Encephaloid.

There is no doubt that this form of cancer has disappeared under the use of specifically-indicated remedies. The celebrated case of Marshal Radetzky is sufficient to prove this. Unfortunately two remedies-carbo animalis and thuja-were employed. Until it has been demonstrated which of those actually should be credited with the cure, we cannot do better than repeat Dr. Hartung's prescription.

I think Dr. Hughes' observations conclusively point to phosphorus as the most hopeful remedy against the highly vascular varieties of encephaloma.

Epithelioma.

It is here that hydrastis finds its true sphere of action. On reading carefully the provings of the Golden Seal we cannot fail to be impressed with the peculiar and profound influence exerted by this drug over the mucous membranes of the body. I have so many times witnessed the rapid disappearance of epithelial lip-cancer under the combined external and internal use of this remedy, that I must claim it as an undoubted exception to my assertion that we have not discovered the specific to any classic form of cancer.

Should it in any special case fail, we should fall back on the use of the time-honoured arsenic.

Cancroid Growths.

Of these the representative is lupus. Its most appropriate treatment I have indicated elsewhere. Undoubtedly the most strongly indicated remedy theoretically, and the most successful in practice, is the bichromate of potash.*

Surgical Treatment.

Sir Benjamin Brodie, the king of conservative surgeons, admirably defined surgery as "bad medicine." Our daily experience has amply confirmed his dictum. Surgical treatment is obviously of limited application in

* I should like it to be clearly understood that I do not undervalue symptomatic treatment. Upon that we must all fall back at times, to give those entrusted to our care the fullest benefit of the resources at our command. Here my object is different; I purposely approach the subject from a pathological point of view.

malignant disease. It is plain that we It is plain that we can remove only superficial growths by external means.

The experience of physicians from the time of Hippocrates confirms the view that the use of the knife is a delusion, either as a means of cure or even of prolonging life. It is unfortunate that the statistics of operation mean the statistics of the knife. If a cancer evidently resist internal treatment, the best chance we can give our patient is by enucleation by means of caustics. The knife I never employ, for however clean the sweep, however careful the sponging, arteries, veins, capillaries, and lymphatics are left more or less patulous, and who shall say that no drop of cancer juice shall reach their gaping orifices? The most convenient caustic is undoubtedly the chloride of zinc. It is usually combined with hydrastis powder to form a paste, but I am convinced that the nature of the substance employed for that purpose is a matter of perfect indifference.* It may be mixed with flour, as was the custom with M. Cancoin, who, in conjunction with M. Hänck, is said to have first employed it as an escharotic.

My custom is to chloroform the patient, make a ring of carbonate of soda paste round the tumour two inches from its circumference. Armed with stout gauntlets I then destroy the area of skin between the tumour and the alkaline paste by painting with anhydrous nitric acid, using a glass brush. Care must be taken to thoroughly protect the circumjacent tissues from the spurting of the

acid.

With a wire ecraseur I then remove the tumour, secure bleeding vessels by ligature or acupressure, and cover the exposed surface with caustic paste spread on lint, covered with oiled silk. Upon this may be placed a bladder of ice to allay pain.

The next day, if the base of the tumour be not reached by the paste, I make parallel incisions with a blunt knife, and apply paste again. The use of the ecraseur spares the tedium and torture of the customary repeated incisions. If the cancer be colossal the ecraseur wire may be passed through it by means of a blunt needle, and the tumour removed in two or more segments.

When the base of the tumour is reached, and, if subja

* A very little reflection will convince any one that a compound intended to react destructively or chemically upon tissues, cannot at the same time exert a therapeutic action on them.

cent tissues allow it, passed, I dress the resultant wound with inf. hydrastis. If healing be tedious, I apply extract. galii ap., using as far as possible the same medicine internally as locally.

I think it judicious to exercise great care in the selection of cases for operation. I do not commend removal if the patient be fat and plethoric, or if the cancer cover an enormous surface; if the patient be of gross habit and overfed on animal food; if of drunken habit; if gouty; if the subject of albuminuria; if markedly dejected or cachectic; if skin be brawny, with firm odema, and wide open hair follicles; if the skin be widely adherent or contain scattered cancerous foci; if the patient be aged, with little prospect of prolonged life in any case; if the glands be seriously complicated; if other organic disease be present.

