TWO RECENT CASES 217
in a pool, or abscess may follow. A local analgesic is unnecessary. Cleanse the part before injection with spirit solution of biniodide of mercury, 1 in 1,000, and seal the puncture with rubber plaster.
The foregoing directions for treatment have my full approval. One or two things may be added to them. With slight alterations, the “ General Directions,” drawn up by the writer, and amended from time to time in 1906-07, in most respects still hold good. While never regarding the oral treatment as more than an adjunct to the patient’s digestion—but a valuable one, without the slightest influence upon the cancer—I see no objections at all—but advantages—in the use of calcium lactate, suggested by Captain Lambelle. It has been my opinion now for more than four years that it was of the utmost importance that each and every trypsin injection should contain much amylopsin. It seems best to follow the procedure adopted by Captain Lam-belle, and to use two separate injections of trypsin and amylopsin. These should never be of less potency than 1,000 units of tryptic activity, and 2,000 units of amylolytic power. The trypsin injection should never be given without at the same time a corresponding amount of amylopsin; and, if this be done, the necessity of using amylopsin alone will, I imagine, disappear. On occasion the full dose of 1,000 tryptic and 2,000 to 2,400 amylolytic units may, in the judgment of the physician, be increased, provided that the rule of two amylolytic units for each tryptic unit be followed strictly.
The injection of amylopsin (2,000 to 2,400 units per cubic centimetre) may, in the judgment of the physician, be given without the injection of trypsin, for it is only the use of trypsin alone which causes bad symptoms. It must be stated distinctly that the dose of 1,000 units of