« ZurückWeiter »
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 followed.
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 com. plexion, 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.
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 particu lar way, will cure dry scab, or scurfy eruptions of the skin and scalp,
I may patent this particular use of it, in this class of cases, and require my brethren to pay me a stipulated sum, or a certain per cent. of the fees they may receive, for the right to use it in such cases. Should I discover that tinct. cayenne pepper and tinct. opii, combined in certain proportions, will cure the cholera, I may claim the sole right to use them in cholera, however many persons may be dying around me for the want of them. If some Yankee were now in Bagdad, with a few gallons of these tinctures, with their use secured to him by a patent, would not he coin money?
The use of a known remedy to produce a particular effect in any given branch of professional practice, or in the treatment of a given class of cases, is the principle involved. This, so far as I can discover, from a careful examination of the specification, is the exact principle implied in it. As to the rectitude of this principle, professionally, socially or morally, I say nothing. Each one can judge for himself. I believe the illustrations I have used above are correct and appropriate that is, if surgery and the practice of medicine are parts of one and the same profession. If surgery is a mere mechanical operation, and is to take its place in the same category as other operations in mechanics, then the case is altered. Success in the mechanic arts depends, not only upon the skill with which their processes are accomplished, but often upon the processes themselves, and when a man invents a process by which the same result can be accomplished better than before, he is permitted, by common consent, to enjoy the benefit of his invention for a limited time. If surgery puts in the same claim for its inventions, let it be divorced from the liberal professions-from the "humanities," and hang out before its office doors, as in the days of Ben Johnson, a staff wound with a red tape, as a sign that "surgery is done here." We all know the origin of the barber's pole; and, Mr. Editor, there is a more close connection be tween surgery and barbery, than one would at first imagine. Many of the operations of surgery are barbarous, and the operations of barbery are often surgical. Indeed many a poor wight would consider it no small alleviation of one of the miseries of human life, could he inhale the letheon before submitting to the most common operations of barbery. Mem. Barbers may use the letheon without infringing upon the patent. With the above remarks, which have extended much farther than I intended, I send you a copy of the specification, which has recently come into my hands, thinking that it will gratify the curiosity of many of your brethren. Yours,
"The United States Patent Office.-To all persons to whom these presents shall come, greeting: This is to certify, that the annexed is a true copy upon the records of this office, of the specification of Jackson and Morton's Letters Patent, dated 12th Nov., 1846.
"In testimony whereof, I Edmund Burke, Commissioner of Patents, have caused the seal of the Patent Office to be hereunto affixed, this twelfth day of February, in the year of our Lord one thousand
eight hundred and forty-seven, and of the Independence of the United
To all persons to whom these presents shall come: Be it known, that we, Charles T. Jackson and William T. G. Morton, of Boston, in the County of Suffolk and State of Massachusetts, have invented or discovered a new and useful improvement in surgical operations on animals, whereby we are enabled to accomplish many, if not all operations, such as are usually attended with more or less pain and suffering, without any or very little pain to, or muscular action of persons who undergo the same; and we do hereby declare that the following is a full and exact description of our said invention or discovery.
It is well known to chemists that when alcohol is submitted to distillation with certain acids, peculiar compounds, termed ethers, are formed, each of which is usually distinguished by the name of the acid employed in its preparation. It has also been known that the vapors of some, if not all these chemical distillations, particularly those of sulphuric ether, when breathed or introduced into the lungs of an animal, have produced a peculiar effect on its nervous system; one which has been supposed to be analogous to what is usually termed intoxication. It has never (to our knowledge) been known until our discovery, that the inhalation of such vapors (particularly those of sulphuric ether) would produce insensibility to pain, or such a state of quiet of nervous action as to render a person or animal incapable to a great extent, if not entirely, of experiencing pain while under the action of the knife, or other instrument of operation of a surgeon, calculated to produce pain. This is our discovery, and the combining it with or applying it to any operation of surgery, for the purpose of alleviating animal suffering, as well as of enabling a surgeon to conduct his operations with little or no struggling or muscular action of the patient, and with more certainty of success, constitutes our invention. The nervous quiet and insensibility to pain produced on a person is generally of short duration; the degree or extent of it, or time which it lasts, depends on the amount of ethereal vapor received into the system, and the constitutional character of the person to whom it is administered. Practice will soon acquaint an experienced surgeon with the amount of etheric vapor to be administered to persons, for the accomplishment of the surgical operation or operations required in their respective cases. For the extraction of a tooth the individual may be thrown into the insensible state, generally speaking, only a few minutes. For the removal of a tumour, or the performance of the amputation of a limb, it is necessary to regulate the amount of vapor inhaled, to the time required to complete the operation. Various modes may be adopted for conveying the etheric vapor into the lungs. A very simple one is to saturate a piece of cloth or sponge with sulphuric ether, and place it to the nostrils or mouth so that the person may inhale the vapors. A more effective