kind of advertising is not limited to one relig- We are very much in earnest about this, for, as if it were not enough that patent medieines of the most common sort are heralded in these periodicals, we find literature of the worst form endorsed, and advertisements that appear word for word on the worst page of the "Police News." We cannot believe that ministers of the gospel can knowingly approve of this, and yet they, many of them recipients of professior al courtesy from true physicians, are more efficiently used by charlatans than any other class of citizens. If some of the editors of religious papers in this city knew what they were sending each week into innocent households, they would be ashamed to meet their readers. HIGHER MEDICAL EDUCATION. colleges all about it reduced their fees one half in order to draw students, on the theory that they were "only making doctors for the cross-roads" of the country districts, this college maintained its prices and its dignity, holding that a course of lectures honestly and ably given should be properly paid for, that a student who had not the material in him to go through a college on a basis of hard work and fair play would not make a good doctor. Desiring to occupy a place in the front rank among institutions of medical education, and recognizing the right of the community to demand of the physician an education in accordance with the intellectual development of the times, this college made, in the year 1876, its first attempt at a thorough reform in the curriculum of studies, by offering an optional graded course of instruction of three years. In the regular session of 1876-77, twelve students availed themselves of the new plan. The number of three term students increased so rapidly, that at the end of the session of 1879-80, two-thirds of the graduates were three years' men. It was thus evident that the better class of students appreciated the advantages of the plan, and the Faculty then resolved to make the graded course of three years obligatory. In these later days when Jefferson and other medical colleges are being spurred up to an appreciation of the importance of elevating their standard and increasing the length of their term of study by the action of Boards of Health and the sentiment of the medical profession, as Since the spring of 1880, no student has recently voiced by the N. Y. Med. Record been matriculated other than for three years, and other leading medical journals of the and since the spring of 1882, no candidate has country, the fact must not be lost sight of received the diploma who has not pursued that upon the western bank of the Mississippi | three courses of lectures. Realizing that river is the center of the section so frequently schooled intellect alone can grasp understandsneered at by the Bartholows and other imported maligners of the West resident in the East, in the great central city of the continent, St. Louis, Mo., is a medical college which may rank with the pioneers in elevating the standard of medical education. We mean the St. Louis Medical College, founded by Drs. Chas. A. Pope, M. L. Liuton, M. A. Pallen, and other heroic workers of the early days, and fostered through long years of worry and work by Drs. Jno. T. Hodgen, E. H. Gregory, Jno. B. Johnson, A. Litton, J. S. B. Alleyne and others loyal and true. ingly teachings that shall prepare him for a professional life, the St. Louis Medical College requires all students either to present a diploma of graduation from a Literary or Scientific College or High School, or to pass a satisfactory examination in the branches of a good English education. In thus raising its standard, both for matriculation and graduation, the St. Louis Medical College deliberately sacrificed numbers to improved methods. Six years have now passed since the adoption of the graded system. Unquestionably Sixteen or seventeen years ago when the there have been times when the result seemed doubtful, and had the faculty been composed of timid men or men not entirely governed by principle and determined to do the right for the sake of right, the example of Bellevue College in the cultured East might have been followed and the principle abandoned. But no, with Spartan courage these workers for higher medical education kept their hands to the plow and their face to the front, and now the harvest is coming. The profession of the entire country, east and west, north and south, have awakened up to the fact that it wants not more doctors but better ones. The question now is not have you a diploma, but what is it worth, does it mean anything? This being the growing sentiment of the profession the St. Louis Medical College will surely receive its reward. THE USE OF CRUTCHES. The use of crutches in posterior spinal sclerosis and all ataxic affections of the lumbo-sacral cord, is a procedure which from satisfactory experience we confidently commend to the profession as a very salutary therapeutic, auxiliary in the amelioration and sometimes cure of the posterior spinal sclerosis, and states which resemble it. Weir Mitchell's injunction of absolute rest is impracticable, not only because the patient will not comply with it for a sufficient length of time, but because, if complied with faithfully for a long time, what would be gained to the motor column of the cord would be but loss to the general health in lost general functional vigor. The habitual use of two crutches by the patient whenever he assumes the upright position or walks, greatly relieves the lumbar and dorsal spine, especially about the lumbar sacral juncture and between the fourth and fifth lumbar by transferring much of the body weight to the axillæ. The use of the crutches must be enjoined as a constant habit, as much so as if the patient had a fracture or sprain of the leg; and when at rest he should be required to lie as far as practicable, and as much as possible, in a recumbent attitude. The chief indication in this disease is rest, not absolute but comparatively complete. All other indications are fulfilled through this. In spite of all our injunctions the movements of the vertebral column and colitional