happily continued, till at the end of three weeks the ulcer completely healed up, and nothing was visible except a white scar.

The second case to which I will allude occurred in a child aged three. The ulcer in this case was situated a little to the inner side of the left nipple, and the history, as far as I could gather it was that an abscess had formed some time back, and burst, discharging matter, but had not healed up. On examination I found it presented all the characters of a phagedænic ulcer, accompanied with great nervous irritability, thirst, and looseness of the bowels. I prescribed Ars, 3, a dose every three hours, beef tea, arrowroot, and a dessert spoonful of brandy to be given during the day; Camphor e morning and evening. On seeing the child four days after the ulcer looked rather healthier, but there was a good deal of prostration, the looseness of bowels, however, being better. I ordered Lachesis 6 for five days. On seeing the patient there was decided improvement, though it still looked suspicious; Lachesis to be continued, and at the end of a fortnight from this time it was quite healed up.

On

Another form of ulceration which is often met with is the indolent uleer. This ulcer, as you know, generally occurs about the middle period of life, and is of a very obstinate character, being healed with the greatest difficulty. A rather interesting case came under my treatment in a man æt. 49, who consulted me about an ulcer situated at the anterior internal aspect of the tibia. He had suffered for some years from this ulcer, and had tried various doctors and various remedies, such as Holloway's ointment, &c., but without success. He said he believed he had spent £200, having taken Blue pills and Sarsaparilla ad infinitum, and he wished me to try and heal this very expensive ulcer. examination I found the edges deep, hard, and excavated, the granulations pallid, and the discharge thin and sanious. The first point to be attended to was to clean the sore, and afterwards stimulate the granulations. I ordered him to poultice the ulcer for forty-eight hours with a poultice made of oatmeal and buttermilk, which is about the best drawing poultice you can get. there was no doubt some disease of the bone existed, I ordered him Silic. 5, every three hours, and after the poultice was removed to use simple water dressings for a week, also to take a pint of stout during the day. At the end of this period I saw him again and found the sore much healthier looking, but still not so clean as I

desired. I ordered the poultice to be continued for a day or two; Silic. to be continued. On seeing him again in a week it looked much better, and I ordered Kali bich. gr. 1, Aquæ 3vi, to be applied to the ulcer, at the same time I encircled it with plaster to keep up some pressure and diminish the size. Week after still improving; continue treatment. On seeing him at the end of this period he complained of a certain boring pain in the part. I resolved now to try Aur. 6, and Carbolic acid lotion for a fortnight. When I again saw him the ulcer was almost healed; but as one or two of the granulations were rather pallid, I touched them with Sulphate of Copper, and prescribed Sulph. O for ten days. On seeing him again the ulcer was quite healed, and he felt in remarkably good health. I told him to keep the leg firmly bandaged from the foot upward; and the last time I saw him he had no signs of a return of his old enemy.

The only other form of ulceration to which it will be necessary to allude is the inflamed ulcer; and I will illustrate its nature and treatment by a case which lately occurred to me.

A young man got scalded in the neck, and got some liniment applied to the part, which eased the pain, but a nasty sore resulted. On examination the part was red, inflamed, and swollen, with a thick offensive discharge streaked with blood, and great pain; in fact, showing all the signs of an inflamed ulcer. I ordered Acon. 1*, one drop every three hours, and a lotion of rectified spirits and water to be applied externally. On seeing him three days after, the inflammation had greatly subsided, but the thick discharge still continued, accompanied with a burning feeling. He was ordered Ars. 1, gtt. x, Aquæ ziv, a dessert-spoonful every three hours, and at the end of ten days he was quite cured.

Before passing on to consider the next subject, I would remark that I am confident the true curative sphere of the treatment of all malignant ulcers lies in the acid group of medicines.

The next subject to which I will refer is meningitis, and I will show its nature and treatment by two very successful cases which occurred in practice during the past year.

The first case occurred in a boy æt. 13. The history of the case was that the boy received a blow on the right temple, the result of a fall against the edge of a fender. He complained a few days after of pain in his head, and appeared to be restless. He was then seen by an allopath, who ordered some mixture,

