crushed fine enough to pass the urethra and it must come away, or a new nucleus in each particle is left to form other calculi. Tepid water may have to be injected frequently into the bladder after the stone is crushed to wash out the particles that remain after urination. The sound may have to be used often to detect any pieces that may have escaped the lithotrite.

Now as to the after treatment. Should the instrument be very carefully handled while in the bladder, and not moved about much over the internal lining membrane, thus avoiding much distress and inflammation, few or any after effects will result for treatment. A careful operator will not push his lithotrite so far in, or press so hard against the delicate tissues of the bladder, as to rupture or perforate the organ; but should he inadver- 5. tently do so peritonitis and death will no doubt be the result. Hæmorrhage may however occur to some extent, when Hamamelis, or Cinnamomum, or Belladonna might be required. Should fever or chills or rigors result, Aconite. If cystitis follow, Belladonna or Cantharis or Cannabis may be indicated, and if the inflammation or irritation extends up to the kidneys, Asparagus officinalis, Apis mel. Apocynum cannabinnm or Arsenicum may be needed,according to indica tions. Should orchitis or prostatitis occur, Belladonna, Pulsatilla or other medicines may be called for.

One result frequently follows and that is, a particle of the calculi may lodge in the urethra and for the removal of such obstructions the instrument shown in Fig 5. will be of use. It is an urethral probe with a hinge joint near its extremity. It can be introduced straight and passed up by the obstructing foreign body and then this joint can be bent at quite an angle, and getting thus back of the object the surgeon can withdraw it on removal of the instrument.

B. W. J.

EPIDERMIC GRAFTING.

The patient

Almost constantly do surgeons have on hand cases of large ulcerated surfaces that are very slow in healing. gets tired of the tedious process of the repair of dermoid structure and the attendant having exhausted all the benefits he can gain by sutures and adhesive strips for drawing the edges of

sound skin in closer proximity, oftens finds that nature still has a long work to perform in the case. Just at this juncture the process of "grafting," introduced by the French Surgeon, M. Marc See, comes in to fill up the surgical gap hitherto existing in this particular. The Boston Journal of Chemistry, Oct. 1870 refers very concisely to the subject under the title of Medical Agriculture as follows: "At a recent meeting of the Paris Surgical Society M. Marc See related a case of what he termed "epidermic grafting." The patient had his arm caught in some machinery, the soft parts of the anterior and external portions of the forearm and of the elbow being lacerated and crushed, the bones not sustaining any injury. The wound was dressed with pure alcohol, and its surface, after the elimination of the superficial portion which became grangrenous, was covered with granulations. M. See then took two small shreds of epidermis detached from the inner side of the arm by means of a lancet, and applied them to a prominent part of the wound. Some days afterwards a new graft was formed by depositing on the surface of the wound epidermic particles obtained by scraping the cutaneous surface of the arm with a lancet. The same day, M. Reverdin, an interne, who is the inventor of this form of grafting, applied to the wound several small epidermic shreds taken from the leg and kept in situ by a strip of diachy lon. In a day or two these different grafts had taken hold, and soon after the epidermic islets extended and united, so as to produce cicatrization over a notable portion of the wound. The process of proliferation of epiderm cells replaces that of suppuration at the points invaded by the islet so that the process of healing is considerably expedited."

NEW LARYNGEAL FORCEPS FOR FOREIGN BODIES.

It is always a great desideratum to get good instruments with the proper curves and leverage, as well as suitable grasping power, to operate in the various external passages of the body, such as the oesophagus, larynx, nares, etc.

With regard to the larynx and oesophagus the joint of the forceps has never been heretofore placed at the proper point in any of the former instruments that we have seen. Here, however, is a laryngeal forceps for removing foreign bodies lodged anywhere in the throat within reach that appears to excel all other yet brought

out (see Fig. A.) You here see the instrument in full, closed. Then you have a view of the jaws opened, and the dilation of the curved part of the forceps amounts to but little, and this is owing to the point at which the pivot is located. One of the jaws is also shown in order to see the roughened inner or grasping surface. A look at the cut will explain at once the mode of applying the instrument. Introduce the forceps closed into the mouth and when they have reached down near the spot where the foreign body is lodged, open the jaws widely, and press them on beyond the object, and when quite certain that the blades can grasp it fully, close the jaws of the instrument, and carefully withdraw it, and with gentle

A.

ness, so that the parts are not scratched with the foreign body should it be pointed or sharp. Chips of bone from meat, fish bones, pins, needles and many other articles of this kind can readily be removed with this instrument from the throat.

