the pillars of the fauces, the side of the tongue, and part of the pharynx. Large doses of potassium iodide had no effect, and it was agreed by all who saw the case that it was malignant, and this diagnosis was confirmed by the microscope, for histologically the growth was found to be a spheroidal-celled carcinoma. A vaccine prepared from the micrococcus neoformans was then employed. The injections were controlled by estimations of the opsonic reaction of the blood. Improvement commenced at once, the mass visible in the fauces greatly diminished, the ulcerated surface lessened in extent, fœtor ceased, and pain and dysphagia disappeared. Most of the enlarged cervical glands subsided, but one small, hard gland remained. The total improvement was marvelous, not only in the local condition, but also in the patient's general health. No other treatment was employed. The result was in no way claimed as a cure, but as very definite improvement followed the treatment it is at least worthy of an extended trial." My own cases have been twelve in number. Three of these have died. The first death was in a case of rapidly growing epithelioma of the vulva, with extensive involvement of the glands in both groins. Operation was followed by immediate recurrence, the new growth very rapidly breaking down. This patient's wound yielded a heavy growth of nearly pure bacillus pyocyaneus. She died after two injections and before I could make a pyocyaneus vaccine. The cause of death appeared to be sepsis.

The second death was in a bad recurrence after hysterectomy for carcinoma of the cervix uteri. There was relief of pain for three days after the first injection, but after that pain and vomiting remained unrelieved to the end. Involvement of omentum and duodenum took place and the growth was breaking down.

The third death was from recurrence after excision of breast. Thrice recurrent growths had taken place. When first seen the arm was swollen to the size of a big man's thigh, the neck was brawny and ulcerating, the face swollen and distorted, and the opposite breast the size and hardness of a cricket ball. She died of exhaustion after two months' treatment. The second case died after six weeks. Two of my cases discontinued treatment because they were inaccessible; two others because it did not appear to be doing good.

A case of cancer of prostate in an old man of eighty-two seems to be controlled. The pelvic tumor has lessened, purulent urine cleared up, swelling of left leg disappeared, threatened obstruction of bowels ceased, lumbar glands lessened, life is being surprisingly prolonged and in freedom from pain or discomfort, except weakness which slowly increases.

A case of rectal cancer recurring after operation improved greatly in general condition, such as strength, walking power, appetite, complexion and spirits. Hemorrhage was checked by the injections, but the growth continued to spread. This patient had a mixed infection, for her index to bacillus coli was very high.

A case of cancer of the liver is improving in general health, and the patient is less breathless, but the liver tumor remains unchanged.

An epithelioma of vulva lessened noticeably in size, but glands in the groin increased considerably.

Two inoperable cases of uterine cancer are under treatment without notable benefit. Whenever operation is possible I advise that treatment. It is quite conceivable that the protective powers of the blood might become equal to preventing a recurrence of controlling a slight growth and yet be unequal to the absorption of a gross mass of diseased tissue.

The vaccine treatment must not be described as a cancer-cure. It requires further working out, in connection with other vaccines. I venture only to repeat the Lancet's opinion that the treatment is at least worthy of an extended trial.

ON SALINE INFUSION IN GYNECOLOGICAL AND OBSTETRIC PRACTICE. WITH A RECORD OF THIRTY CASES.*

BY GEORGE BURFORD, M.D., LONDON, ENGLAND.

Senior Physician for Diseases of Women to the London Homeopathic Hospital; Fellow of British Gynecological Society, ete

SECTION I

HISTORICAL

I purpose to take, as a historic hors d'œuvre, a brief survey of the evolutionary stages in the development of Saline Infusion as we have it to our hand to-day.

The problems of the arrest of hemorrhage, and the replacement of the red tide of life, have ever been the most insistent in the Art of Healing. Numberless historic crises, fraught with the fate of kings and peoples, have raised these questions to the very front rank alike in professional and lay estimation.

With Ambrose Paré came the introduction of the ligature, and the problem of the arrest of hemorrhage was in a fair way to be solved. But its counterpart, the effective replacement of the blood loss, remained untouched by Paré's epoch-making procedure. Men still died of the results of hemorrhage after this had been stayed by the application of the ligature.