As regards the hygienic conditions of cancer patients, after what we have said of the tendency of damp, lowlying soils to assist in the generation of cancer cachexia, it is obvious that a removal from them to high-lying primary strata, such as you are aware may be found in this country in the upper grounds of Scotland, of Wales, and of Devon.

I have seen no benefit accrue from depriving patients of animal food.

ON THE PHYSIOLOGICAL AND THERAPEUTIC ACTION OF ALOES.

By W. B. A. SCOTT, M.D.

THE date of the introduction of aloes into the medical armarium lies at some unknown point in the long interval between Hippocrates and Dioscorides; by the former the drug is not even mentioned, while the latter refers to it as in extensive use as a polychrest in his own days. More fortunate than many other remedies of, perhaps, equal value, aloes have, up to the present day, consistently sustained the high reputation they thus early acquired. They were held in high esteem by the Arabian school; and entered into a large proportion of the favourite nostrums of the middle ages. In the latest edition of the British Pharmacopoeia they form an ingredient in about twenty officinal preparations, many of which, from the polypharmacy displayed in their composition, are evidently of no recent date. Very various are the virtues which have been ascribed to this drug at different times. Thus in Hufeland's Journal (1822) we find a case of deafness alleged to have been cured by aloes, and this action has been confirmed by other observers. In 1824 we find the drug recommended by Rau for dysentery, without, perhaps, sufficient pains having been taken to indicate the forms of that disease to which it is specially applicable. Again, in 1839 Biermann employed it externally in the treatment of burns. Among the allopaths of the present day, as is well known, it ranks high as a tonic, stomachic, purgative, emmenagogue, and occasionally as an anthelmintic.

Socotrine and Barbadoes aloes, the two officinal forms of the drug, so named from their respective sources, consist of the inspissated juice of the leaves probably of several different varieties, as aloes spicata, vulgaris, socotrina, rubescens, &c. That in general use among homœopathists is prepared from a. spicata; but the chief provings

which I have been able to obtain (viz., those in the American Homœopathic Review, to which your VicePresident kindly drew my attention), seem to have been made with the ordinary Socotrine aloes. I have found it impossible to obtain other provings of any length, for which reason, among many others, I trust I shall meet with your kind indulgence for the very meagre and imperfect nature of the following remarks.

Under the head of "morale" we find the following leading symptoms ascribed to aloes :-Anxiety, anguish, restlessness, fear of death, repugnance to conversation, anthropophobia, disinclination to labour, amorous thoughts, despondency and moroseness. Accordingly, we find this drug recommended as a "divine remedy for melancholy" by Aretæus. All these symptoms seem usually to be aggravated during the morning and afternoon, and to be diminished towards night. They are also relieved in the open air. Symptoms of a totally opposite nature have been observed in some cases, but those above mentioned seem to be of the more frequent occurrence. It will be at once seen that they are all but identical with those of aconite, with the exception that the latter presents a nocturnal aggravation. Also, dislike to noise is specially recorded under aconite, and not so distinctly referred to under aloes, though even here one prover mentions a liability to start at sudden sounds under certain circumstances. The symptoms of agaricus under this head appear scarcely distinguishable from those of aloes; and here the period of exacerbation nearly corresponds. This is also true of aurum. The same may be said of belladonna, only here the aggravation is towards evening. Colocynth, ipecacuanha, conium, and bryonia, too, present striking resemblances, as also does nux vomica, though in the lastnamed drug the action is more variable. Something similar is perceived with pulsatilla. Phosphorus and lycopodium; also offers many points of similitude; while platina, plumbum, assafoetida, arsenicum, and clematis exhibit a partial, though less complete, resemblance.

For Morale; compare with aconite, agaricus, aurum, belladonna, colocynth, ipecacuanha, conium, bryonia, nux vomica, pulsatilla, lycopodium, platina, plumbum, arsenicum, assafoetida, clematis, phosphorus.

We find the following cerebral symptoms produced by aloes: Vertigo, worse on turning quickly, or going up