special motor actions will be more than sufficient to avoid the possibility of atrophy from disease of any sound motor channels in the posterior root zones and columns of the cord, and the comparative rest obtained by this remedy, gives a better chance for the damaged motor conducting mechanism of the cord to undergo physiological repair. At all events the use of crutches is a relief and a comfort to the patient, and our experi ence has now been sufficiently extensive and satisfactory to justify them confident commendation. C. H. HUGHES. THE ALTERNATIVES TO CRANIOTOMY. Before the Section of Obstetric Medicine at the annual meeting of the British Medical Association this question was discussed in a paper, headed as above, by Robert Barnes. R. J. Kinkead followed with a paper on Craniotomy and Cesarean Section, a general discussion following the reading. Barnes takes his position in a most unequi vocal manner, by asserting that the more nearly we approach to the abolition of craniotomy, the more nearly do we attain perfection in obstetrical practice. To obtain an idea of the former prevalence of sacrificial midwifery over conservative midwifery, we have the statement of Tyler Smith, who, in 1859, first brought the subject before the Obstetrical Society in a paper entitled, "On the abolition of craniotomy from obstetric practice in all cases where the child is living and viable," that in British practice craniotomy was performed in about one in ev ery three hundred and forty labors. Now, the long forceps with the pelvic curve with its manifold modifications has largely supplanted the perforator. Barnes discussed at great length and by reference to many valuable statistics the proper line of conduct to be adopted in cases of maternal distortion, of labor obstructed by ovarian or pelvic tumors, of convulsions, of hemorrhage, etc. As the only clear indications for craniotomy or embryotomy, Barnes gives the following: When there is obstruction to the labor, the child being dead, there is no object in seeking alternative to craniotomy. Embryotomy, as by decollation, is especially indicated in cases of impaction of the child's body in shoulder presentations, the child being dead or turning hazardous. A case in which there is no proper alternative for craniotomy is that where obstruction is due to excessive size of the child's head from hydrocephalus or other deformity. Embryotomy is in like manner indicated where the child's abdomen is of excessive 'size from dropsy, or enlarged liver or kidney. The summary of arguments presented by Barnes is as follows: 1. The legitimate aspiration and tendency of science is to eliminate craniotomy on the living and viable child from obstetric practice. 2. The advance of hygienic rule, the improvements in the forceps, in turning, in the induction of labor, and in obstetrics generally, have materially curtailed the field within which craniotomy can be justifiable. 3. In the most extreme cases of pelvic distortion, where delivery per vias naturales can only be effected with doubtful success to the mother, Porro's operation is the legitimate al ternative for craniotomy, it being understood that the opportunity for inducing abortion has gone by. 4. In the less advanced degrees of pelvic contraction, but still incompatible with the delivery of a living child per vias naturales, the opportunity for inducing abortion having gone by, but in which craniotomy would effect delivery, with strong presumption of safety to the mother, the Cesarean section may be a proper alternative for craniotomy. This is the most debatable point. 5. In the minor degrees of contraction, say from three inches to three and a half or three and three quarter inches, the opportunity of inducing labor having gone by, the far greater safety to the mother obtained by craniotomy, and the prospect of obtaining living children in future pregnancy by inducing labor, make craniotomy the proper course to adopt. 6. In other emergencies than deformity, as in obstructed labor from ovarian tumors, the alternative to craniotomy is to remove the tumor. 7. In cases of immovable tumors Porro's operation is the proper alternative. 8. In rupture of the uterus, the child being delivered or not, Porro's operation is the proper alternative. There the interests of mother and child coincide. 9. In cases of disease of tumors of the uterus obstructing delivery, Porro's operation is the proper alternative. 10. In atresia of the cervix or vagina, Cesarean section or craniotomy may be necessary; but incisions and gradual dilatations will more frequently be the proper alternatives. 11. When obstruction is due to hydrocephalus or dropsy in the child, embryotomy or tapping is indicated. When the child is dead, embryotomy is indicated, and decollation when the child is impacted and turning is hazardous. 12. In convulsions and hemorrhages the proper alternatives for craniotomy are found in the more scientific methods of conducting labor under these complications. From the foregoing it will be seen that a spirit of close analysis and reflection guides the author. He is not willing to accept the extreme that Lawson Tait holds, who says that before long, the decision of the profession will be to give up the performance of those operations destructive to the child in favor of an operation which saves it, and subjects the mother to little more risk. Barnes argues that the risk is more than little, and that little involves the sacrifice of mothers who might plead their right to be spared. Barnes does not wish to discourage the hope that Cesarean section may become equally as successful as ovariotomy or other abdominal operations that are acquisitions of modern surgery. Still the cases are not analogous, a Porro or a Cesarean section being far more formidable. And the limited opportunities of practicing Cesarean section must be a bar to the acquisition of the experience and skill requisite to the undertaking. EPISPADIAS AND ECTOPIA VESICE IN THE FEMALE.