GENERAL DIRECTIONS 197
over, it must be understood distinctly, that if “test cases” are to be treated, after the lines of Messrs. Ball and Thomas and Dr. W. S. Bainbridge, certain other scientific stipulations must be made, and in scientific fashion “the test” must be carried out under rules of procedure agreed upon between the testing surgeon and the scientific investigator. In other words, all apertures for the creeping in of “errors of experiment” must be closed up. Above all, cases such as post-operative recurrent ones, in which any other treatment had been employed previously, cannot be used and cited as failures in any test claiming to be scientific.
1. From Captain Lambelle’s results, published and unpublished, and from the outcome of the Uppingham case, the treatment appears to be applicable to inoperable, recurrent, and primary cases; but in taking up treatment the physician is urged to bear in mind all along the size and extent of the tumour and the previous history in fixing upon strengths and doses. On occasion much larger doses might probably be injected with safety, provided that for every increase of trypsin an adequate amount of amylopsin be injected at the same time; or under the system of Roberts units advocated, for every tryptic unit let there be at least two amylolytic ones.
2. The injections should be freshly made, and whenever possible not many days old. All boxes should bear the date of manufacture.
3. On no account may the injections be made up from commerical “ trypsin in powder” or similar things.
Great stress must be laid upon both of these points. Obviously injections containing peptones are unfit for use, though in some instances the treatment has been condemned after the employment of such. A special reason for the use of freshly-made-up injections lies in