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CASE 8. -George A-, aged thirteen months. Had hadpertussis two months. He was put on two-grain doses of thebromide three times a day. The whoop (not very frequent)ceased in twenty-four hours, and the spasms diminished in

frequency and severity. The conclusion of the case was notknown, as the mother ceased to attend.

CASE 9.-Ann M-, aged fifteen months. Ill with per.tussis three weeks; and when first seen she was suffering withpain in the belly, was constantly moaning, and had some pneu-monia of one lung. The whoop was not then frequent. Shetook three grains of the bromide of ammonium in a drachm ojipecacuan mixture four times a day, and was ordered a jacketpoultice of linseed meal. She improved, and was better at thetwo next visits, and was then lost sight of.CASE 10.-Henry B-, aged one year and five months.

Had whooped one week only, and had the disease mildly. Hewas ordered three grains of the bromide in a drachm of ipeca-cuan mixture thrice a day, and in a week he was quite well.CASE 11.-Emma Amelia S-, aged three years and eight

months. Had had pertussis two weeks; she raved at night,and was feverish; the spasms occurred every two hours, andwere so severe that, as her mother said, " she turned black inthe face." Ordered four grains of the bromide in two drachmsof water three times a day; with rhubarb, soda, and greypowder at night. She was better at the next visit, and thenceased to attend; whether she was cured or not is thereforeuncertain.

In some clinical remarks made by Dr. Gibb, he stated thatthe foregoing cases were a few only that he had kept a note of,as showing the value of the bromide of ammonium in whooping-cough ; and in some cases the results were satisfactory enough.If the little patients had been treated within the hospitalwards, and carefully watched, the general results might havebeen more to be depended on ; for although the children hadmostly got well as out-door patients, yet they were liable to arecurrence of the disease on any unfavourable change of theweather, the result of their general exposure. Judging fromhis experience in these cases, and those also at the West LondonHospital, he would say that whooping-cough, even in very badcases, could be readily cured by the new salt of bromine; but,like many other remedies, it could not be expected to cure thedisease invariably. Learning from experience the effects of thesalt upon the mucous membrane of the entire body, but moreespecially of the upper respiratory tract, he thought thatwhooping-cough was one of those diseases that ought to besubmitted to its influence, and in the general results he wasnot disappointed. As a permanent remedy, he had more faithin the dilute nitric acid given in pure syrup, when combinedwith topical application to the larynx of a solution of nitrateof silver; but as others had either found it useless or had notgiven it a trial, it was but right that other agents capable ofcuring the disease should be made known, and one of thesewas bromide of ammonium.With regard to the dose : for infants, two or three grains

three times a day are enough; to older children from four toeight grains may be given, and in some cases, where the symp-toms are remarkably severe, even ten grains. The simpler thevehicle the better, but if there is a tendency to bronchialor pneumonic inflammation it should be combined with eithera mixture or the wine of ipecacuan.The special nervous symptoms seem to be more under the

control of the drug than the catarrhal, for the spasms diminishin frequency and severity, and consequently the whoop is notso often heard, showing a subsidence of the active symptoms.Pari passu, the cure is not more speedy than from the dilutenitric acid in uncomplicated cases ; nevertheless, it is worthyof a more extended trial, especially in severe and obstinatecases.

ST. BARTHOLOMEW’S HOSPITAL.

AMPUTATION OF THE BREAST OF A PREGNANT WOMAN

FOR CARCINOMATOUS DISEASE.

(Under the care of Mr. SAVORY.)

ON Saturday, the 12th instant, a female, aged thirty-five,underwent amputation of her left breast for carcinomatous dis-ease. As the operation and the malady are common enough inthe situation mentioned, we should not have noticed the case,but that there was a fact of some importance associated with it.The patient was in the sixth month of utero-gestation. In preg-nancy, as a rule, any operation at all, even the extraction of a IXMMy, as a. rule, any operation at all, even the extraction of a

tooth, is deferred until after the period of confinement, for the-reason that it sometimes induces miscarriage or prematurelabour. But occasionally it is expedient to submit a patient toan operative proceeding when it is imperatively demanded bythe peculiar exigencies of the case, and such were the circum-stances here.The patient had a cancer of the breast, which was rapidly

growing, painful, and causing much inconvenience and discom-fort ; moreover, it would have been a source of great uneasinessto the mother to have been obliged to suckle her child withan apparently healthy breast, whilst the other was affectedwith malignant disease. These considerations, therefore, influ-enced Mr. Savory to undertake the operation, which was per-formed under the influence of chloroform. It was attendedwith some amount of haemorrhage, explained by the fact thatthe cancer was fed by a large number of vessels, and the glandgenerally was much congested, as a necessary accompanimentto the pregnancy. The bleeding, however, was readily con-trolled by ligatures, and the wound closed.At the present time the healing process is going on favour

ably, without any tendency fortunately to the occurrence ofpremature labour. It is not the first time that we have seenan operation of magnitude performed upon a pregnant femalewithout being followed by untoward events.

LONDON HOSPITAL

LITHOTRITY, AND LITROTOMY FOR THE SECOND TIME, INA MALE AGED SEVENTY-TWO; RECOVERY;

CLINICAL REMARKS.

(Under the care of Mr. MAUNDER.)

S. P- was submitted to lithotrity on Nov. 10th, 1861,and the calculus crushed. The operation was followed by veryacute cystitis, and was not repeated. On Nov. 21st lateral

lithotomy was performed, and five fragments of stone re-

moved. On Sept. 2nd, 1863, the patient again presented himself at the hospital with symptoms of stone more aggravated’than on the previous occasion. The sound readily detected a.calculus, and two (phosphatic) were removed by the medianoperation on Sept. 3rd.Mr. Maunder remarked to the class that the patient about

to be submitted to operation had been lithotrized and cut oncepreviously, and had made a good recovery. Lithotomy hadbeen substituted for the crushing because the bladder had be-come so acutely inflamed after one attempt that it was notdeemed prudent to repeat lithotrity. Judging from the past,.he was not disposed to try lithotrity; and indeed such was im-practicable row, owing to the irritable state of the bladder,the patient being unable to retain more than a tablespoonful ofurine. The patient’s age was seventy-two years and a half, buthis history was favourable and his health good. The symptomsof calculus had existed altogether only two years and a half,and it might therefore be hoped that the kidneys were sound ; yindeed there was no evidence of organic disease whatever. Theman was of a cheerful and hopeful disposition. At the sametime his sufferings were great, micturition very frequent, andhis rest much broken. Under the circumstances, he (Mr.Maunder) did not hesitate to repeat lithotomy. Having triedboth the lateral and the median methods, he preferred thelatter. Anatomically it was safer, because less important,structures were severed by the knife, and the bloodvessels inthe median line were small. There was little danger of pelvicurinary infiltration, presuming the prostatic capsule to be leftintact. The operation itself was not difficult, and the interiorof the bladder could be more readily examined by the finger;and unless the stone were large or multiple, necessitatingbruising of the parts, there was no subsequent incontinence of £urine, and consequently much less discomfort to the patient.There was one circumstance which would facilitate the com-

pletion of the operation : before withdrawing the knife aftersection of the soft parts, the probe, which was to serve as aguide to the finger, should be introduced into the groove of thestaff by the side of the knife, otherwise the mere slit in themembranous portion would often be not readily found by theprobe.The man took his usual diet on the second day afcer the

operation, and by the 18th September was quite convalescent.

HASLAR HOSPITAL is no longer to be used as a lunaticasylum, the patients having been removed to Yarmouth.

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