in utero, its farther development being prevented, and abortion the necessary consequence; in other instances the death of the fœtus is the result of impediment to delivery, from the schirrous enlargement of the mouth or neck of the uterus.

Of one hundred and twenty cases of malignant disease of the uterus, referred to by Mr. Lever, abortion occurred in forty per cent.; in twenty-seven of delivery, fifteen children were born dead, ten living, and in two the result was not known, or we may say fifteen out of twenty-five were lost.

The object of the present communication is to give a brief history of a remarkable case of pregnancy and parturition in connexion with cancer of the uterus.

July 28th, 1845. I was called in haste, eleven or twelve miles in the country, to visit Mrs. -, who I was informed had been some time in violent labour. There was considerable time lost in consequence of my absence from town. On my first examination I found the head very low in the pelvis, the mouth of the womb extinguished, except a small portion, which had a tumid, hard, rough, unnatural feel. This labor was far more difficult, painful, and protracted than her two preceding labours, in which I had attended her. The child was expelled about a half hour after my arrival. I remarked a smell very similar to that of cancer of the womb, but did not at the time suppose it possible that it could be identical with it, for she was apparently in most excellent health, remarkably robust and stout, weighing not less than two hundred and fifty pounds, and being about twenty-eight years old, and furthermore, as the child to which she gave birth was large and healthy.

Two or three months previous to her confinement, I was consulted by her family physician in reference to a sanguine discharge to which she had been subject for some time, and which I feared might depend on placenta prævia, but which I have no doubt now was consequent on carcinoma. I have since learned, upon enquiry, that as early as January, she complained of severe pains in the region of the uterus, and that in the very commencement of gestation she experienced unusual sensations that caused her for a long time to doubt whether she was pregnant.

After her confinement Mrs. had an offensive discharge from the vagina. On expressing the opinion, when consulted in reference to it, that she was laboring under organic disease of the uterus, I was requested to visit her, October 5th, with a professional friend, and make an examination with the speculum.

The touch discovered an extensive schirrous enlargement of the neck of the uterus. We could not determine satisfactorily the extent of the ulceration by the speculum, because, before we could make a proper inspection, we were compelled to remove the speculum, for she became so excessively agitated that we feared an hysteric convulsion would have been induced.

As she was young and remarkably robust, we considered this was a case in which every possible effort should be made, although even

under such favorable circumstances we had scarcely the slightest shadow of hope-favorable, I mean, in reference to her age, constitution and general health, but quite the contrary when viewed with respect to her recent gestation.

We put her on the internal use of proto-iodide of mercury, and chloride of soda as a vaginal injection, with an occasional resort to the sulphate of morphine, whenever pain might call it into requisition; she was however at this time, and for a considerable time after, comparatively free from suffering. We proposed to apply some cautery, at another visit, when she might be sufficiently composed to bear its application, either the nitrate of silver or nitrate of mercury. I was requested to visit her again, the 21st of the same mouth, sixteen days after my first visit. She had not yet lost her embonpoint, but the cancerous ulceration had made most frightful and destructive progress, having involved not only the posterior lip, but the posterior part of the cervix or body. It was now too late to think of anything beyond palliative measures. We advised a lotion of the nitrate of silver, with the view of correcting the fetor and improving the condition of the ulcers, perhaps in some degree checking their course. After this she became subject to most alarming and exhausting hæmorrhages at each menstrual period. She now began to lose. flesh, and strength rapidly, and to suffer severe lancinating pains.

I visited her again the 6th of November. The disorganization was still more rapid, far exceeding anything I had ever before witnessed. We endeavored to support her strength by tonics, to alleviate her sufferings by opiates, to restrain the hæmorrhages by styptics and astringent lotions, and to correct the horrible fetor by the chloride of soda.

After the destruction of the posterior lip, posterior portion of the neck and body of the uterus, the ulceration extended through the vagina and rectum, allowing the fæces to pass from the latter through the former, and must have involved even the sacral plexus of nerves from the excruciating paroxysmal pains she suffered in that region.

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 occured in so young, healthy and robust a subject, from the fact, that the process of gestation was conducted most perfectly, notwithstanding the presence of schirrous 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 gestation, 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 possessed uncommon vigor 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 commencement of ulceration: I would infer, from the hæmorrhages during gestation, and the fœtid discharge during labour, that it existed previous to her confinement; but it certainly had not progressed 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 singular 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 gestation, at the commencement of labour, and a month or six weeks after delivery, these details would have been more satisfactory; but 1 have related them as particularly as I could under the circumstances. Southern Med. and Surg. Journ.

Two Cases of Croup cured by Cauterizing the Larynx with a Solution of Nitrate of Silver. By WM. N. BLAKEMAN, M. D.-On the 10th Nov. 1846, I was called to see a child of Mr. A. about two years old, very fat, large of his age, and of leuco-phlegmatic temperament. I first saw him at 10 o'clock in the evening, five hours after the commencement of the disease, with a hot, dry skin, quick pulse, great restlessness, laborious breathing, and the hoarse barking or crowing sound peculiar to croup. The family had, previous to my arrival, given freely of Coxe's hive syrup.