A precaution to Surgeons. They should never administer an anæsthetic to a patient, especially a female, unless a third person who is disinterested, or on friendly terms with the operator, is present. Some years ago in Philadelphia, an eminent dentist had a long law suit entailed on him, and with considerable loss of moral reputation, owing to the affidavit of a female whom he etherized to extract some teeth, she believing on becoming conscious, that the hallucinations she had experienced while under anesthesia were really true.

Recently in England a surgeon was charged by a woman with having feloniously assaulted her while chloroformized, and when brought before Court he could not adduce evidence against the charge, while the jury were disposed to believe the statement of the female.

Again, in case the patient should suddenly die, what evidence have you to offset the charge of murder on the part of such a patient's relatives and friends if you should be found alone with the deceased.

Clinical Observations.

W. 8. SEARLE, A. M. M. D., BROOKLYN, N. Y., EDITOR.

A FEW WORDS FROM THE CLINICAL EDITOR.

We desire more clinical matter from our readers during the coming year, and we want that of the right stamp.

When we took charge of this department of our journal, the general editor sent on a mass of clinical matter to be prepared for the press, which gave us great hope that our chair would prove the " easy chair" of the Observer. But instead of the easy chair of an observer, it has become so stiff backed and bare that it is uncomfortable, and we fear our department has in consequence had altogether to Searle-y an air. We beseech our friends for a little paper stuffing.

What is the matter? Have our colleagues stopped curing their cases? We think not. Are they dissatisfied with the manner in which we have conducted this department? We hope not. True we have abbreviated, and re-arranged the cases sent to us for publication. In fact, this work is often absolutely necessary. What with poor chirography, hasty composition, and redundant matter, few cases as they reach us are fit for the printer, and often they must be entirely re-written. In this labor we endeavor to act courteously and fairly, but if any is offended, let him speak.

Clinical records are desirable, chiefly, on two grounds. First, and most important, as confirming and illustrating the Materia Medica. And secondly, as empirical guides in the treatment of disease.

Now, in order that they may subserve these purposes, they should be written clearly and concisely, and should state the symptoms fully, especially these upon which the prescription is based. Suppose we should receive a case like this-A. B. æt 21 was seized with a violent chill and subsequent fever, accom

panied with frequent stools of bloody mucus, which were associated with violent colic and tenesums; Acon. and Merc. cor. were prescribed, and recovery was almost immediate. Now of what earthly use is such a case as that. One might as well say, I cured a case of dysentery with Acon. and Merc. cor. This is not pure ridicule. Such cases not seldom find their way to the editor's waste basket. They neither give the distinctive symptoms, the dose, nor the frequency of repetition. The diagnostic symptoms of a disease-the central symptoms, as they may be termed, are of very little use, for they belong equally to a large class of remedies. The more remote, peripheric symptoms are those which diagnose the remedy in each case. First in order, the modalities should come in; as whether the tenesmus occurred before, during, or after the stool: the color, consistence, odor of the stools; the conditions of alleviation and aggravation. Second, more remote, and often most decisive, come both objective and subjective symptoms which have nothing to do with dysentery as dysentery, and may equally occur in any form of disease, but which are the very turning point as to the remedy indicated and curative. Such, for instance, are the smooth, red, varnishedlike tongue of Kali bich. and Lach., the restlessness, anguish and peculiar thirst of Ars., the sudden uncontrollable stool of Aloes and Sulphur; the icy coldness in the stomach of Colch. etc. etc., Such symptoms, which individualize each case of dysentery and render our peculiar homœopathic mode of prescription at once so certainly curative, and so different from the routinism of a school that squirts laudanum and starch injections into every inflamed rectum; such symptoms, I say, are the most useful both as confirming our Materia Medica, and as affording to the young practitioner a guide and a help in the treatment of disease.

In this light the folly appears of filling our pages with halftold cases, where remedy after remedy is poured in alternately or in rapid succession. That too many of us from ignorance, anxiety, or carelessness, treat cases in that way is most true. That the patient gets well because of the medicnes thus given, may doubtless also be true. But the narration of cases of this kind can serve neither of the purposes above mentioned, and hence should be banished from the pages of our journals to the limbo of perhaps pardonable ignorance, where they properly belong.

As to the remarks in which we have sometimes indulged by