THE TURKISH ARMY. 
 
 HE Turks have always been essentially and above everything 
 
 else a military people. By this I mean that they soon 
 learned to frame the martial qualities of their race in a strong and 
 comprehensive organisation which raised them from the level of 
 warriors to that of soldiers. The foundations of this system, which 
 for several centuries was far in advance of the conceptions and 
 practice of Europe in the matter of warlike institutions, were laid as 
 early as the first half of the fourteenth century in the reign of their 
 second Sultan, Orkhan (i 326-1 360). Ever since that time they have 
 disposed of standing armies, regularly recruited and strictly national, 
 instead of the levies of feudal troops and mercenaries, raised only 
 as occasion arose, in and outside of their own geographical limits, by 
 the European States until a comparatively recent "date. (The 
 Janissaries, though recruited by means of raids from among the 
 neighbouring Christian peoples until 1648, after which they became 
 a caste, were thoroughly assimilated, the men who composed this 
 celebrated corps being transplanted into the Turkish community as 
 very young children.) To-day the principle upon which the military 
 establishment of Turkey was reared has become almost universal. 
 The " armed nation " idea is only an extension of it. In many other 
 respects relating to preparation for war, especially in their armament, 
 which included artillery long before it came into use in European 
 camps, the Turks showed themselves superior to their Eiiropean 
 neighbours. This superiority has disappeared long ago. Turkey 
 has still retained all the characteristics of a military State, but the 
 poison of dissolution, which has been circulating in her veins for the 
 last two centuries, and which has reduced to profound decay a State 
 once so exuberjintly healthy and vigorous, has not spared her military 
 institutions. It is all the more necessary to give an accurate 
 description of the military condition of Turkey in the present day 
 because the general public labour under misapprehensions in this respect, 
 
404 
 
 THE CONTEMPORARY REVIEW. 
 
 the tendency being to overrate her fighting powers. It is the object 
 of this article to deal with this important subject from a general 
 point of view. For technical details the "Statesman's Year Book" 
 can be consulted with profit. 
 
 Militajy service is compulsory in Turkey, but only for the Mussul- 
 man population. The Christian subjects of the Sultan are and have 
 always been excluded from the army on the reasonable ground that 
 their presence in it would only be a source of weakness, owing to 
 social and political causes. The difference is so great between the 
 customs of the followers of the Cross and the Crescent respectively ; 
 the relationship in which they stand to one another in Turkey places 
 them on such different levels as citizens of the same State; the 
 aspirations of the former, encouraged and supported by Europe, are so 
 dangerous to the integrity of this State, which is founded on the 
 predominance of one religion over the other, that the Sultans have 
 wisely held by the rule not to introduce into the ranks of their troops 
 the Christian element, which, on its side, has not been in the least 
 disposed to protest against an arrangement thoroughly in accord 
 with its secret wishes. It would have been wiser still, though from a 
 modern point of view execrable, on the part of Osman and his 
 successors if they had forced into the Mussulman fold the Christian 
 peoples conquered by them, and, at the same time, reduced to a 
 common Turkish denominator these same peoples, as well as those 
 who accepted Islamism voluntarily from the Turks as a result of 
 defeat, like the Albanians and Kurds, and especially that people to 
 whom the conquering race itself owes its religion and which also 
 came under the Ottoman sceptre, namely, the Arabs. The strength 
 of the State would have increased enormously not only in a militar>' 
 but in a political sense, and in all probability this would have allowed 
 it to tide over the evil days which have come upon it, a thing which 
 seems impossible to a Turkish dominion of which the prop is a people 
 not numbering more than 9,000,000. As a compensation for 
 exemption from military service, the Rayahs (Christian subjects of 
 Turkey) hare to pay a military tax called Bedel-i-Askeriye. 
 