I gave tinct. sang., comp. syrup scillæ, with pulv. ipecac., which caused vomiting, but no relief to the patient. At 3 o'clock on the morning of the 11th, I gave six grains prot. chlor. hyd., and after waiting two hours, began with the above mixture, to which I added five grains of tart. antim.; more free vomiting was produced, and a

copious discharge from the bowels, at 8 o'clock, but without any mitigation of a single symptom. I then stopped using the above mixture, and gave per-sulph. of mer., in doses of qu. grain, the second dose to be given in half an hour after the first, and then at intervals of an hour. The child drank freely of warm water, and vomited some after each repetition of the medicine, but none of that peculiar, heavy, glairy substance, which is the secretion of this specific inflammation. At 5 o'clock, P. M., the remedies having done no good, and with the symptoms of suffocation becoming alarming, I resolved to try the effect of cauterizing the larynx with a solution of nitrate of silver, a drachm to an ounce of water.

The application was somewhat difficult, and the dyspnoea very great. A quantity of the thick tenacious substance was brought away by the sponge, &c., a large quantity by vomiting, which fol

lowed.

After waiting ten minutes, I made a second application, bringing away a larger quantity of membranous matter on the sponge than before, and a much more copious discharge accompanied the vomiting, caused by the application.

The disease now seemed to be arrested, as very great relief was apparent to all the family. The breathing was less laborious, the crowing sound less sharp, and the child more quiet.

I saw the boy at half past 10 o'clock, same evening, five hours and a half after the first application; he had improved in all the symptoms, breathing decidedly better, the barking sound heard only at intervals, and he had asked for drink,

I now made a third application of the same solution, which brought as before, on the sponge, some thick tenacions matter differing from the first in being of a yellow colour. The boy vomited several times after this application, each time throwing off a large quantity of the same yellow-coloured, thick substance, so tough that it could be raised from the bowl by the fingers. Soon after the vomiting ceased the child was so much better he fell asleep, in which situation I left him, with directions to be called if required before morning.

12th, 7 o'clock, A. M., I found him sitting on the bed calling for food; he had slept pretty well, asking for drink occasionally, a slight hoarseness left, for which he required no further treatment.

CASE II.-I was called on the 20th of January, at 12 o'clock at night, to see a boy six years old, of sanguine temperament, and florid complexion, who was taken about two hours before with croup. The pulse quick, skin hot and dry, the breathing hurried and difficult, the crowing noise loud, and the child very restless. I determined that the remedy used last in the former case should be first in this. I made two applications of the same solution used in the former case. Some tough phlegm came away on the sponge, and free vomiting followed, which relieved the patient so that he fell asleep.

21st, 7 o'clock, A. M. The boy has slept well all night, and says he is quite well, only a little hoarse.-N. Y. Med. and Surg. Reporter.

A Spotted Child.-A foundling child was brought to the New York Alms House on Saturday last. It was a little girl about sixteen months of age. About one half of its body was of a fair complexion, and the remainder of a rich copper color, and the dark spots were all covered with a long white hair. In the centre of its forehead was a round dark spot, and the same hue covered the breast and legs.--Ibid.

The Patent Letheon-Jackson and Morton's Specification.-It has been repeatedly said that Dr. Jackson is not concerned in the Patent for the Letheon; that Mr. Morton alone has taken out the Letters Patent, and that whatever interest Dr. J. may have in it, arises out of some private contract between them. But it now appears that Dr. J. is really one of the proprietors--that the patent is issued in favor of Jackson and Morton conjointly,

The question has been asked, probably by every member of the profession, "what is patented?" I put the question, the other day, to a gentleman in Boston, who ought to know, and he replied, "The inhalation of the letheon by means of a valvular apparatus." This answer is far from satisfactory, for the same effect may be produced by inhalation of the vapor, without any valvular apparatus at all. If the "apparatus" is an essential part of the patent, the use of a different apparatus would enable any one to evade the penalty of the law. Have they patented the production of insensibility to pain by the inhalation of etheric vapor? No. A physician may administer the vapor, and produce insensibility to pain, with or without the valvular apparatus, without infringing upon the patent. He may administer it for the headache, the heartache or the bellyache, for tic douloureux, asthma or hysterics, and the patent will not reach him. Indeed, I am not quite sure that the patent will reach him if he uses the vapor in reducing dislocations or hernia, or in any operation in which the knife or other instrument of operation of a surgeon" is not used.

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What, then, is the precise thing patented? I answer, the combining with surgical operations the application of ether, or the vapor thereof. This is the whole thing. The use of it in the practice of medicine, by inhalation, is not patented, nor in surgery even, except when connected with operations. They claim the right to use an old and well-known medicine to produce a given result, in the treatment of certain cases. The principle, then, is, that a member of the profession, if he discover that a certain effect may be produced by any remedy or agent in common use, when used in a specified manner, in a certain case or class of cases, which effect had not (to his knowledge) been previously produced by said remedy or agent, he may secure to himself, by patent, the use of said article for producing this specified effect. For instance, should I discover that tinct. digitalis would cure Dixon Lewis, and others similarly affected, of excessive obesity, as it probably would, I might patent the use of tinct. dig. in such cases. If I discover that hydriod. potassæ, applied in a particular way, will cure dry scab, or scurfy eruptions of the skin and scalp,