same time ordering steam inhalation of 1 part fl. ext. grindelia rob. to 2 parts water. Was ready to do tracheotomy if necessary, but relief was afforded in a few minutes and an uneventful recovery took place under the administration of apis 2x for twenty-four hours. Arnica 2x. Mrs. B., æt. 35. Rheumatic neuritis of left ulnar nerve in hands and fingers, also extreme tension with soreness and stiffness of the tendons of the semi-membranosus and biceps of the left thigh. Left foot swollen and puffy. Tubercular tendency, fever, cough, night sweats, etc. Two or three doses of arnica 2x caused the tendons to relax and dissipated the soreness. Recovery from constitutional symptoms took place under the administration of ars. iod. 3x. Helonias 2x. Miss M., æt. 19. Amenorrhoea from exposure to damp, uight air, with scanty secretion of urine. No positive symptoms upon which to base a prescription. Apis 2x would restore kidneys to normal function only as long as taken. Helonias 2x, two grain powder four times a day for three days brought the functions of the kidneys and menses to normal. CALIFORNIA COFFEE.-An experiment in coffee growing on a large scale is to be made in San Joaquin Valley, California, which, if successful, may mean that coffee planting will become an important industry in that State. It will be at least six years before the result of the experiment can be known. Experts are somewhat doubtful of its success. They say the soil and sunlight are all right in the San Joaquin Valley, but the moisture necessary to the successful raising of coffee is lacking. A NON-POISONOUS match has been invented by a distinguished chemist, M. Pouteaux. Permanganate of potash and acetate of amyl are among the inoffensive ingredients. At the Pasteur lucifer match manufactory the combination has been tested with satisfactory results. The matches are easily made, without the slightest danger to the factory hands. They ignite readily, there is no danger of explosion when stored, and the disagreeable odor common to lucifer matches is in these replaced by that of aniseed. GOVERNOR MORTON has apppointed Dr. Theodore K. Tuthill, of No. 319 West Eighteenth street, as Coroner for New York City, in the place of Coroner O'Meagher, deceased. CONDUCTED BY WILLIAM TOD HELMUTH, M.D., LL.D. GEORGE W. ROBERTS, Ph.B. M.D. SIDNEY F. WILCOX, M.D. B SURGICAL CLINIC AT THE FLOWER HOSPITAL. New York. EFORE I proceed to the more important business of this clinic, I propose to show you one or two minor cases, which being of the kind which you will certainly meet in the earlier days. of your professional career, will no doubt interest you more than the capital operation. I am disposed to believe that the clinician often takes too much for granted in lecturing before a class of students, some of whom are but beginning their medical studies while others are about completing their medical education. The Professor from constant repetition has become so familiar with his subject that he is prone to consider his hearers on almost an equal plane of medical knowledge with himself, and is likely to forget that there are in the class to which he speaks so technically, those who are just beginning the alphabet of medical knowledge. I. Ulcers. The minor surgical cases are those which come under the eye of the young graduate much more frequently than those serious diseases which require the major operations, and even if the latter are encountered they are generally sent by the young beginner to his professor in the adjacent city, or to some one more experienced than himself. For these reasons let me introduce for your consideration first a case of ulcer. In days not very long ago-well within my own remembrancewhen inflammation was considered a very destructive disease, instead of, as it is known to us, a regenerative process, an ulcer was supposed to be made by "ulcerative absorption." This was the doctrine or rather theory advanced by John Hunter, and although there were evidences appearing constantly to prove the fallacy of such a theory, still it held sway among the profession for quite a number of years. It was very soon proved that during inflammation the function of absorption was diminished, and new explanations for the destruction of surface were advanced. We know now, however, that inflammation is a process of repair, we know that if there be microbic infection which does not allow the process to proceed normally the parts die molecule by molecule. This is ulceration and the sore thus made is an ulcer. (Patient brought in.) Here is a woman 26 years of age, married, of fair fatness and intelligent expression. On both of her legs she has broad, flat ulcers, not deep or with overhanging edges, with very little induration, and a pinkish looking base. I question her, and find she has had sores upon the vulva, bone pains at night, occasional sore throat. As the ulcer presents none of the appearance due to other forms which I will briefly describe in a moment, I diagnose it as specific, and call it a syphilitic ulceration. Ulcers are divided in two great classes, the specific and the nonspecific, and the latter have been divided and subdivided until the different nomenclature is as varied and unintelligible as that of tumors. For clinical purposes, the non-specific ulcers may be divided into the simple ulcer, the irritable ulcer and the indolent ulcer-the latter has had numerous subdivisions. In the olden times, Sir Everard Home made more than half a dozen divisions, and Mr. Miller classified about a dozen, most of the terms applied were to explain certain conditions of the ulcer. Thus, if the veins were varicose, we had a varicose ulcer; if inflammation is present, an inflammed; if there was sloughing, a sloughing one and so on. But, as I have already said, the simple classification is the best : first, the two great divisions, the specific and the non-specific, and the subdivision of the latter into the simple, irritable and indolent. As a rule the treatment of specific ulcers is described when considering the diseases in which they occur. The lower portions of the lower extremities, are the sites most obnoxious to ulcers, especially of the