 The Turkish law obhging all Mussulmans to do mihtary duty 
 contains several exceptions, of which the most notable are those 
 relating to Constantinople — a town of over 1,000,000 inhabitants, a 
 good half of whom are Mussulmans — and to the province of Tripoli in 
 Barbary. Neither of these regions provides a single regular soldier 
 to the Sultan's forces. The privilege of the capital dates from the 
 time of Mehmed II., the Conqueror (the only Sultan to whom the 
 surname of Conqueror has been attached in Turkish history, he 
 being the Conqueror far excellence in the eyes of the Turks by reason 
 of his capture of Constantinople), when it was meant to attract Turkish 
 settlers to the place, and still survives owing, in a great measure, to 
 sentimental and political reasons. That of Tripoli is due to the desire 
 
THE TURKISH ARMY. 
 
 40s 
 
 not to create what would be a source of serious discontent in a 
 detached province of the Empire. Even in this restricted sense the 
 obhgation under which the Mussulmans are placed to serve in the 
 army exists only in principle. The Porte has been taught by bitter 
 experience that in Albania, Kurdistan, Yemen and Hedjaz the enforce- 
 ment of conscription can be obtained only at the cost of regularly 
 recurring campaigns. Therefore these lawless provinces are 
 practically allowed to enjoy exemption from military duty. Only 
 those who care join the colours. This means that the Albanian cind 
 Kurdish contingents are at least 50 per cent, below par. The Arab 
 contingent has never come into existence in any shape or numbers. 
 The only perfectly reliable sources of recruitment of the Imperial 
 Army are : first and principally, the Turks proper, the founders of 
 the Ottoman Empire, who are still to be found practically free from 
 all alloy in the central provinces of Anatolia, but live also in con- 
 siderable numbers (relatively speaking) as a mixed race throughout 
 Asiatic and European Turkey; secondly, the Lazes, a people of 
 Greek descent living along the southern shore of the Black Sea; 
 thirdly, the Syrians. 
 
 In time of war the Ottoman Army could muster close upon a 
 million of men, 10 to 15 per cent, of whom, however, would be 
 represented by irregular troops and volunteers, that is to say, by 
 Kurdish and Circassian cavalry, and Albanian, Bosniak and other 
 amateur warriors eager to take up arms in defence of the Crescent. 
 The backbone of this force would be the Turkish contingent, sur- 
 passing the others not only in numbers but in all the natural qualities 
 of the soldier. 
 
 The bravery of the Turkish " Mehmed " (Tommy) is well known. 
 It proceeds from the absolute unconsciousness of danger. In its 
 blindness it is almost animal like, but, precisely on that account, 
 knows no limits. Its nature is best revealed by the attention the 
 Turkish soldier is capable of giving in the thick of battle to trivial 
 details of ordinary life, such as the undoing of his boot strings, which 
 he will sit down calmly and unconcernedly to put right, or the flight 
 of a bird, which he will follow in its course, or a humorous incident 
 which will set him laughing. It is a purely racial characteristic. 
 Contrary to what is generally thought to be the case, religious 
 inspiration has little or nothing to do' with it. Islamism only adds to 
 the warlike enthusiasm of the Turk. It makes him more eager, 
 more strenuous, more enterprising in battle with the infidel, since 
 death in such a case secures to him the transcendent rewards of 
 martyrdom ; but his fearlessness is not greater when he is waging 
 war against the latter than when he is fighting his rebellious Albanian 
 or Arab co-religionist, which he is constantly employed in doing by 
 order of the Sultan. He is as enduring as he is brave, and as 
 disciplined as he is enduring. What he can put up with in the way 
 
4o6 
 
 THE CONTEMPORARY REVIEW. 
 
