bent, could not fail to awaken very great interest, because of the singular nature of the novelty and of the success attending it. It is strangely novel, inasmuch as it chemically dissolves the cancerous cell in the midst of the tissues: and it is strangely successful, for it has effected the absolute dispersion of small cancerous tumours, without destroying, as caustics do, the natural textures in which the tumours lay. Both these facts I happened to have the opportunity of demonstrating; and I took occasion to bring them before the Pathological Society of London at its first meeting in the present session.

The introduction of this method constitutes a most important epoch in the treatment of cancer; for the acid is as nearly a specifie against the disease as anything can well be-a specific, happily, which is, in a great degree, intelligible in its action, a specific without a mystery.

Like all new remedies, its value needs exact estimating. It is capable of doing certain good; its applicability is still uncertain. There are situations in which difficulties of manipulation may prove insuperable, and the remedy cannot be brought into action against the disease. There are conditions of bulk in some cases, which we do not yet know that a remedy so slow in its action can overcome. There are also misconceptions in our own minds as to the extent to which the disease is diffused; for disappointment consequent on which no remedy is answerable. Acetic acid dissolves cancerous tumours, and the absorbents may remove the inert remnants of it; but the acid does not change the disseminating power of the disease. If fragments be left beyond the limits of a tumour, they will grow again, whether the main mass have been cut away with the knife or dissolved with the acid.

Again, there are dangers to the reputation of the acid as a local remedy which are incident to its misuse. If employed too strong, it acts as a caustic, and produces sloughing; only in a certain degree of dilution is the proper action obtained which was contemplated by Dr. Broadbent.

I have been led into these remarks by the present interest of the subject; but my intention in writing was to refer to the questions raised in the letter of Dr. John Barclay of Banff. Who originated, in whole or in part, the method of treating cancer by injection of the acetic acid? No one can deprive Dr. Broadbent of the credit of the treatment as a whole. He devised it; he employed it; he published it. But others are answerable for the parts; for detecting the action of acetic acid on cancer-cells; for the invention of the syringe and cannula for subcutaneous injections; and for adapting them to throw remedies into the substance of a cancerous tumour.

Dr. Barclay claims to have originated the use of acetic acid in cancer, and he assigns to use the credit of having first treated cancer by injec tion. I do not know whether either claim can be substantiated.

That Dr. Barclay's suggestion was independent and original, I have no question; it needs only to peruse the account of his valuable comparative experiments with the citric, acetic, and carbolic acids, to perceive that he had obtained good results from the use of acetic acid in cancer in the living subject. I was aware of his observations, having carefully read his paper at the time of its publication, and afterwards employed the carbolic acid, according to the form he recommended, on some of my patients at the Middlesex Hospital. Nothing was further from my intention than to ignore Dr. Barclay's work, of which I do not doubt that, as it certainly contributed to our knowledge of the use of acetic acid, it may also have led up to the choice of it by Dr. Broadbent. It was in connection with the method of injecting cancerous tumours, not with the superficial treatment of them when ulcerated; and it was in contrast with my own injunctions of other substances, that I referred to Dr. Broadbent's happy selection of the acetic acid.

This acid had, in fact, been thought of, and actually used, in the. treatment of cancer before 1866. My former colleague at the Middlesex Hospital, Mr. Mitchell Henry, when he had not yet condescended from Surgery to Politics, was in the habit of giving it to his cancer patients as an internal remedy, on this very account of its action on the cells under the microscope. Mr. Henry retired from the profession in 1862. And I was once informed by Mr. Charles Hawkins, that Sir Benjamin Brodie used this remedy in the local treatment of an open cancer of the breast. Dr. Barclay has had the satisfaction which always accompanies the exercise of ingenious and original thought, and that of extending our knowledge of the action of acetic acid; but it does not appear that he has the additional pleasure of having been the first to discover its usefulness in cancer.

My own connection with this treatment is not that of an originator. At least, I did not, in my remarks of October 16th, intend to make that claim. I said that, "as the hypodermic injection-syringe was so much in use at present, it would be surprising if it were not employed in the treatment of cancer." And I said, speaking inexactly, that I had for a year or two, or a year and a half, been trying various remedies introduced in this manner in the treatment of that disease.

Whether I really first used injections in the treatment of cancer I do not know. In a London hospital our proceedings are so public, that that which we originate may be adopted by others as usual treatment,

and may be afterwards published without reference to the inventor, and certainly without the intention of depriving him of the credit of his thought. But Dr. Barclay's letter has led me to refer to my notes, and to cull from them the following history of my doings.

In a clinical lecture on surgery, which I delivered on June 30th, 1860, I detailed a case of lupus exedens in a young woman, which had destroyed the tip and one ala of the nose, had split the lip, and extended far into the nostril. After failing to arrest the disease by ordinary treatment and superficial caustics, I injected, at Mr. De Morgan's suggestion, perchloride of iron into the tissues beneath the disease. At that part the lupus was stopped; elsewhere it went on. In the same lecture, I suggested that the plan was applicable to the treatment of cancer. My first application of the method of injection to cancer is thus due to advice from Mr. De Morgan in what was practically a similar disease. And I am disposed to attribute to this hint from him the direction of my thoughts to that treatment of cancer by zinc after incisions, which I adopted first in a vast rodent cancer of the face, and which has been since frequently practised for those gigantic ulcers with surprisingly successful results. My first patient so treated lived in comfort for three years, until the age of 75; and I presented her before the British Medical Association at its meeting in the College of Physicians in London. The same hint, and the result in the cases of lupus and rodent cancer, led me on to apply solid zinc and zinc paste to the wound after removing a cancerous breast; but, in Mr. De Morgan's mind, his thought produced the more practical and widely useful plan of treating all wounds, cancerous or not, with the zinc solution.

