them mainly since they prove that the problem is not in its very nature insoluble, and that a cure for cancer, apart from the use of the knife, is certainly possible.

A few of the other non-operative methods that have been tried and discarded may be mentioned. Much interest was attracted a few years ago to some papers by the well-known French surgeon, Doyen, in which he claimed to prove that the cause of cancer is a microorganism (which he termed the Micrococcus neoformans) which is very readily demonstrable and cultivable. We may say at once that all claims of this nature are met with absolute incredulity on the part of pathologists. The structure and the bacteriology of cancer have been studied so carefully that it is impossible that an organism such as the Micrococcus neoformans can have been overlooked if it is really present in all cases of cancer. The truth seems to be that the germ in question is one that is very common in the skin and in the air, and that it readily gains access to ulcerated cancers or to those that are in proximity to the skin, alimentary canal, etc. Doyen prepared a vaccine which he considered to be efficacious against this organism, and claimed to get very favourable results as regards the amelioration of the symptoms and the retardation of the rapidity of the growth. His claims were investigated by a committee of the Société de Chirurgie, who reported absolutely unfavourably to the use of the vaccine. At the same time, it appears probable that cases in which there is much inflammation due to this organism in the neighbourhood of the tumour may be benefited temporarily by the use of this vaccine. It may be pointed out that nothing is more difficult than to estimate the real value of any palliative method of treatment. Tumours differ enormously in their rapidity of growth, and sometimes even cease to grow at all; and a considerable number of examples of the spontaneous cure of cancer are on record. If a remedy should happen to be applied to a patient just as the tumour ceases to grow or grows more slowly, the practitioner will naturally attribute the improvement to his remedy. Again, with regard to the improvement in the general condition which is often an apparently definite result of some of the newly introduced methods of treatment, here faith often plays a part of great importance,

and the enthusiastic introducer of a new remedy often claims, quite honestly, to get results that his more critical colleagues are entirely unable to verify. Lastly, it seems probable that a very large number of substances, if injected subcutaneously, cause in certain conditions a marked improvement in nutrition and general health, and many observers have claimed, and we believe with some amount of correctness, to have obtained some temporary improvement after the injection of substances of the most diverse description. This must always be borne in mind in reading of new remedies for which marvellous results are obtained. When a medical man overlooks these facts and happens to meet with one or two cases of apparent success after the use of a new remedy, it behoves him to be most cautious and critical, or he may become a danger to the community.

Another method which seemed to rest on a rational scientific basis was the trypsin or, more correctly, the enzyme treatment suggested by Dr Beard of Edinburgh. It was based on the fact that a structure which is developed during the early stages of the development of the embryo-the trophoblast-has a marked resemblance to malignant tumours whether regarded from a structural or physiological standpoint; the two structures erode the tissues in a strikingly similar manner. The trophoblast is only a temporary structure, and it degenerates and disappears at the time at which the pancreas begins to show signs of functional activity. Now this organ produces ferments which it is at least conceivable might digest and destroy the cells of the trophoblast; hence it seemed reasonable to hope that these ferments might, if injected into patients suffering from cancer, act on the cells of the growth in the same way, causing their death and digestion. This is the theory-a perfectly rational one-which was made the basis of the method of treatment. It met with the few apparent successes which seem to be the lot of so many of the methods of treatment which have been introduced, tried, and quietly laid aside. Unfortunately it was not brought before the profession in a manner calculated to gain their confidence, and it did not at first have the thorough testing it seemed to demand. This, however, has now been done in America by Dr

*

W. S. Bainbridge of the New York Skin and Cancer Hospital. The tests were carried out on one hundred patients, and Dr Bainbridge was in close touch with Dr Beard throughout; the best materials were used, and all the conditions were most favourable. The results were entirely unfavourable; the process was not checked, and its spread to distant parts of the body was not inhibited. In a few cases there was a slight degree of improvement in the general condition, but, on the other hand, the remedy proved to be by no means harmless. It is sad to think that a method of treatment apparently based on such logical lines must be relegated to obscurity.