 of hardships of every description is far beyond the capacity of the 
 European soldier, not excluding the Russian, who, however, might 
 equal the Turk in this connection were it not for the drinking habit 
 to which he is a victim and from which the former is absolutely free. 
 To find an exact parallel for the power of the Turk to defy all forms 
 of suffering we must go to China and Japan. It does not detract in 
 the least from his merit in this respect to say, what is perfectly true 
 in his case as in that of the Chinese and Japanese, that his impassive- 
 ness where pain-producing circumstances are concerned proceeds in 
 a great measure from insensibility. Ultimately this means the 
 possession of an exceptionally healthy and robust constitution ; and 
 health and strength, which certainly are among the inheritances of 
 the Tiirk, are great virtues. The discipline of the Turk does not 
 show in superficial matters. He reserves his salute for full-blown 
 generals, and otherwise behaves towards his superiors with a sans 
 gene which produces a bad impression on those who are accustomed 
 to connect obedience with a complicated display of respect. But his 
 submissiveness to those in command is quite extraordinary, though 
 under the present Government of Turkey the conditions of his 
 military service have become so intolerable that mutiny has become a 
 frequent occurrence in the Imperial Army. The wonder is that any 
 discipline at all exists in its midst. The Turkish soldier is withal 
 good-natured, self-reliant and resourceful. I should add that this last 
 quality is characteristic of all the inhabitants of Turkey, who, in the 
 semi-barbarous condition of the country, are constantly forced to 
 exercise their wits with great keenness to preserve their bare 
 existence. 
 
 • The Laze is almost equal to the Turk in military virtues. What, 
 however, distinguishes him particularly from the latter and makes 
 him rather less valuable as a soldier in the Imperial Army is the 
 absence on his part of that blind devotion to the Sultan-Caliph which 
 finds the Turkish Tommy ready for any kind of work asked of him 
 in the name of his Imperial Majesty. 
 
 The Albanian, the Kurd and the Circassian are very much of the 
 same quality in the field. They are all brave, especially the Albanian, 
 but more consciously so than the Turk, and therefore more subject 
 to reactions. They all have more dash than he, but less steadiness, 
 and are not easily amenable to discipline. Thus, splendid fighting 
 men as they all are, they do not come up to the Turkish standard as 
 soldiers. The Syrian ranks lowest in the scale of military attributes, 
 but still provides a useful contingent to the Ottoman Army. 
 
 On the whole, and considering the great preponderance of the 
 Turk in its midst, the Ottoman Army is composed of the most 
 admirable material. Well organised, well trained, well officered and 
 well treated, it would constitute a force capable of extraordinary 
 achievements, especially in a struggle with a Christian adversary. 
 
THE TURKISH ARMY. 
 
 407 
 
 But it is so deficient in all these conditions that m a war with a 
 civilised Power nothing but splendid episodes leading to no practical 
 results could be expected of it, unless it enjoyed, in a very marked 
 degree, the advantage of numbers. The idea that under the present 
 Sultan the Turkish Army has made great progress is entirely 
 erroneous. So' far from this being true, it has considerably 
 degenerated from the standard to which it had risen under Abd-ul- 
 Aziz, the reason being that the present ruler of Turkey, who, 
 unfortunately for himself and his country, is a monomaniac, sees an 
 internal source of danger to his throne and person in every step 
 towards reform, and more particularly in an army with a sense of its 
 own efficiency. It is a pathetic instance of the work of destruction 
 deliberately undertaken by the practically irresponsible Abd-ul-Hamid 
 in his Empire. Everybody has been long accustomed to think of the 
 civil institutions of Turkey as rotten to the core, but the mind of 
 the historical student feels something akin to pain in being initiated 
 into the secrets of the degradation of the Turkish Army, which only 
 thirty years ago stood out alone, still glorious even in defeat, as a 
 pleasing survival of the greatest and most interesting element of 
 Turkish civilisation, which was once of a very high order. 
 
