of the two more profitable than in cases of anæmic amenorrhoea. But a course of this alkaline purgative should not be taken by the cancerous, the epileptic, or the pregnant; and it should, if needful on other accounts, be used with the greatest caution in valvular disease of the heart, in tubercular disease, and in weakly persons. It should be discontinued if loss of appetite, flatulence, persistent diarrhoea, sleeplessness, or increasing debility, result.

As regards the iron waters, they will be of use in anæmic and enfeebled conditions generally, and in the vast number of cases of deficient nutrition, where not the blood, but the nervous supply, is the first imperfection; and where not excessive feeding, but excessive working, whether of body or of mind, is the cause of this waste of force.

But still a word about the restorative influence of the climate and the scenery. The pure, clear, bracing air, of equable warmth and moderate moisture; the bright sunshine tempered by pleasant breezes; and the high-lying situation, with its lessened earth attraction and diminished air pressure, must, nay do, have an immense curative power over the human body, racked and strained with the ever-increasing tensions and vibrations of modern life. And the influence of these more refined curative agents is not less real, not less sure, than that of those coarser materials on which we are too prone, I fear, to place our chief reliance in the treatment of disease.

But is there nothing to be said for the still more delicate influence of glorious scenery and peaceful quiet on the weary brain? Surely this is real too. It is not the mere absence of noise and worry and work, but the actual, all-pervading presence of natural beauty which brings rest and repose. Through the mind and soul of man the body is refreshed and purified, and in these quiet Alpine valleys, and among these stupendous Alpine hills, the voice of God himself is heard and seen and felt, saying in blessed tones of holy calm, "Peace be still."

CANCER SUCCESSFULLY TREATED BY THE

INJECTION OF

BROMINE.

BY A. WYNN WILLIAMS, M.D.,

PHYSICIAN TO THE SAMARITAN FREE HOSPITAL FOR WOMEN AND CHILDren.

THE successful efforts occasionally made by nature to remove disease from the human frame will frequently excite our surprise and admiration, and ought at all times to incite us to emulation or imitation. In the commoner forms of disease these endeavours are not only attempted, but completed with a little timely assistance from the physician or surgeon. The diseases, however, known as malignant, such as the various forms of cancer, have in the main baffled the attempts of not only the physician and surgeon, but nature herself has had to succumb under their dire and fearful ravages. The vis medicatrix nature of animal life will again and again renew the struggle to cast out, so to speak, the venomous reptile gnawing the very vitals, until at length the poor frame, in which the conflict for life is carried on, becomes so shattered and enfeebled that the combat has to be given up, though most unwillingly. Many, if not all, who read these lines have at different times witnessed the scene which I have so briefly depicted, during the growth of, and changes in, a cancerous or malignant tumour. I am not going to discuss the point as to whether or not cancer is a purely blood disease, but shall merely observe that although it may not be a blood disease in its early commencement, contiguous or even distant parts sooner or later, by means of the circulation, become tainted with the disease, and when such is the case it is like the hydra-headed monster, and to attempt to battle with it is worse than useless.

Many years ago it fell to my lot to witness, on more than one occasion, cancerous tumours undergo spontaneous death and removal by sloughing out, the cavity ultimately filling up by granulation and cicatrization, leaving the parts around to all

appearance healthy, and remaining so for several years. Indeed, in one instance, where this fortunate occurrence took place, in a very elderly lady, the disease never returned. She lived long past the period allotted to man, and died at the age of ninetytwo, of what may be properly termed natural decay. In cases

of cancer of the uterus, it is not so very uncommon to see nearly the whole of the mucous and muscular structures removed by this process of death and sloughing, leaving a mere shell of muscle, and the peritoneal covering. This is most graphically described by Dr. West, in his admirable work On the Diseases of Women. Anatomically the muscular structure of the uterus is composed of three layers, and it would seem as if the mucous lining and the two inner muscular layers were first removed during the progress of the disease, and in this way we must account for the length of time the unfortunate sufferer often exists before the final catastrophe. Having then witnessed and studied these too often abortive efforts of nature, and, at the same time, the very unsatisfactory results following the use of the knife, not only in my own practice, but also in that of others, I often pondered over this want of success. Again, having witnessed the wonderful effects of a pure solution of iodine in the removal of strumous deposits, and the extraordinary short period, comparatively speaking, in which caries and scrofulous ulcerations of the different textures of the body would heal when dressed with only weak solutions of iodine, I often regretted we had no drug possessing the same powers over

cancer.

