act as the re-agent to precipitate fresh supplies from the plasma is not a demonstrated fact, but may be inferred. So also with the other tissues. Should this be admitted without positive evidence we would not then be at the end of our problem;—for the question may be asked as to what causes the first or initial deposit. Here we must stop and acknowledge our ignorance.

But you may now ask what all this physiology and chemistry of the plasma has to do with a report on surgery. I propose to use it for the purpose of explaining some peculiarities in the process of repair in surgical cases.

A few months ago I had a case of delayed union in a fracture of the tibia, at the hospital, and spent more time in waiting for nature, unassisted, to accomplish a cure, than I should ever spend again. One week after putting the patient on the use of ten grain doses of hypophosphite of lime, I had the pleasure of seeing bony union commencing. And why? Simply because the quantity of phosphate of lime in solution in the plasma was not sufficient to supply the waste of bone tissue in all parts of the body, and at the same time furnish a supply for the provisional callus which is thrown out in the repair of fractures.

In September, 1878, August G——, aged 18 years, single, a native of Switzerland, was admitted to the Santa Clara County Hospital with incipient spinal disease. He was of that peculiar temperament which indicates a scrofulous cachexia. The fifth dorsal vertebra was sufficiently prominent to indicate the sight where the attack was being made by the enemy. There was considerable tenderness on pressure; slightly accelerated pulse, and elevated temperature;—in other words, a well defined case;—one which would have resulted in caries and deformity within a few months. By the administration of ten grain doses of hypophosphite of lime for several weeks, I had the pleasure of seeing recovery take place. Reasoning by analogy, I am led to conclude that the nature of the wound should, to a great extent, govern the kind of food given the patient during the treatment. In many cases of surgery, medicines are not necessary. But in some exceptional cases, as in similar ones to those above noticed, medicine is demanded. And in all cases of flesh wounds, I believe the patient will be benefited by a liberal diet of animal food; that is, after the first inflammatory condition has subsided.

Why this is so, is simply because those very materials are furnished to the system which are required for the repair of the tissues injured, viz., the organic compounds. In flesh wounds of weak and debilitated persons which are slow in healing, a diet of beef tea, eggs, oysters, etc., will often bring about a rapid improvement. Thus, we see that chemistry, organic and inorganic, has something to do with surgery.

I will now present the following cases which have seemed of special interest to me:

Case First.—In 1874, while in the mountains on the Trinity river, Dr. —— was kicked by a mule in such a manner as to rupture the ligamentum patellae. The tendon of the quadriceps femoris, at once drew the patella at least two inches above its normal position. Of course he was unable to walk, but was taken to a house near by. With some assistance from a brother physician the patella was brought down to its place, but it would not remain. I suggested the use of a gutta percha mould or covering for the knee. Without much difficulty, a piece one-fourth of an inch thick, softened in hot water, was applied, and kept in place by means of compresses and bandages until it hardened. This made a perfect and firm, splint fitting all the inequalities of the knee, covering all but the posterior part of the leg, and extending three or four inches above and below the patella. With this bound moderately tight to the leg by a roller bandage, it was simply an impossibility for the patella to move from its proper position. At the