 What in the eyes of many people maintains the illusion that 
 progress is being made in the Turkish Army is the employment by 
 the Sultan of a German military mission, which, when it first took up 
 its duties twenty years ago, was under the presidency of that eminent 
 soldier and military author. Baron von der Goltz. But the Sultan's 
 object in engaging it was to throw dust in the eyes of Europe and 
 his own people. Baron von der Goltz himself practically told the 
 writer that the arrangement proved to be a farce. Thanks to 
 miracles of diplomacy and energy, thanks to repeated threats of 
 resignation, this conscientious as well as highly capable mihtary 
 adviser to the Sultan succeeded in carrying through, during the term 
 of his contract, a few reforms, principal among them being 
 those relating to the system of recruitment and mobiHsation. This is 
 the only part of his work which has survived, and constitutes almost 
 all the progress accomplished in the Turkish Army during the reign 
 of the present Sultan. In every other respect but one, that of its 
 armament, which in greater part has been brought up to date, it has 
 either remained stationary or retrograded, notwithstanding the 
 continued presence in Turkey of the German military mission, which 
 after the departure of its first chief seems to have easily resigned 
 itself to inactivity. 
 
 The training of the Turkish soldier is confined to elementary drill 
 in the barrack yard. Anything beyond this, especially shooting 
 practice and manoeuvres, is considered by the Sultan as likely to 
 offer opportunities for a movement directed against the Palace, and 
 is therefore stricdy forbidden. The cadres are formed, with few 
 
4o8 
 
 THE CONTEMPORAR Y RE VIE W. 
 
 exceptions, by men who have either' received no technical instruction 
 at all, and some of whom are even illiterate, or whose educational 
 equipment is that provided by the Military Academy at Con- 
 stantinople. To give an idea of the spirit which presides over this 
 establishment it will suffice to say that for the last twelve years it has 
 been under the direction of a man whose special and only qualification 
 for the post was his well-proven aptitude to act the part of spy, and 
 that the teaching of chemistry ceased to form part of its programme 
 after the bomb outrage committed two years ago during one of the 
 Selamhk ceremonies. 
 
 But what interferes even more with the efficiency of the Turkish 
 Army is the complete demoralisation into which it has been plunged 
 by the misguided Abd-ul-Hamid. It has been one of the principal 
 objects of his reign to sow rivalry and dissension in its midst, so that, 
 with the exception of the Turkish regiments, who have not been 
 worked upon because they are too devoted to be feared and too 
 stolid to be moved to hatred against their own co-religionists — 
 besides which they are meant to act the part of general policeman in 
 the Empire — each racial section is at feud with the other. It is 
 especially among the troops entrusted with the safety of the Imperial 
 residence, and of which there is a whole brigade, that this spirit is 
 fostered, so that it is not uncommon for regular battles to take place 
 between them. No doubt when things have reached this pass the 
 Sultan considers that his object has been exceeded. But the remedy 
 is easy.^ The guilty battalions are tricked out of their cantonments 
 at Yildiz, surrounded by Turkish regiments, and packed off to some 
 remote part of the Empire, others taking their place and retaining it 
 until they have also lost the sense of the limits they may reach in 
 their hostility to one another. 
 
 Irrespective of race, every officer is tempted with the prospects of 
 promotion and other rewards to spy upon his comrades and report 
 their domgs. Thus cohesion and esprit de corps are totally absent 
 from the Imperial Army. Popularity in those who belong to it causes 
 considerable umbrage and anxiety. When it is great and attaches to 
 officers of the highest rank it leads to their practical exclusion from 
 the army. Thus, under the title of Grand Marshal of the Court and 
 with innumerable favours heaped upon him, Osman Pasha, of Plevna 
 fame, now dead, was neither more nor less than a prisoner at Yildiz. 
 Thus also Moukhtar Pasha, the Anatolian "Ghazi," has been for 
 twenty-five years as much of an exile as an emissary under the title 
 of Ottoman Commissioner in Egypt — an exile on 2,000 a year, 
 enough ^ to reconcile him to his fate. In officers of lower rank 
 popularity leads to commands on the confines of the Empire or to 
 perpetual removal from one military district to another. 
 