With the Renaissance came renewed enquiry after adequate measures to repair the blood loss. Harvey's immortal discovery led the way. The blood, so authorities taught, was the life. How natural, then, the primary instinct which looked to the replacement of the former, the blood volume, as ensuring the continuance of the latter, vitality itself!

At any rate this procedure, the actual transport of blood from one organism to another, was the initial step in the replacement of lost blood. To Dr. Lower, of the University of Oxford, is due the credit of performing in 1666 the first successful transfusion of blood. The experiment concerned two dogs; blood was directly transfused from the carotid artery of one into the jugular vein of the other.

*Presented to the International Homœopathic Congress, Atlantic City, Sept. 1906.

The experiment was successful, and the imagination alike of the profession and of the scholarly laity was stirred to its depths. The wits of the day made merry over the delightful confusion likely to ensue from the transfusion of the blood of a Quaker into the veins of an Archbishop.

To Lower followed Sir Edmund King in 1667 with further successes; and these two pioneers added to their fame by making the bold experiment of transfusing blood from a sheep into the human circulation.

All over the civilized world the impetus of this advance was felt. Denis, Professor at the Sorbonne, and Emmerez, physician to the King of France, repeated Lower and King's successes. Germany, Italy and the Netherlands each produced their moiety of experiments and experimenters.

But time, which tries all things, soon put a veto on indiscriminate transfusion. The earlier successes were not repeated; many disasters had happened; and public feeling, backed by legal enactment, had in the course of a quarter of a century reduced the perfervid hopes of the earlier transfusers to ashes.

But "even in our ashes live their wonted fires;" and after the lapse of a century, inspiration again seized the workers with transfusion. To an original mind, that of Dr. James Blundell, in 1819, it occurred that part of the failure hitherto attending transfusion might be due to the injection of animal blood into human veins. He accordingly utilized blood of human origin only, invented an apparatus for its reception and injection, and achieved so notable a series of successes as to revive the hopes that still centered in transfusion. Him followed Dumas and Prevost, the eminent French scientists, who confirmed Blundell's views as to the advantage of using "similar" blood, and added thereto their own discovery of the advantages of defibrination.

Defibrinated blood now held priority for several decades, but its use, nevertheless, languished until 1863, when its advocacy was warmly renewed by Panum, afterward Professor of Physiology in the University of Copenhagen. Panum was a man of original genius and threw his whole heart and soul into the work. He boldly suggested that tanks of defibrinated blood should be prepared and kept for use on the field of battle. With this flicker of intensity practically closes the illumination shed by defibrination on the practice of transfusion.

Two centuries had now elapsed and as a safe remedial measure, transfusion was practically in statu quo.

But the hour and the man looked for for two hundred years had arrived. The hour was the year of grace 1864, and the man was Goltz, then Prosecutor in Königsberg. Goltz experimentally proved that the effective factor in transfusion was not the addition of blood to a depleted circulation, but merely the provision of sufficient fluid to enable the heart to contract upon; that in the byways of the circulation there still existed, even in the severest hemorrhages, sufficient red corpuscles to meet the passing needs of the body, and that

all that was essential, all that was possible even, was to restore the mechanical balance of the circulation.

Goltz's paper, published in Virchow's "Archiv" is a model of lucidity and scientific insight; all succeeding work has been simply to confirm and amplify his postulates.

The work of Goltz stimulated further production by a band of distinguished followers. To Von Ott of St. Petersburg is due in particular the credit of doing much to translate Goltz's conclusions into clinical practice. By rare good fortune Cohnheim's classical experiments with his celebrated "Salzfrösch" lay ready to hand, and after preliminary trial of various fluids, salt solution of the same strength as that used by Cohnheim, i.e., about 7 per cent, was used as the appropriate emergency fluid.