Lastly, a word with regard to the quack cancer-curers. They fall into two classes. In the first, the so-called remedy is one which is obviously inert, and is both harmless and useless; there is apparently nothing to prevent any one from selling tap-water at a high price and vaunting it as a cure for any disease he may care to select. The second group make use of strong caustic substances, such as chloride of zinc or arsenious acid. Materials of this nature eat into and destroy all tissues, whether healthy or diseased, and were much used in the treatment of cancer before the discovery of antiseptics had rendered surgical operations so safe and satisfactory. In skilled hands they may perhaps have had some slight value, but as used by the ignorant impostor (often with the accompaniment of a nauseating religious element) they are dangerous in the highest degree, being atrociously painful, filthily dirty, and liable to cause death from sepsis, or from hæmorrhage from the erosion of a large vessel. They are never successful in curing the disease. In some cases the destruction of the main mass of the tumour may lead to an apparent cure, but it is of short duration, and occasionally the action of these caustics even appears to aid the dissemination of the disease. They only effect a real cure in innocent tumours and other lesions which might be cured more safely, quickly, and pleasantly by other methods. It is amazing that the law should be powerless to deal with such a source of danger and suffering to the community.

'Scientific Report of the Committee on Scientific Research of the New York Skin and Cancer Hospital,' 1909.

Art. 4.-THE GENIUS OF THE RIVER.

1. Rivers and Streams of England. By A. G. Bradley. London: Black, 1909.

2. The Hudson River. By Edgar Mayhew Bacon. London: Putnam, 1902.

3. The St. Lawrence River. By George Waldo Browne. London: Putnam, 1905.

4. The Columbia River. By William Denison Lyman. London: Putnam, 1909.

5. The Historic Thames. By Hilaire Belloc. London: Dent, 1909.

6. The Story of the Thames. By J. E. Vincent. London: Smith, Elder, 1909.

7. The Story of the Tweed. By the Rt Hon. Sir Herbert Maxwell, Bt. London: Nisbet, 1909.

'What a number of things a river does, simply by following gravity in the innocence of its heart.'-R. L. Stevenson.

AT the close of the great Ice Age, when the last mer de glace had drawn back towards the poles, and the glaciers to their alpine strongholds, a living element was awakened in the still landscape, and for the first time, though there were few to hear them, the voices of rivers sang loudly as they hurried down from the hills to trace a winding colophon to the pleistocene chapter of earth's story. These symbols of the renascence of thawed Nature were henceforth to enliven scenes once dead and frozen, and they made the landscape as they went, wearing down the hills, carving their way through such obstacles as lay between them and the sea, and then, before losing themselves in its embrace, piling up island deltas to mark the union. We talk lightly of the faith which moves mountains. Nay, we regard even the hills themselves as everlasting. Do we realise what the rivers are doing for all time, year in year out, day and night, deterred only by the frost which deadens their activities and reverts to the conditions of the glacial epoch? They are levelling the proudest summits with the plain, grinding them to dust, and carrying them as mud to the ocean. The process is a slow one, invisible to the uninformed eye patent only to the geologist, who looks beneath the

surface, but it is none the less inexorable and unremitting. Rivers are Nature's architects; and what monument is there to Wren or Inigo Jones like unto the Grand Canyon of Colorado! Burnaby, in his famous 'Ride to Khiva,' has a passage which admirably describes this function of rivers:

'Many streaks down the rugged sides of the heights around us showed where the rain, pouring down on their crests in the early spring, diverged in foaming torrents. Here, dashing with irresistible force through the narrow pass, they would furrow a road before them; there, emerging from the gradually widening defile, they would rush in a hundred different channels to swell the volumes of the mighty Oxus.'

For ages, then, before it figured in the history of nations as the highway and the frontier, before it carried adventurous pioneers into the heart of the forest, or made possible the crushing of remote inland autocracies, like that of the Dervishes, by civilised powers, the river played a great part in moulding the earth.

The river, running, as Stevenson has it, 'from among reeds and lilies' to the sea, is the very emblem of our life. First a joyous stripling rushing out of darkness, then a weary creature passing into the unknown, with a gleam of sunshine between. It is surely the most sympathetic water in all nature. The sea is too boisterous, the lake too lethargic. The river alone suits every mood in which we seek its companionship. Its rapids wake the Wanderlust, for they sing of hurry, change and an ocean goal. The backwaters bring sweet content.

The river is the daughter of the rains and mountains. Always this is true: of the Jordan, though it seems to flow from an underground spring; of the Rhone, though we see it descend spaciously from melting snows; of the St Lawrence, which looks merely the overflow of a mighty lake. It is the rains which are at the root of every river, great or small. The Psalmist had this in mind when, grateful in a thirsty land, he sang of rain as the 'river of God.' In the Holy Land, it is true, more than elsewhere, rivers have a way of leaping up suddenly from some hidden underground source, so that the eye of man has never beheld their tender beginnings. This phenomenon it was, no doubt, which inspired the prophet Isaiah with Vol. 213.-No. 424.

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