 Another and equally great source of weakness in the Ottoman Army 
 is to be found in the lam.entable incompleteness and imperfection 
 
■i 
 
 THE TURKISH ARMY. 409 
 
 oi its commissariat and medical arrangements. There is no doubt 
 that in time of war Turkey will find herself extraordinarily crippled 
 and enfeebled by this situation. It takes an incredible amount of 
 hardship to disable the Turk, and he dies as hard as a cat. But 
 there are limits even to his powers of endurance. Owing to 
 insufficient and unwholesome food, owing to the complete absence of 
 sanitary precautions and ambulance aid in campaign time, a large 
 proportion of the Turkish battalions engaged in war are destined to 
 die miserably and ingloriously lying on their backs. Under these 
 circumstances" it is reasonable to discount in a very large measure the 
 numerical strength of the Turkish Army and consider that it does 
 not really represent more than 500,000 to 600,000 men, since the 
 destructive causes just mentioned will begin to operate as soon as it 
 is involved in hostilities. What is happening in Arabia fully bears 
 out these contentions. The Imperial regiments are melting like snow 
 in the sun as a result of disease, hunger and thirst. What under a 
 fairly competent administration might easily have been a victorious 
 campaign seems to be assuming the aspect of a most disastrous 
 expedition, leading to political results of an even more serious 
 character. It gives the measure of the folly and stupidity presiding 
 over the counsels of the Empire that in a question of vital importance 
 to the State and dynasty, viz., that of retaining the holy cities of 
 Islam under the sceptre of Osman, no departure from the ordinary 
 methods of Yildiz should have been attempted. But Quos Deus vult 
 ferdere .... 
 
 To sum up, the Ottoman Army might be one of the most formidable 
 military machines of the world. In its present condition, however, 
 which is becoming intrinsically worse from year to year and is further 
 affected by the general state of disorganisation of the Empire, it is 
 questionable whether it will secure victory to the latter in what seems 
 to be its unavoidable struggle in the near future with Bulgaria, a 
 State with a population under 4,000,000, but one which is making 
 rapid strides in civilisation and is particularly well equipped for war. 
 
 In its relation to England, whose occupation of Egypt constitutes 
 a source of friction with Turkey, the Turkish army is not very much 
 better situated. True, it would possess a huge advantage in numbers 
 over a British expeditionary force ; but this is more than neutralised 
 by the political situation in Syria, where an Anglo-Turkish war would 
 be fought out, and by the strategic advantages which accrue to 
 England by virtue of her presence in Cyprus and her naval power. 
 For this reason, and also because of the general political situation, 
 which is becoming more and more favourable to England, the friction 
 between the two Powers can scarcely lead to hostilities. This was 
 proved during the Tabah incident last year. 
 
 A. DE BiLINSKI. 
 
THE NEW 
 
 TREATMENT 
 
 OF 
 
 CANCER. 
 
 S the reader can scarcely fail to be aware, the recent study of 
 
 cancer has specially concerned itself with the possibility of 
 opposing the disease by means of the hypodermic injection of certain 
 ferments which pass into the blood and are carried by it to the site 
 of the malady. At the present time there is a striking difference 
 between the verdict of our own Cancer Research upon the results of 
 this treatment in the mouse, and that of the German Cancer Research 
 upon its results in man : but so many clinical reports have lately 
 been obtained that the prospects of the treatment of malignant 
 disease by ferments may now be discussed. More than nineteen 
 months of work and waiting have passed since my attention was 
 actively directed to this subject, and my present warrant for writing 
 depends mainly upon the work which has been done in America since 
 the beginning of April, 1906, upon work done in Italy, and upon the 
 recent researches of Professor Von Leyden and his assistants at the 
 German Cancer Institute in Berlin. 
 
