I never saw her after the 23d December, but was informed by my friend that she continued to linger in the most painful and deplorable condition until the 25th of June, when death kindly released her from sufferings indescribably severe, almost beyond endurance. It is impossible, from any thing we could learn of the history of this case, to determine how long the schirrus may have preceded the commencement of gestation: it is probable not very long, from the excellence of her general health and the fact that she did not complain of pain or any unusual sensation in the pelvis, until about: the time she became pregnant. This case is remarkable, from having occurred in so young, healthy and robust a subject, from the fact that the process of gestation was conducted most perfectly, notwithstanding the presence of schirrus certainly, and I think we may safely say cancerous ulceration, from the discharge and the characteristic fetor, parturition only being rendered somewhat more tedious and difficult. But if it is remarkable for the absence of any obvious effect of the cancer on the gesta tion, it is still more so for the very marked influence of the latter over the former. After delivery, the progress of the disease was extremely rapid, although in the early age, health and vigor of the patient, it might have been expected to have run a slower and longer course. Mr. Lever considers twenty months to be the usual or average duration of uterine cancer. Dr. Ashwell concurs with him, if he refers, as he doubtless does, to the stage of ulceration. I would suppose, from my own comparatively limited observation, that the ulcerative stage generally lasts at least twenty months. In this case, there intervened only eleven months between her confinement and her death, although she posessed uncommon vigour of constitution and appeared to resist death much longer than any person could have supposed, considering the ravages of the disease and the intensity of her sufferings. I cannot speak positively with respect to the com. mencement of ulceration: I would infer, from the haemorrhages during gestation, and the fœtid discharge during labour, that it existed previous to her confinement; but it certainly had not progress. ed far, even at my first visit, more than two months afterwards; it was so superficial that it was not evident to the touch, and, as I have remarked, in consequence of her extreme agitation and excitement, the examination by the speculum was not satisfactory. It is singu lar that ulceration had made comparatively so little progress, between the time of her confinement and my first visit, and so much between my first and second visit. It is probable if I could have made a satisfactory examination at my first visit, a larger ulcerated surface would have been discovered; but after making all due allowance, I am confident, it was very limited compared with the progress made at my second visit. If I had had an opportunity of examining this patient, during ges tation, at the commencement of labour, and a month or six weeks after delivery, these details would have been more satisfactory; but I have related them as particularly as I could under the circumstances. ARTICLE XIII. Gun-shot Wound-carrying away a portion of the right Clavicle, and passing through the summit of the Lung and Scapula: patient recovered. By L. B. BEAL, M. D., of Richmond county, Ga. On the 18th of April, 1846, R. D—, a youth of fourteen years, while on a hunting expedition, was shot by the accidental discharge of a comrade's gun, charged with elven buck-shot, and others of a smaller size. I was immediately called to him in great urgency, as the wound he received was supposed to be mortal; being distant three miles I reached him in about an hour. As he was in the woods when the accident occurred, his friends were removing him home when I arrived. I observed an oozing of blood from the wounds through the temporary dressing which had been applied, and which I was unwilling to disturb for fear of hemorrhage. Arrived at his father's house, I proceeded to the examination of the injury sustained. The shot had entered through the skin, platisma myoides and cellular tissue, then the clavicle of the right side, a little nearer the acromion than its sternal extremity, passing obliquely backwards and downwards, coming out by making four openings in the skin covering the scapula, one of these being above and the other three below the spine of this bone. The opening of entry was an inch or more in diameter, cutting the clavicle completely into two fragments, which were more than an inch apart. In probing this wound, it commenced to bleed, and apprehending from this circumstance and the situation of the injury, that the subclavian artery or some of its branches might require the ligature, I deemed it prudent to desist and ask for assistance and consultation. Dr. Paul F. Eve, Professor of Surgery, was sent for, and while waiting his arrival, cold astringents were applied to restrain the hemorrhage. But to my astonishment he now vomited a half pint of florid frothy blood, by hawking and coughing. I instantly tied up his arm and bled to 203., and gave opium grs. ii., combined with sugar of lead grs. x. By these means, the hemop. tysis was arrested. When Dr. Eve arrived we went into a more thorough examination of the parts injured, and he removed, as well as I recollect, four fragments of bone, (clavicle,) and no shot were discovered. As the hemorrhage, both by the mouth and the wound had ceased, mild cold poultices to the wounds, cooling drinks, perfect quietude, &c., were strictly enjoined. I was to remain with the patient, and Dr. Eve was to return on the third day, Augusta being distant fifteen miles. The day after the accident, he took a dose of Epsom salts, and on the next day, his pulse was 110, 20 less than it was after the accident. There was not much inflammation or discharge from the wounds. We again proposed to continue the same mode of treatment, emollient poultices and chloride of soda injections to the opening made where the shot had entered as a mass, moderate diet and careful watching of the patient. Lime water-this with olive oil and charcoal poultices were also employed during the treatment. The sloughing process advanced regularly for six weeks, when after the removal of some specula of bone from the opening of entry, it finally healed up. The space between the ends of the clavicle is completely filled up, and no deformity of the shoulder-joint can be detected. One of the openings on the back, where the shot came out, suppurated. I opened it and extracted a flattened buck-shot, pieces of clothing, and a piece of paste-board, used for wadding the gun. The patient is now in perfect health. - Remarks by PAUL F. EVE, M. D.