fices temporarily, if not permanently, to arrest any bleeding; it is, however, regarded desirable to twist, either immediately or after the tongue is removed, every bleeding vessel.

(6) A single loop of silk is passed by a long needle through the remains of the glosso-epiglottidean fold of mucous membrane, as a means of drawing forward the floor of the mouth should secondary hæmorrhage take place. This ligature may with safety be removed the day after the operation, and, as it is invariably a source of annoyance to the patient, it is always desirable to adopt this rule.

The after-treatment consists in feeding the patient for the first three days absolutely and solely by nutritive enemata, satisfying thirst by occasionally washing out the mouth with a weak iced solution of permanganate of potash, forbidding any attempt at speaking, and requiring that all the wishes of the patient shall be expressed in writing, or by signs. The difficulties and dangers of the operation are few, and more imaginary than real. Hæmorrhage, the bete noire of most surgeons who contemplate removing the tongue, is in reality easily controllable, and frequently trifling. I have twice removed the entire tongue without having to secure a single vessel, and more than once have only had to twist one lingual artery.-Dublin Journal of Medical Sciences.

THE PRECANCEROUS STAGE OF CANCER, AND THE IMPORTANCE OF EARLY OPERATIONS.

In a clinical lecture on this subject (British Medical Journal, January 7), Mr. Jonathan Hutchinson observes: The patient who has just left the theatre is the subject of cancer of the tongue in an advanced stage. As I demonstrated to you, the lymphatic glands are already enlarged. It is hopeless to think of an operation, and there is nothing before him but death, preceded and produced by a few months of great and continuous suffering. His case, I am sorry to say, is but an example of what is very common. Not a month passes but a case of cancer of the tongue presents itself in this condition. The cases which come whilst the disease is still restricted to the tongue itself are comparatively few; nor does this remark apply only to the tongue. "Too late! Too late!" is the sentence written but too legibly on three-fourths of the cases of external cancer concerning which the operating surgeon is consulted. It is a most lamentable pity that it should be so; and the bitterest reflection of all is, that usually a considerable part of the precious time which has been wasted has been passed under professional observation and illusory treatment. In the present instance, the poor fellow has been three months in a large hospital, and a month under private care. I feel free, gentlemen, to speak openly on this matter, because my conscience is clear that I

have never failed when opportunity offered, both here and elsewhere, to enforce the doctrine of the local origin of most forms of external or surgical cancer, and the paramount importance of early operation. I have tried every form of phraseology that I could devise as likely to impress this lesson. Nearly twenty years ago I spoke to your predecessors in this theater concerning the "successful cultivation of cancer;" telling them how, if they wished their patients to die miserably of this disease, they could easily bring it about. The suggestion was, that all suspicious sores should be considered to be syphilitic. and treated internally by iodide of potassium, and locally by caustics, until the diagnosis became clear. More recently, I have often explained and enforced the doctrine of a precancerous stage of cancer, in the hope that, by its aid, a better comprehension of the importance of adequate and early treatment might be obtained. According to this doctrine, in most cases of cancer of the penis, lip, tongue, skin, etc., there is a stageoften a long one-during which a condition of chronic inflammation only is present, and upon this the cancerous process becomes engrafted. I feel quite sure that the fact is so. Phimosis and the consequent balanitis lead to cancer of the penis; the soot-wart becomes cancer of the scrotum; the pipe-sore passes into cancer of the lip; and the syphilitic leucoma of the tongue, which has existed in a quiet state for years, at length, in more advanced life, takes on cancerous growth. The frequency with which old syphilitic sores become cancerous is very remarkable; on the tongue, in particular, cancer is almost always preceded by syphilis, and hence one of the commonest causes of error in diagnosis and procrastination in treatment. The surgeon diagnoses syphilis, the patient admits the charge, and iodide of potassium seems to do good; and thus months are allowed to slip by in a state of fools' paradise. The diagnosis, which was right at first, becomes in the end a fatal blunder, for the disease which was its subject has changed its nature. I repeat that it is not possible to exaggerate the clinical and social importance of this doctrine. A general acceptance of the belief that cancer usually has a precancerous stage, and that this stage is the one in which operations ought to be performed, would save hundreds of lives every year. It would fead to the excision of all portions of epithelial or epidermic structure which have passed into a suspicious condition. Instead of looking on whilst the fire smoldered, and waiting till it blazed up, we should stamp it out on the first suspicion. What is the man the worse if you have cut away a warty sore on his lip, and, when you come to put sections under the microscope, you find no nested cells? If you have removed a painful hard-based ulcer of the tongue, and with it perhaps an eighth part of the organ; and, when all is done, and the sore healed, a zealous pathological friend demonstrates to you that

the ulcer is not cancerous, need your conscience be troubled? You have operated in the precancerous stage, and you have probably effected a permanent cure of what would soon have become an incurable disease. I do not wish to offer any apology for carelessness, but I have not in this matter any fear of it.-London Medical Record, February 15, 1882.

THE EXCISION OF THE CANCEROUS UTERUS.