 There are so many urgent things to say that I must be 
 extremely brief in discussing the theory advanced in 1902, to which 
 many years of embryological work led Dr. Beard of Edinburgh, 
 and which later issued in his recommendation of trypsin and 
 its brother ferment amylopsin as means of treating cancer. 
 As briefly as possible, he beHeves that what is known as the 
 "alternation of generations" obtains amongst the higher animals as 
 well as amongst the lower ; that indeed at a certain stage even in 
 human development a larval structure can be found ; that this begins 
 to be destroyed and gradually disappears when the pancreas or sweet- 
 bread of the developing individual becomes active; that this 
 disappearance is due to the digestive action of the ferments produced 
 by the pancreas ; and that essentially a malignant tumour is one and 
 
 THE TROPHOBLASTIC THEORY OF CANCER. 
 
THE NEW TREATMENT OF CANCER. 
 
 411 
 
 the same as this larval tissue or trophoblast. In other words, a 
 cancer is "irresponsible trophoblast." Since the "critical period" — 
 as Dr. Beard calls it- — at which the embryo changes its mode of 
 digestion, is determined by the activity of the pancreas — that is to 
 say, since normal trophoblast is killed and digested by the pancreas 
 —active pancreatic extract should effect the death and digestion of 
 "irresponsible trophoblast" or malignant tissue. Such malignant 
 tissue Dr. Beard believes to arise from certain orders of aberrant or 
 misplaced germ-cells, such as he has found in almost all parts of the 
 embryos of various lower animals. The reader who is concerned with 
 the theory must be referred to Dr. Beard's many monographs, mainly 
 published by Gustav Fischer, of Jena, and his various contributions 
 t6 the Lancet. But for my present purpose the theory is nought. 
 The manner in which Dr. Beard was led, on December 13th, 1904, 
 to suggest the pancreatic ferments as the natural means of treating 
 cancer, may be of the utmost interest from the scientific standpoint : 
 here our only question is whether the suggestion is worth anything to 
 victims of this appalling disease. 
 
 THE USE OF THE FERMENTS. 
 
 The essential agents of the treatment are the pancreatic ferments 
 which have for some time been known to physiologists under the 
 names of trypsin and amylopsin. They are in no sense whatever 
 patent medicines or empirical drugs, but substances which are being 
 manufactured at this moment within every one of my readers, and the 
 principal properties of which have long been familiar to students of 
 the chemistry of digestion. The ferment trypsin is known as the 
 most powerful means by which the body of any of the vertebrates, 
 including man, digests and breaks down the albuminous or proteid 
 matter which constitutes the most important ingredient of the food 
 of all animals whatsoever. Now, according to Dr. Beard, trypsin 
 can not only digest certain of the dead proteids of the food, but also 
 it can kill and digest the living proteids of a malignant tumour. This 
 conclusion has lately been confirmed by Professor Von Leyden and 
 several others in Berlin, as we shall see. 
 
 The reader will remember that Dr. Beard was led to his theory by 
 observing in the developing animal the coincidence in time between 
 the appearance of functional activity in the gland known as the 
 pancreas or sweetbread, and the gradual disappearance of the 
 particular tissue which is called trophoblast, and of which he 
 believes a cancer to be composed. But the pancreas secretes not 
 merely trypsin but three other ferments. It would seem probable, 
 according to Dr. Beard, that when a gland secretes more ferments 
 than one, they have a relation to one another, and may indeed be 
 complementary. This would appear to be so in the present instance. 
 
412 
 
 THE CONTEMPORARY REVIEW. 
 