I well remember, although many years ago, having under my care a farmer whose whole lip, in fact the entire covering of the lower jaw, was removed by the ulceration of an epithelioma, and my applying to it a solution of bromine. I was made aware of the first good resulting from the application by my patient's daughter, who made the remark that since that strong stuff had been applied the horrible stench of the wound had been got rid of. The people of the house were in comparative comfort. The wound was dressed twice a day with a lotion composed of ten drops of bromine, a little spirit, and eight ounces of water; the result being the removal of the cancerous deposit from the more superficial parts, and the actual cicatrization of the wound to a very considerable extent. The disease, at the same time, extended its ravages below and within the mouth, the old man ultimately dying of exhaustion.

What was the lesson to be derived from this? Why,

that when bromine is kept applied to certain forms of malignant ulceration, the process of decay in the cancerous deposit is hastened, and the reparative powers of nature are permitted to exert their influence; and that, to be of any ultimate benefit, it would have to be applied to the root of the evil, that is, it would be useless to apply it to the more superficial parts whilst the disease was allowed to carry on its ravages in the deeper and more vital parts. I thought over in my own mind the possibility of injecting bromine into a cancerous mass. Ill health and my removal to London, prevented the carrying out of my, as I may say, crude intention; and upon mentioning the idea to some of my professional friends, I did not receive much encouragement to put it in practice. Then there was the difficulty of procuring a suitable case. Nevertheless,

I did try it in one or two cases of cancer of the mamma, which had been pronounced too far advanced for surgical interference, the results being somewhat unsatisfactory. In some the solution injected was too weak. Finding, however, that I did my patients no harm, and that they were not poisoned by the absorption of the bromine into the system, I became more courageous, and injected stronger solutions; until at length I found that bromine might be injected with impunity of such a strength as would cause the death and softening of the tumour, and, indeed, of the other textures with which it came in contact, but acting more powerfully, as might à priori have been presumed, on the diseased or abnormal

structures.

These lines were written some time before meeting with the following paragraph from the pen of the late Sir James Y. Simpson. "If you use a caustic you can remove as much of the mass as can be done with the knife, but you have, in addition, the probability of the substance becoming absorbed and infiltrated with the tissues around, and poisoning or modifying the character of any cells which may have a tendency to take on the cancerous type of development. That such absorption does occur is proved by the fatal 'result ensuing in some of the cases where arsenic has been employed as an ingredient in the escharotic, and in the distressingly painful effects of some less fatal agents. Such being the case, if we could only discover some agent which would first destroy the great mass of the disease, and then, becoming absorbed into the surrounding texture, would there destroy altogether those cells which have taken on a perverted type of development, or modify in some degree their vitality, then we might hope, by the use of such a caustic, not

only to remove the disease more effectually at the time, but afford more security against the chances of its return.”

To say that bromine fulfils these requirements may be set down to egotism, but that it does so when employed in suitable cases, no one will venture to deny, after giving it a fair trial. Unlike its kindred substance iodine, it does not appear to be absorbed into the system. Its action is local, although there can be no doubt that on becoming gaseous it permeates the surrounding tissues beyond the point where it acts as a caustic. That it modifies the ulcerated surface of malignant tumours is beyond the shadow of a doubt. Our object then is to get this volatile semi-gaseous caustic applied to the base of the tumour-that is, to commence the destruction of the tumour at its junction with the healthy tissues-and the only means of doing this is by injection. It has been attempted by others to destroy these tumours by various injections, but hitherto with little or no success. Bromine also has been employed in combination with other ingredients as an escharotic by Landolfi, but I have never heard of anyone injecting a simple spirituous solution of bromine into a malignant or non-malignant tumour until after I had done so again and again, and had proved beyond doubt its harmlessness, excepting only so far as regards its escharotic action. In its manipulation the greatest care is required.

It is almost needless to observe that the earlier you can bring your patient under treatment the more likely you are to succeed. How is it, I would ask, that patients will go on suffering from tumours in the breast for months, nay years, without calling the attention of their medical men to their state? The dread of the knife and the uncertainty of permanent benefit. It is in great measure owing to this delay that no lasting benefit is derived. Patients come and seek advice after having suffered the tumour to remain unmolested so long that the contiguous parts have become implicated, more especially the skin and the glands, and when such is the case, your patient's state is very little advanced, even though you may succeed in removing the tumour, as secondary growths are, under such circumstances, and with our present knowledge, certain to recur. Would this be the case if our patients knew that the tumour could be destroyed as certainly without the knife as with it, that there need not be the loss of a single drop of blood, and that the chances of erysipelas, &c., are nil? We may, I think, safely presume that such would not be the case, but that they would seek relief at once without fear or dread,