Thus the venue was changed from the transfusion of blood to the infusion of saline fluid. Other original workers have, during the last quarter century, effectively tilled this field. Thus, William Hunter, in 1889, showed that human blood transfused had no nutritive value; that defibrinated blood for this purpose was a dangerous medium; and that normal saline solution possessed all the advantages and none of the special risks of the alternative fluids. Ringer and Murrell also worked at the subject, and latest that distinguished and gifted American investigator, Crile. But the research work of all these scientists has been to verify, directly or indirectly, the soundness of the views enunciated by Goltz.

II

SCIENTIFIC

What, then, are the scientific findings that further research has correlated with Goltz's law?

The principal parts that interest us here are those dealing with the character of the fluid best used for infusion, and the conditions which call for its employment. The claims of various alternative fluids here fall to be considered first.

A. Alternative fluids proposed for infusion. I. Pure blood, defibrinated blood, and blood serum.

If, then, blood, as an elaborated pabulum, cannot be used as a ready-made article to supply the place of the vital fluid lost, why should it not be employed in sufficient quantity as mere fluid to restore the circulatory balance? It says much for the clinical acumen of the early workers that they actually isolated a group of toxic symptoms commonly following blood transfusion, and called the syndrome "fibrin intoxication." Hematuria, rigors, hyperpyrexia and anuria are chief among these. But it required the farreaching work of Ehrlich and his colleagues to show that the transfusion of pure blood or defibrinated blood or blood serum must necessarily be a dangerous procedure.

II. Albumen Water. Goltz himself suggested the use of water containing albumen, corresponding to the density of blood. This recommendation found no following of consequence, and the findings of hematology have ruled it out as alien organized material.

3. Sodium Phosphate was suggested in 1864 by Braxton Hicks. Sodium Carbonate with Sodium Hydrate was advised by Samuel in 1884; the results with these sodium salts in solution for infusions were uniformly disastrous.

4. A conglomerate of sodium chloride, sodium bicarbonate, calcium chloride and potassium chloride dissolved in sufficient water was recommended by Ringer and Murrell in 1874 as desirable for transfusion purposes. We believe that composite tablets of this character, duly proportioned to so much water, are still made and sold. But this recommendation was avowedly based on what we now know to be an entirely erroneous pathology, i.e., that the heart muscle requires to be stimulated; there is thus no necessity to consider a method erroneously based. As a matter of fact, it has since found no scientific sponsor.

5. Milk for some time enjoyed the same precarious popularity as defibrinated blood, for infusion purposes. The results were unsatisfactory; the practice lapsed. Exactly the same objections apply to the use of milk as to the selection of any other organic fluid.

6. Sugar plus Saline Solution. In 1882, Landerer suggested the use of sugar dissolved up to 3 per cent in a .6 per cent solution of sodium chloride. He recorded some successes with its use. The employment of sugar in one or another form continually emerges in the ephemeral research-literature of the subject. But it has found no substantial scientific basis and unnecessarily complicates a simpler procedure.

It is interesting here to note that it was Landerer who, in 1881, first used saline infusion as a remedial measure on man. All hitherto had been merely laboratory work.

Out of this elementary history one point stands saliently: that while various fluids have once and again been pressed into the service of infusion, the uniform tendency has been to again return to the use of simple saline.

Alike in research work and in clinical use, the issue is now narrowed to the use of normal saline solution for infusion purposes.

B. The conditions which call for the employment of Saline Infusion. William Hunter, in 1889, definitely indicated acute hemorrhage as a condition to be benefited by the infusion of normal saline solution. But all prior work has been swallowed up in the masterly researches of Crile, who has extended the use of infusion to meet all causes of shock, of which hemorrhage is one. Surgical shock, Crile insists, is essentially a vaso-motor phenomenon: it is due to the breakdown of the vaso-motor mechanism; thus the blood-pressure in the vessels dwindles, the heart is deprived of its relays of blood, and arrest of the circulation ensues. Precisely a similar issue supervenes in acute hemorrhage. The similarity of the states of acute shock and acute hemorrhage was in fact first pointed out by Goltz. The blood pressure diminishes; the venous trunks supplying the heart are practically empty; the cardiac chambers are minus their usual fluid content. Now, in either of these cases, no matter whether the vaso-motor breakdown be due to shock or hemorrhage, let sufficient saline fluid be injected into the circulation. Again the wheels