 It seems that the administration of trypsin alone may suffice to 
 destroy the albumin contained in the cells of a cancerous growth, and 
 essential to their life : but the products of the digestion are by no 
 means such ultimate and easily-disposed-of compounds as carbonic 
 acid gas and water. On the contrary, no one who has any acquaint- 
 ance with the amazing complexity of the compounds we call proteids 
 will be surprised to learn that, in all probability, trypsin breaks them 
 into a large or small number of intermediate substances, which 
 necessarily enter the blood from the tumour and have then and there 
 to be reckoned with. These substances may belong to the series which 
 the chemists call alcohols, amido-acids, amines and others. They may, 
 even, be higher proteoses and albumoses, some of which are known 
 to possess markedly poisonous properties. In considering these matters, 
 and pondering over the various unpleasant symptoms v/hich may 
 follow the use of trypsin alone in cancer— such as drowsiness, nausea, 
 and pufEness of the skin— it occurred to Dr. Beard that perhaps it was 
 not wise completely to follow Nature's indications by using trypsin 
 alone : that perhaps in man and the mammals Nature "made a mistake " 
 in trusting to trypsin alone, until the stage of mammary or milk- 
 nutrition was passed — for the pancreas produces no amylopsin till 
 after this period. (That is why babies cannot digest starch.) Trial 
 has therefore been made of the injection of the powerful ferment, 
 amylopsin, which is also produced by the pancreas. Just as trypsin 
 is without action on glycogen or starch, so also amylopsin has no 
 action upon proteids ; and there is no reason to beheve that it is 
 capable of effecting any good by itself : but the argument is that it 
 should be of value in disposing of the intermediate products which 
 result from the digestion of the cancer-proteids by trypsin. This 
 theory has now been widely tested by practice, and with apparent 
 success (Morton, Cleaves, Pinkuss). It is reported that the use of 
 amylopsin in the later stages of treatment, when unpleasant symptoms 
 are apt to arise in consequence of the absorption into the blood of the 
 products of the dead and degenerating tumour, goes very far to 
 avert these symptoms. They have repeatedly been suppressed 
 immediately after its use. Trypsin alone, without amylopsin, "is a 
 "very deadly remedy for cancer" (Beard). 
 
 It must be remembered that, in these early days, it has not been 
 legitimate — except in the case of mice — to trust in trypsin except as 
 a forlorn hope in inoperable cases. It is evident that the larger the 
 tumour the more abundant will be the products of its disintegration. 
 Thus the difficulty arising from the absorption of such abundant 
 matter from the dead tumour may be regarded as no more than 
 incidental to the first phase of the new treatment. When a tumour 
 is young and quite small, the products of its death and degeneration 
 should be proportionately scanty, and it should be an easy matter to 
 deal with them. 
 
THE NEW TREATMENT OF CANCER. 413 
 
 And now as to trypsin itself. Probably the ordinary student of 
 physiology fancies that he knows what there is to know about this 
 ferment. But a discovery like this always tests the state of science in 
 regard to the matters with which it deals. It is difficult, for instance, to 
 ascertain how much trypsin is normally produced every day in the body, 
 or whether — and if so, how — the amount varies at different ages — a 
 question which may bear on the age-incidence of cancer. Nor until the 
 new German work could I find any statements as to what becomes of 
 the trypsin which each of us daily produces. Does it leave the body 
 somehow as such, or is it broken up within the body ? Is it normally 
 contained in the blood, and, if so, to what extent? The blood and 
 the body-fluids in general are alkaline, be it remembered, and it is in 
 an alkaline medium that trypsin acts best. (It also acts in weak 
 acid, and in a neutral medium.) All these questions will have to be 
 investigated soon. Probably the great firm of Fairchild Brothers and 
 Foster, who have long studied the digestive ferments, know more 
 about them than anyone else, but even their knowledge is not yet 
 sufficient for our needs. It is to this firm — of New York, by the way 
 — that application should be made for trypsin and amylopsin.* 
 Certain facts of more immediate importance have been ascertained. 
 No one on earth knows how any ferment acts : but some of the 
 necessary conditions are known. If a ferment be heated, it loses its 
 activity permanently. Some pioneers of this subject have filled their 
 syringes with the injection before allowing them to cool after the 
 boiling which is necessary for purposes of sterilisation. The conse- 
 quence has been the destruction of the trypsin and failure to obtain 
 any results from its use. Or the water with which the injection is 
 diluted has not been allowed to cool sufficiently after boiling, and the 
 same consequence has ensued. (The newest injections require no 
 dilution.) Again, it is found that trypsin only keeps at all under certain 
 definite conditions. Injections prepared with an insufficient pro- 
 portion of glycerine have been found to be totally inert after a few 
 days, and none will keep for many weeks : hence the possibility of 
 many more failures. 
 