Statistics as to operations, compiled from the practice of many different persons, represent, not the possible results, but what may be called the average result only, because they include operations done by men of very different knowledge, skill, and experience. They tell us what has been done, but we cannot judge from them what may be done, nor always what ought to be done. The results obtained by one surgeon of experience are of much greater value for the guidance of others. Professor Schroeder, of Berlin, has recently published in the Zeitschrift für Geburtshilfe und Gynäkologie the results obtained by him from the partial and complete excision of the cancerous uterus. The first group of cases which he gives comprises those of removal of the body of the uterus, the cervix being left. He has done this five times-three times for carcinoma, twice for sarcoma. Four recovered, one died from septicæmia. In one, a case of carcinoma, four months after the operation there was no sign of relapse. In another, a case of sarcoma, five months after the operation, the disease had recurred. The subsequent history of the other two is not given. The next group is of cases of Freund's operation, of which Dr. Schroeder gives eight cases, six of which were operated on by himself, one by Dr. Veit, and one by Professor Freund. Of the eight, three recovered, five died. Of the three recoveries, one had relapse eleven months afterwards, one died six months afterwards from recurrence of the disease; the other, fourteen months after the operation, was as yet without relapse. Dr. Schroeder then gives his experience of the supravaginal excision of the whole cervix; that is, dissecting off upwards the mucous membrane, connective tissue, and peritoneum, and then cutting through the cervix high up. Of this proceeding he gives thirty-seven cases, with four deaths. In one, the disease was not completely removed. Of the remaining thirty-two cases, successful so far as recovery from the operation was concerned, in fourteen recurrence took place: in three within two months, in three within three months, in three within six months, in three others within seven, eight, and nine months respectively, in the other two the date of recurrence is not given. Seven are reported as continuing well, having been watched, in two cases two months only, in the remaining five

cases, three, four, five, six, and seven months respectively. The subsequent course of the remaining eleven cases is not stated. The last operation for uterine cancer of which the results are given, is the total extirpation of the uterus through the vagina. This Professor Schroeder has performed eight times, with only one death, which took place from internal hemorrhage, the result of a laceration of the broad ligament. The successful cases were at the time Professor Schroeder wrote too recent for him to make any statement as to the frequency of relapse. So far as these statistics go, the latter operation would seem the most promising. But it is one difficult of performance, in which success must depend largely upon the manipulative dexterity and experience of the person who performs it; miscellaneous statistics cannot show what results may be obtained by an exceptionally skillful and careful operator.-Medical Times and Gazette.

CASE OF ACUTE TRAUMATIC TETANUS TREATED SUCCESSFULLY BY CHLORAL AND POTASSIUM BROMIDE.

Dr. Salter gives (Practitioner) an interesting history from which we abstract the following:

I began by giving him steadily, chloral in ten-grain and bromide of potassium in fifteen-grain doses, every two hours, increasing the frequency of the dose as the spasms were more frequent or severe. In addition to this I usually gave him from five to ten grains of chloral hypodermically whenever I called to see him, which, during the early part of the time, was three or four times in the twenty-four hours. These hypodermic doses quieted him much more markedly than those taken by the mouth, and the influence of the drug remained for a longer period. The bowels acted without much trouble, now and then requiring assistance by an ordinary aperient or by injection. The urine was always loaded with lithates, and scanty; perspiration being remarkably free, especially during the painful

paroxysms.

He was fortunately able to swallow, in small quantities, a great deal of nourishment, consisting of strong meat broth, raw eggs and new milk; but I withheld stimulants in the early days, reserving them until I found, by pulse indications, that they were required.

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His twenty-four hours' allowance of nourishment after the first week, during which he could swallow very little, amounted to from three to four pounds of meat made into concentrated broth; six to ten eggs; and from two to three pints of new milk; and, after the first fortnight, ten to fifteen and even twenty ounces of sound sherry, in wine whey; so that the sum total amounted to something considerable.

Between the 22nd of April and 12th of May, he took about two hundred and forty grains of bromide of potassium and one hundred and eighty grains of chloral per diem-administered in doses of ten to fifteen grains sometimes every half hour, but usually every two hours, occasionally at longer intervals. The total amount given in these twenty days was sixty drachms of chloral and eighty drach ms of bromide of potassium, more or less.

EXPLOSIVE MIXTURES.

Medical men but rarely pretend to be good chemists, for it would require longer devotion to chemistry than the average medical student can afford; thus can it be marveled at when we see formulæ and prescriptions that, if dispensed according to the wishes of the prescriber, would result in an incompatible combination and often explosive compounds? Thinking it not ill-placed to, perhaps, refresh the memory of the profession regarding such mixtures, especially explosive mixtures, we have selected some examples and formulæ that when combined in certain proportions become dangerous, and in many instances have ended seriously; they are examples that have been experimented with, some intentionally, while others were prescribed by a badly informed physician and dispensed by a very incompetent druggist:

(1) Chlorate of potash, powdered galls, tannic acid. Mix. Ft. Pulvis. To be used as a gargle. The powders should be mixed separately, with water, and not rubbed together.

(2) Chlorate of potash and pulverized catechu. This combination is intended as a dentrifice. It however, should not be dispensed alone. If other combinations are made the danger is averted.

(3) Chlorate of potash, hypophosphite of soda and water. If the salts are rubbed together they will explode, but if dissolved separately in water, and mixed, no harm results.

(4) Chlorate of potash, tannic acid, glycerine and water. If the tannin, chlorate of potash and glycerine are rubbed together an explosion ensues, but if the acid is first dissolved in the glycerine and the chlorate of potash in the water and mixed, no harm follows.

(5) Chlorate of potash, tincture of ferri chlor. and glycerine, half an ounce of each.

This combination, so often used, when put together in the above proportions, is very liable to explode, especially if warmed.

(6) Soda chlo. two drachms; antimony sulph. aur. twenty grains. This combination, if even gently triturated, is liable to inflame with a crackling noise.

(7) Lac. sulphuris, three grains; antimony sulph. aur.