I next find in my notes sundry thoughts on the treatment of cancer, from which I extract the following:

"Treatment of Cancer.-It seems to me clear that our methods of treatment for cure fail for want of quantity and continuousness of application. Some medicines cannot be administered in more than a small dose; and we already know that within the limits of their tolerance by the system they are useless for the cure of cancer. Of this kind is arsenic, which influences solid new growths, but kills without curing.

It

"But if we would alter cell-growth in the body, we must have a long continued stream of the medicinal agent flowing through the cancer. might be introduced through the skin, as by a long residence in a bath of it, or by wearing it inside a caoutchouc dress. It might be made to saturate the liver by profuse and repeated enemata. It might be inhaled. Only, whatever the substance chosen, there should be enough of it, and it should be long continued.

"Whether the cancer be at first local or constitutional, it is usually already diffused through the system when surgeons operate. From its earliest existence, a cancerous tumour contaminates the system and invades adjoining tissues. These are its first victims, and glands next, which have no power to eliminate its surplus or refuse. Are we then upon the right track in merely extirpating the tumour? We know nothing of a constitutional remedy; have we the completest local one? Subcutaneous injection might do with local deposit what other organs could not-neutralise, dissipate, render it innocuous.

"We want not merely to extirpate the tumour, but to remove adjoining blastema. Could acetate or perchloride of iron, or chloride of zinc, or chlorine, or what not, much diluted, be driven into the tissues all round a growth, beneath it, into it? The tumour might be injected with undiluted, the tissues with diluted solutions. And, after a cutting operation and cicatrisation, could the same be done with the whole region?

"Slow daily injection, as diffuse as emphysema, to wear out the propensity to the disease or to destroy the material of it.

"What is wanted to destroy the tendency to recur in tissues and in glands, is a cutaneous and subcutaneous application of the chloride of zinc. The skin should be soaked in it; the subjacent tissues flooded with it, until the cancer growing elements wear out. The whole region leading to the axillary gland should be acted on, and the tendency of cancer of the breast to grow towards the clavicle should be observed.

"Should this seem effective, some less painful way of arriving at the same result might be discovered.

"If it saved from recurrence, it might also be of service to destroy a young growth, when extirpation was objected to. The progress to glands by the natural circulation would be the means of acting on them, if not diseased; but if diseased, they also should be punctured.

"In the beginning of such treatment of the primary tumour, would any advantage come from underbinding the absorbent vessels below the edge of the pectoral with a wire ligature; so only as to interrupt the current, but not to obliterate and cut through them, as in varicocele ? The changes in the primary tissues would perhaps be more complete, if the injected liquid or gas did not so readily run off by those vessels."

Though these suggestions were committed to paper from time to time as they occurred to me in 1859-64, I did not put my thoughts into execution until 1865, when I had some syringes and sharp-pointed cannulæ prepared for the purpose. I first injected into an advanced case of epithelial cancer of the face a solution of twenty grains of the chloride

of zinc to the ounce of water. The effect was severe pain, which was over in an hour and a half, and oedema around the diseased parts which were infiltrated with the liquid. I have not kept the date of this operation.

The next case was one of cancer of the breast, sent me by Dr. Rowe of Margate. The disease was in an advanced stage, and unfit for ordinary operations. My report of the injection is as follows:

Nov. 10th, 1865. The parts being all quiet, though the dull vascularity of the skin towards the sternum continued, I made the first injection to-day. Having a long silver cannula, steel pointed, screwed on a vulcanite syringe, and in order, I filled it with a solution of chloride of zinc in distilled water, of the strength of one grain to one ounce. Then, introducing the cannula about an inch from the middle of the sternum below the red part, I slowly thrust it up in the subcutaneous tissue for two inches. I held it steady for a minute or two, that the bleeding in the track of the puncture might cease, and then slowly injected three drachms of the solution. No hæmorrhage occurred; the fluid formed a long bulging prominence, which soon spread out and lost its tension; and, on withdrawing the cannula, no fluid escaped. I dressed it with

collodion. The puncture hurt a good deal; and she complained of the stinging of the solution the instant I began to inject it. The latter pain. was at once relieved when the cold collodion was laid on, but it returned, and then gradually lessened.

Subsequently, within a brief time, the pain recurred and became It kept her awake till 3 A.M.

severe.

Nov. 11th. There was swelling over the injected spot and along the chest for two or three inches towards the axilla; redness of the skin from the same spot over the fold below it to the furrow next adjoining; much tenderness over the spot and soreness to the mesial line, the inner end of the right clavicle, and rather beyond the redness outwards. No inconvenience in the armpit or tumour. She had suffered so much that she determined to leave to-day. Lest the injected spot should suppurate, I ordered a lead lotion, and requested her to show it on Monday. Nov. 13th. She returned to the hospital to-day before going to the country. The redness and swelling had much diminished, and they were now chiefly concentrated over the small remaining swelling from unabsorbed injection. This part was still, but much less, tender; and the integument over it seemed a little more supple than before the injection was made. There was now no more appearance of suppuration.

This excessive and long continued pain, which had led to the patient's abandoning the plan of treatment, may have been simply due to the