irritable and indolent variety. A simple ulcer shows a reparative process, and is really the means adopted by nature to restore tissues which have been destroyed. The appearances are characteristic. The sore is generally oval, the granulations are round, regular, pinkish, smooth, like little cones set into a cavity containing a substance resembling soft boiled custard which washes the base of the granulations and fills the interstices between them. Around these fresh capillaries are formed, a fibrogenous material is thrown out full of formative leucocytes and thus the process of cicatrization takes place. Such an ulcer in a fairly healthy person needs little treatment. Nature does the work. And let me say here, gentlemen, when you find that nature is willing and able to cure anything, let her do it and don't interfere with her. She often is a tempestuous dame, when thwarted in her good intentions and can do much damage. An irritable ulcer is often a gouty one, occurring in those addicted to high living-patés, cheeses, rich food and strong wines. It is found mostly among men, and has a rather peculiar appearance. The sore is uneven, and the surface surrounding it is red; the edges are ragged and abrupt, the granulations are pointed and wavy, entirely too red and the substance bathing them is an ichorus and bloody serosity. An indolent ulcer presents a sharp contrast to this. The area surrounding the sore is of a dusky red almost brown color. The edges slope into the base, sometimes overhanging a little, and the base itself has no granulating surface. It is covered with a deposit resembling wash leather; the surface being sometimes shiny and covered with a spoiled fibrine. I cannot go further into the description of these ulcers, but will say, that whether a sore is specific or non-specific, whether it be simple, irritable or indolent, the greatif not the greatest-factor, certainly in the non-specific variety, in the cure, is rest, the more absolute the better. This cannot be always attained, especially in those patients afflicted with the indolent sore. These persons are found among the working class, whose families require their services for actual maintenance, and therefore six weeks or two months in bed means privation and penury. In such cases as these the next best thing to do is, to strap the limb from top to bottom and envelop it with roller bandage. I shall prescribe for the patient before us, rest in bed, which she will be able to take while in the hospital, and shall give her internally Iodide of potassium, five grains in a large quantity of water three times a day; the bovinine treatment locally and support the parts by a proper roller bandage. I make this prescription for the same reason that I would give tangible doses of per-oxide of hydrogen in a case of arsenical poisoning-it is antidotal. In the treatment of all these varieties of sores, if the patients are unable to take perfect rest in bed, which few of them are, the ulcer should be strapped as well as bandaged. The constitution should be prescribed for according to the totality of the symptoms, and perfect asepsis should be used. There is no special homœopathic treatment for any variety of ulcer, because the symptoms of each patient differ materially. It is only by the careful differentiation of symptoms that the proper homoeopathic treatment can be arrived at. I may say, however, that of the medicines which will be found best adapted to the general treatment of ulcer are, Arsenic, Carbo vegetablis, Lycopodium, Graphites, Phosphoric acid, Sanguinaria, Sepia, Silicea and Sulphur. These, I think, will be found most frequently to cover the totality of the symptoms. Medicines adapted to the treatment of the irritable ulcer are Arsenicum, Asafatida, Lycopodium, Hepar, Mercurius solubulis, Nitric acid, Silicea, Staphysagria, Thuja and Sulphur. II. Bursa. The next patient that I present to you is a young man apparently in good health, but he has, you see, on the dorsum of his right hand, a fluctuating swelling, which presents inflammatory appearance. This is an adventitious bursa. A simple bursa is a sac which is found in different portions of the body where friction is present persistently. Thus we have a bursa mucosa, which is found in the subcutaneous cellular tissue. What are termed synovial bursæ are those which extend between muscle and tendon and bone. In some instances some of these swellings should be termed "synovial hernia," because they consist of the overextension of the synovial membrane which protrudes from the joint into the subcutaneous tissue. These bursæ become enlarged and inflamed and receive different names on the different portions of the body. For instance, the large bursa which lies under the tendon of the patella, is called a "housemaid's knee"; the bursa that becomes enlarged under the tendon of the triceps of the arm receives the name of "miner's elbow," because miners, in working their way through the narrow galleries in different portions of a mine, rub their elbows frequently against the sides of these canals, and thus produce inflammation of the bursa. There are, also, bursæ underneath the gluteii muscles, "weaver's bottom," which sometimes give rise to a great deal of inconvenience. There is, also, a deep synovial bursa beneath the deltoid muscle, which, when it becomes inflamed and ulcerated, enlarges the top of the shoulder joint, which crepitates and fluctuates, and is very likely to be mistaken for a disease of the joint itself. Sometimes this bursa is considerably distended with serum and, indeed, may contain loose bodies. There is also still another variety of bursa, which, when it is enlarged and incised, shows a number of bodies resembling melon seeds, which are composed chiefly of fibrous material; and to this variety of the disease, the name "melon seed bursa" is applied. A simple bursa as a rule is not a serious disorder. An adventitious bursa, or that variety which receives the name of "ganglion," which is found sometimes beneath and often communicates the sheaths of the tendons, especially of the forearm, may present such serious symptoms that amputation may have to be resorted to for its |