-The restoration of this patient from so critical a wound, is mainly due to his own admirable fortitude, and the assiduous attention of his intelligent physician, and father. That the clavicle was cut in two, I know, since a portion of its whole circumference was removed. And that the lung was wounded, is also proven by the free and copious discharge of blood by the mouth. This young man was directly behind his companion, and within a few feet of him when the gun was fired. He was also lower down a hill, which will account for the direction of the wound. ARTICLE XIV. Amputation of the Fore-arm for injury sustained by machinery in motion-death. By PAUL F. EvE, M. D., Professor of Surgery in the Medical College of Georgia. Subscribing the aphorism of a German physician set forth in this Periodical last year-viz., that a Journal was needed by the profes sion, which would communicate only unsuccessful and unfavorable cases, I have had it in contemplation for some time to make my confessions on this subject. And as by the article on the Statistics of amputations, published in the August No., my success was made to appear to the best advantage, there is propriety in commencing my acknowledgments on this very point. Fortunately, however, my failures thus far have here been but few. By reference to the paper alluded to, "Remarks on the Statistics of amputations," page 465, of the last volume of this Journal, it will be seen that up to that period I had amputated 51 times. This includes all the varieties of this operation. Since then I have removed 1 big toe, 1 leg, (making 15 consecutive successful amputations of the thigh and leg, including 1 partial of the foot,) and 1 of the forearm-total, 54 cases, of which 53 were successful, and 1 death. It is the details of this fatal case that are about to be submitted. Stepney, a black boy, aged 13, and belonging to Dr. T., a highly respectable and intelligent physician of South Carolina, was brought to my Infirmary on the evening of the 15th January, by the owner, in his carriage. He had that morning been injured by the machinery of a cotton-gin, propelled by horse power. The right fore-arm was drawn into the wheel, and the momentum expended upon it and the hand. Its radial or external edge was extensively lacerated, the tendon of the long supinator was detached, and the radio-carpal articulation opened, making a compound dislocation at the wrist-joint. The integuments on the dorsum of the hand were also torn up from the metacarpophalangeal articulation of the fore-finger around to the pissiforme bone. The Doctor had dressed the wounds soon after the accident, and found it necessary to apply fourteen sutures. This account of the injury was only confirmed by an examination after the amputation, which revealed also a comminuted fracture of three bones of the carpal row-viz., the trapezium, magnum and unciforme. As the wounds had been dressed with a view to union by adhesion, they were not disturbed until Monday the 18th, the fourth day since the accident. The night previous, the patient had complained greatly, and had now considerable fever. Upon removing the dressing and all the sutures, no union had occurred, but a dirty muddy discharge flowed out, tinted yellowish about the joint by the sinovial fluid. Chloride of soda, compresses, a splint and light bandages were applied. January 19th. Decided upon the propriety of amputation, and wrote the next day for his master to return and see him. From the great anxiety to save the limb, naturally enough to his owner, and from unavoidable circumstances, the consultation was not definite and decisive until the evening of the 21st. Amputation was then yielded to, chiefly upon the apprehension of tetanus, entertained by Drs. Dugas and Ford, but on my own part, from the nature and character of the wounds and the effect they had exerted upon the patient's system, independent of any accidental circumstance that might arise. At 10, A. M., the 22d, exactly a week after the injury, the double flap amputation was performed before the class in the Medical Col. lege. The bones were divided about two inches below the elbow joint, 8 to 10 arteries were ligated, and after waiting an hour, the stump was dressed as usual. There was considerable tumefaction at the part amputated. 233. The patient is doing pretty well. A call up the Rail-road prevented my seeing him until the morning of the 25th. Contrary to instructions, Stepney got up and walked into the garden on the 24th, the third day after the operation, and repeated the game before I saw him on the 25th. The weather during this whole time was very inclement. He had had some fever attended with nausea, and had vomited a live worm, ascaris lumbricoides. Took a dose of oil and turpentine, which acted well. 25th, fourth day, dressed the stump; found the bones well covered and soft parts united over them, but no union of the integuments. 26th. Has fever; gave 10 grs. of calomel in two doses, followed by magnesia and rhubarb. Bowels well operated opon. 27th. Dressed the stump, which looks badly. The edges are everted and much tumefied, though the bones are still perfectly covered. The ligatures (animal) are all dissolved. Applied chloride of soda and a flax-seed poultice. 28th. No improvement. The patient has little or no appetite. 29th. He is thought to be better this morning, and there appears |