520 LOOKING BACK.

and not infrequently when the abdomen is opened singularlyfew vessels require ligature. In our opinion, besides the

fact that any hæmorrhage can be easily and certainly con-trolled by the abdominal route, the extirpation of the uterushas the great advantage of removing not only a potentsource of infection, and this danger is a very grave one, butit has the further advantage of removing a gravely damagedorgan and one which, as the recorded cases show, is verylikely to give way in a subsequent pregnancy. We quiteagree with Mr. Paterson that whenever possible in a casein which it is decided not to open the abdomen an attemptmay be made to suture the tear or part of the tear, inaddition to carrying out drainage by plugging, but wethink he goes too far in affirming that if suturing bepracticable the performance of hysterectomy is an unsurgicalprocedure. There are certainly cases in which any attemptto perform hysterectomy can only lead to the death of thepatient, but there are just as certainly other cases in whichthe patient will have the best chance of recovery if the

abdomen is opened and the uterus removed, and in whichher chance of recovery will be very poor indeed if the

operator contents himself with attempting to suture the

tear through the vagina, usually a very difficult operation,and one very likely to be carried out imperfectly. It is,indeed, impossible to lay down hard-and-fast rules for thetreatment of these cases, each must be judged on its merits,and the best results will be obtained, not by the adoptionof any one method of treatment in all cases, but by a judiciousselection of one or other of the varying methods availablein cases of varying severity.

RECURRENCE OF CANCER 18 YEARS AFTER

AMPUTATION OF THE BREAST.

IN the Boston Medical and Surgical Journal of Jan. 27thDr. C. A. Powers has reported a case of recurrence of cancerof the breast after a remarkably long interval. On April 14th,1889, he assisted at an operation for cancer of the breast ona married woman aged 42 years. The operation was of theVolkmann type-excision of the breast with clearing out ofthe contents of the axilla. The growth was diffuse and

irregular, of the size of a very small apple, and occupied thelower inner quadrant. Microscopic examination showed thatit was scirrhus cancer. The axillary glands were enlargedbut not malignant. During the first year the patientwas examined every three months, during the second yearevery four months, and afterwards every six months. No

evidence of recurrence was found until December, 1907,18 years and 8 months after the operation, when a small,hard mass was found about the middle of the scar. This was

excised and found by microscopic examination to be cancer.In May, 1909, 18 months after the second operation, asmall, hard mass was found in the scar near the site of theprevious recurrent growth. In June it was excised and the

microscopist reported that it was a " carcinoma of relativelymild malignancy." Late recurrence of cancer of the breast

after operation was discussed by the American Surgical IAssociation at its Washington meeting in 1907. Dr. Ranshoff

reported a case in which he found a relapsing nodule in March,1904, 21 years after an operation by Professor T. A. Reamey formicroscopically proven carcinoma of the breast. Such casesshow that the three years’ freedom from recurrence which hasbeen laid down as an indication of the cure of cancer of thebreast is unreliable. Mr. Thomas Bryant pointed this out inour columns not many years ago, and stated that the intervalbetween amputation and recurrence is most uncertain. Inhalf of his cases of recurrence the interval was five years or

less ; in the other half the interval varied from 6 to 32

1 THE LANCET, May 17th, 1902, p. 1397.

years, and in at least two-thirds of these was more than--

10 years. -

A TELEGRAM from our correspondent in Madeira states thatthe outbreak of enteric fever which has been reportedfrom that island is local. 14 cases have cccurred, which areall doing well. Drastic measures have been taken to

prevent the spread of the epidemic.

THE Morison lectures of the Royal College of Physiciansof Edinburgh will be delivered in the College Hall on

Feb. 28th, March 2nd, and March 4th by Dr. William AldrenTurner, who will take for his subject Epilepsy.

WE regret to announce the death, on Feb. 14th, at

Kibworth Harcourt, Leicester, of Sir Charles Hayes Marriott,M. D., F. R. C. S., consulting surgeon to the Leicester Infirmary,.in his seventy-seventh year.

-

Dr. T. Kilner Olarke, formerly surgeon to the HuddersfieldInfirmary, died in that town on Feb. 14th, in his sixty-seventhyear.

_______________

Looking Back.FROM

THE LANCET, SATURDAY, Feb. 18th, 1882.RELIEF OF THE SPASMS IN THE CHOLERA. EFFLUVIUM

OF BARK.

To the Editor of THE LANCET.SIR,-Permit me, through the medium of your Journal, to-

draw the attention of medical men to the use of frictions-with tincture of opium, for the purpose of relieving those-spasms in cholera which seem to be the chief cause of agonyin this disease. I am subject to tonic spasms in the calvesof my legs, which I believe arise from the peculiar conditionof my stomach ; on one occasion, when that organ was morethan usually deranged, they became excessively painful, andso impeded my power of locomotion, that I had great diffi-

culty in getting across the room with the help of two sticks.This affection was completely removed by rubbing into mylegs about four ounces of tincture of opium, surcharged,however, with double the usual quantity of that substance,and did not recur again, though the state of my stomachcontinued unaltered for a long time afterwards. I mayobserve, that I dare not take the smallest quantity ofopium internally, from an idiosyncrasy in my constitutionrelative to it.

I cannot help thinking, that if the quantity of a quart ofthe hot supersaturated tincture of opium was well rubbed intoa cholera patient, it would at least have the effect of makinghim die easy. It is moreover well known, that in many cases-the stomach will retain nothing.

I am, Sir,Your obedient servant,

CHARLES R. GORING, M.D.

P.S. I once read in a book of travels (the title of which has-escaped my memory) that in some very aguish district ofSouth America, where it chanced that a large magazine ofcinchona was accumulated, the persons who inhabited the-building were observed to enjoy a complete exemption fromintermittent and remittent fever ; the odour of the bark, itseems, was sufficient to protect-them.

MEDICO-PSYCHOLOGICAL ASSOCIATION OF GREATBRITAIN AND IRELAND.-The next quarterly meeting of this-association will take place, by the courtesy of Mr. Rothsay C.Stewart, at the new Leicestershire and Rutland CountiesAsylum at Narborough, on Feb. 24th, at 3 o’clock, under thepresidency of Professor W. Bevan-Lewis.