 Indeed, though the principles of the treatment are so simple, its 
 details require the utmost care. The trypsin in the injection must be 
 active in the first place, and must not be destroyed by heat in the 
 second place. Yet, again, in the course of diluting the solution and 
 actually injecting it, the most careful antiseptic or aseptic precautions 
 must be observed. In one early instance, where results were 
 published in a professional journal in America, abscesses formed at 
 the site of injection, and the recorder minutely described those 
 abscesses, under the impression, presumably, that they were caused 
 by the trypsin. Possibly he shared the opmion, communicate3 a 
 
 * Their agents in Great Britain are Messrs. Burroughs, Wellcome & Co. Messrs. 
 Squire & Sons, of Oxford Street, also prepare active and trustworthy injections. 
 
414 
 
 THE CONTEMPORARY REVIEW. 
 
 year ago to a London newspaper by a physician, that the injection of 
 trypsin anywhere would cause an abscess. But this is utter nonsense. 
 Trypsin has no power whatever to injure or in any way affect the 
 normal living cells of the body. This is sufficiently shown by the 
 fact that it is daily produced in the body. Abscesses following 
 an injection have the same meaning as abscesses following any other 
 injection — germs have been allowed to enter. But this should never 
 happen, and, in the cases I have myself observed, it has never 
 happened. In the pioneer case which I watched, in February and 
 March, igo6, in a poor quarter of London, where every excuse existed 
 for contamination of the injections by dirt, I found it impossible even 
 to discover where they had been made. Dr. Luther, of the University 
 of Pennsylvania, reports that he has given 500 injections without a 
 single abscess : and I have never seen an abscess following injection 
 in any of the many cases I have watched. 
 
 In my articles published last year I endeavoured — but apparently 
 without success — to emphasise the innocent character of this ferment. 
 Subsequent correspondence has shown that it is regarded with the 
 utmost apprehension and suspicion by many of those who have used 
 it, with the consequence that not nearly sufficient has been employed. 
 One wonders what on earth some people think trypsin to be. They 
 treat it as if it were some rare and subtle poison, the properties of 
 which are entirely unknown. But trypsin is not a poison — or rather, 
 not a poison to normal tissue. It is an entirely innocent, normal, and 
 invaluable constituent of the body. It is incapable of causing an 
 abscess, for instance, and cannot possibly give rise to any symptoms 
 in anyone who does not suffer from cancer. No physician has any 
 hesitation in prescribing pancreatic extract, which has been used for 
 years as a digestive. Why, then, should the administration of its 
 principal ingredient, trypsin, be looked upon with such alarm? One 
 would think that trypsin was a fancy name given by Dr. Beard to 
 some secret nostrum of his own invention, instead of being the name 
 given by the celebrated physiologist. Professor Kiihne, in 1876, to a 
 normal ingredient of every healthy body. In so far as trypsin does 
 cause unpleasant symptoms in patients who suffer from cancer — such 
 symptoms cannot arise in anyone else — it furnishes evidence of its 
 own utility. With the means of meeting such symptoms I have 
 already dealt. The local irritation which may follow injections is due 
 not to the trypsin but the at present indispensable glycerine. 
 
 In the summary of Professor Morton's Provisional Report of 
 December 8th, 1906 ("New York Medical Record"), it is noted, as 
 I have formerly insisted, that the appearance of constitutional 
 symptoms, inconvenient though they may be, is of good omen, clearly 
 auguring an influence of trypsin upon the tumour. Very different 
 are the facts in health, where, according to Dr. Beard's theory, there 
 is no tissue upon which trypsin can act. Dr. S. N. Pinkus, of Berlin^