indeed, these varieties are sometimes met with not only in different organs of the same individual, but even in the same organ.

14. The points, however, of dissimilarity are very striking, as remarked in the article referred to ( 141-144), and, notwithstanding these circumstances, are sufficient to constitute them distinct diseases. As these points have not

fore, appears, from its vascular relations, from its peculiar structure, and from its early characters, its advanced course and terminations, to be a distinct malady, although it may be consequent upon, or complicated with other alterations of structure. When it occurs in young subjects, it is always primary, or is not preceded nor attended by the carcinomatous formation. But in persons past the meridian of life, in whom only scirro-cancer, or carcinoma, is met with, the fungoid structure is sometimes produced consecutively, or in an advanced stage of it, and thus occasionally exists as a secondary complication with that disease, or as one of the advanced changes of structure consequent upon the constitutional vice. The question, therefore, as to difference, is reduced to this, that when fungoid disease attacks young persons, it is always a primary and distinct malady; and that when it affects persons ad

Those of the lymphatic and nervous temperaments, of a scrofulous constitution, of a sallow or pale complexion, and of a lax fibre, with a flabby state of the soft solids, and languid erculation, are oftenest its subjects. As to the influence of sex, sufficient data have not been furnished to admit of an opinion; but the most of several cases which I have seen have occurred in males. The same may be said of the influence of climate; but, like cancer, it seems to be most prevalent in countries the inhabi tants of which partake largely of animal food. It has even been supposed that eating much pork predisposes to it. An hereditary disposi tion to it may be admitted with more truth. General debility is, however, its most common antecedent.-b. The exciting causes are often unknown. Sometimes an external injury, as a blow or bruise, has occasioned it, often after a by long period. Most of the cases which I have seen appeared to have arisen chiefly from a poor and unwholesome diet, aided by cold and moisture.