but with no good result. His mother then consulted a more eminent allopath, who ordered a blister at the back of his neck. The only effect resulting from this treatment was the formation. of a large sore which did no good, and the boy continued to get worse. The mother then at the end of the tenth day asked me to see the boy. I found him sitting in an armchair looking pale, but occasionally a hot flush passed over his face, skin hot and dry, pulse wiry and jerky, tongue whitish, and inclined to be sick. On asking him where he had pain he put his hand to his head, complaining of pain nowhere else, but seemed to be irritable and disinclined to answer questions. I carefully examined the head, but could detect no depression. Taking the history into consideration, and the different symptoms, I diagnosed meningitis. I ordered the boy to be put to bed, and his diet to consist of milk and water, as being the most unstimulating. I prescribed Arnica 1x, and Acon. 1, every three hours. On seeing him the next day no improvement had taken place. Continued the same treatment for five days, but with no success. I then ordered Bell. 1, for four days, but with no benefit. The boy continued to get worse, and began to get rather deaf, and could with great difficulty be roused. On the eighth day I ordered Bry. 1*, and continued this till the twelfth day, with a dose of Arnica every day when I saw him. He continued to get worse, and on the thirteenth day was almost insensible, quite deaf, and sleepless. From these signs I was convinced effusion had taken place above the arachnoid membrane, and being desirous of sharing the responsibility with some one, I determined on having a consultation. I requested a medical friend on whose sound judgment and skill I could place every reliance to see the case with me. We both agreed as to the nature of the case, and determined on prescribing Iod. 1, and Verat. viride 1, every two hours in alternation, the hair to be cut, and hot cloths applied to the head. On seeing him next day he had slept rather better. This line of treatment was continued till the twenty-seventh day, when he was quite sensible, but rather weak. During that critical period I always when seeing him gave a dose of Arnica, but under the Iod. and Verat. vir. treatment the effusion completely disappeared. then gave him Sulph. O for ten days, afterwards following it up by China 1x, and at the end of six weeks he was quite convalescent, and able to move about. I then ceased my attendance, having

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ordered him to be sent to the country as soon as convenient to his parents. I have seen him often since, and a stronger or more intelligent boy it would be difficult to find.

The next case occurred in a girl æt. 11. The history of this case was that the child had fallen against a table, and two or three days afterwards complained of pain in the head. The parents did not consider this of any consequence; but the child continued to get worse and inclined to lie down, and was very restless. About ten days from this period of receiving the blow the parents asked me to see the child. On seeing her I carefully examined for any depression, but none was to be detected. She showed all the signs described in the last case, the deafness being also well marked. From the history and the signs present I diagnosed a case of meningitis, with incipent effusion. Warned by my previous experience, I determined to strike at the disease at once, and prescribed Iod. 1 and Verat. viride 1*, every two hours in alternation, the hair to be cut, and hot cloths applied to the head; the diet to consist of milk and water. This treatment was pursued for nine days, at the end of which period she was quite sensible. I then prescribed Sulph. 0 for ten days, following it up with China 1, and at the end of a month she was quite convalescent and robust.

I would now make a few observations on the treatment and what appears to me to be the guiding points in diagnosis. In the first place be sure the Iodium you obtain is pure and of the strength you order. The first which I ordered was as clear as water, and its medicinal properties were equal to the 200th dilution so eloquently recommended by a London practitioner. What I obtained personally was of a bright red colour, and its action was most decided; and as life or death often hangs on the purity of the drug, it behoves us to be very careful to obtain the exact strength we consider to be necessary. In the second place the diet should consist of milk and water, as any stimulating diet, such as beef tea, will precipitate the dormant effusion. In the third place, hot cloths to the head are of infinite advantage, soothing the patient and procuring that needful sleep which enables nature to restore the diseased organ to its former vigour. In the fourth place, it is highly necessary to have an intelligent nurse always with the patient, as he may turn over on his face and become asphyxiated.

The guiding points in diagnosis appear to me to be the following-viz., 1st. The history of a blow or a fall; no depression on examination, all the pain complained of situated in the head. In the second place, the gradual development of the symptoms. In the third place, when effusion has taken or is about to take place, the development of deafness gradually increasing. In the fourth place, you often find the patient lying on the back or side turn him round and you will invariably find him resume his old position, a look of irritation rapidly passing over his features. It now naturally occurs to us, with what may this disease be confounded? It may be wrongly diagnosed for concussion or compression. How are we to distinguish these?

In concussion and compression the mental operations are suspended. In meningitis they are not exercised; temper is irritable. Pupils in concussion are not fixed; in compression fixed; in meningitis generally contracted. Respiration in concussion feeble, silent ; in compression slow, stertorous snoring; in meningitis unaffected. The alimentary canal in concussion, no swallowing, involuntary movements of the bowels; in compression, no swallowing, constipation; in meningitis the alimentary canal is unaffected.

Having thus briefly alluded to the leading distinctions of these diseases I would pass on to the consideration of my next subject, conjunctivitis, glancing also at ulceration of the cornea; and, as before, I would illustrate these subjects by some cases which I have lately treated.

Conjunctivitis is one of those diseases which the practitioner is continually called on to treat, especially in children. You may see the patient at first when there is simple inflammation of the conjunctiva, or at a later stage where muco-purulent discharge exists. In the first stage you may speedily cure the disease by a course of Bell., while in the second stage you must resort to a different mode of treatment.

A child aged five was brought to me with what the mother termed sore eyes. On examination I found the conjunctiva deeply congested and inflamed, and the child very sensitive of light. The mother informed me that the child's eyes were glued together in the morning. I prescribed Bell. 2 every three hours, to be continued four days, and a plain bread poultice on the eyes at night. On seeing the child at the end of this time the con

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