-Dr. Mermann, of Mannheim, (Archiv. fuer Gynack., Band xxvi., heft 1), reports a case of complete ectopia vesicæ and epispadias in a female child six years old. The external genitalia consisted of two symmetrical prominences formed by the labia minora, the divided clitoris and the prepuce. Between the prominences was an oval orifice leading to a blind canal, at the end of which the uterus could be felt through the rectum. Ovaries not found, hymen perfect and at the orifice of canal. Slight though distinct separation of pubic bones at the symphyasis, perineum perfect and rather long. The lower part of the exposed bladder lay between the widely separated external organs. He suggests two plans for operation: first, to draw the ureters down and fix them, forming a cloaca; second, by first forming a urethra into the vagina, and closing in the bladder anteriorily, (Thiersch's method). The latter method was decided upon, to be done when the child reached the age of from one to two years. Urinary InFILTRATION. In the Centralblatt fuer Chirurgie (London Med. Record), Roser makes the following distinctions relative to this condition: 1. True urinary infiltration occurs only when urine is forced into the connective tis sue by internal pressure, especially when its free discharge is interfered with or prevented. 2. This infiltration is more dangerous when the urine is decomposed and has become, or is about to become, ammoniacal. 3. The mixture of putrescent urine with putrescent pus and blood gives rise to certain products of decomposition, which, both by their localaction and by the results of their absorption, add considerably to the danger of urinary infiltration. 4. When decomposed urine merely flows over exposed tissues the ammoniacal fluid will, as a rule, act slightly and on the most superficial tissues. This temporary contact may, however, if the urine is very ammo. niacal, lead to necrosis or incrustations. 5. Those wounds that are washed by pu trescent urine are of especially dangerous import, as they are liable to admit of the introduction, passive or active, of bacteria into the connective tissue of the vessels. TUBERCULOUS INFECTION OF WOUNDS.— Dr. Kraske, of Freiburg, brings forward in the Centralblatt fuer Chirurgie evidence to show that inoculation of tubercle bacilli in a wound may occur. Tubercular laryngeal ulcers, and tuberculous proctitis, and periproctitis in phthisical persons probably origin. ate in that way; for, if they were due to purely anatomical conditions, no phthisical person would escape. Other cases in point are tubercle of the cervical glands, arising from eczema of the scalp and lupus. Again, recently Karg and Riehl (Centralbl. f. Chir., 1885, Nos. 52 and 36) have demonstrated the presence of tubercle-bacilli in the so-called anatomical tubercle, which is undoubtedly due to inoculation. Tscherning (Fortschr. d. Med., 1885) records a case where tubercular disease of tendon-sheaths and glands arose from an accidental inoculation. Dr. Kraske himself recently removed caseating axillary glands from a colleague who cut himself during an operation on tuberculous bone. DOCTORING AN AFRICAN KING.-The fol lowing extract is from the correspondence of the Scottish Geographical Magazine: "It is no joke to be doctor to the King of Uganda, for whenever I took him a new supply of medicine I had always to take a dose myself, and to administer one to seven of the persons who might happen to be present. Should one of the seven unfortunates die within a week, : 1 4 it would be considered that I had attempted to poison the king. If the king had to take a pill, I had always to hold two in my hand; he chose one, and I had to swallow the other, unless I had a friend with me who kindly undertook the office. I soon noticed, however, that Mtesa always chose the smaller, so I arranged accordingly. One day Mtesa played me a nice trick. I had been to the palace to take him a lotion, and had warned him particularly not to drink it. After I had left he sent a page after me with a gourd of mwengi, asking me to taste it and say if he might have some. I did so, and said, "Yes." It being a very hot afternoon, my friend drank the remainder; but it soon became evident that the king had doctored the wine, for my friend became violently sick. It turned out afterward that Mtesa wished to see what effect the lotion would have upon me. THE VALUE OF NOSTRUMS.-The New York Evening Post says: "What a commotion there would be among our patent-medicine venders if the New York police followed the example of the Berlin police, who are continually issuing warnings to the public, of which the following is a specimen: "The tradesman, Paul Heider, of this city, Anklamer Street 28, is selling under the name of "Harz Mountain Tea," a mixture of lavender flowers, sassafras root, peppermint, and several other plants, weighing fifty grammes. price is fifty pfennige, and he advertises it as a remedy. Official analysis has shown that the real value of one of these packages is hardly ten pfennige." His BLOOD CLOTS LEFT IN WOUNDS. The practice adopted by Schede, of Hamburg, of leaving a blood-coagulum in a wound cavity in the expectation that it will become organized and form new tissue, to fill up the defect created by the removal of pathological products, is a brilliant achievement to be credited entirely to antisepsis in surgery. In antiseptic precaution all stand united at the present day. Though the complicated methods of wound-treatment by antiseptic and germicidal agents may not be adjusted with mathematical accuracy, it is obvious, in watching such work as Schede undertakes and succeeds in, that mere soap and water cleanliness is not sufficient to obtain the best results, and at that, frequently, under adverse circumstances. By those who are familiar with the detail of thrombus-organization and the organization of blood-extravasations, hematomata, the possibility of a permanence of a blood coagulum, that accumulates in a sterilized wound-cavity, that is subsequently shut off, as if hermetically sealed, against the invasion of putrefactive germs, is readily understood. The obvious advantage of filling up a hollow pouch or cavity by an organizable material stands to reason. Only thus can an approximation of parts and exclusion of atmospheric air be secured, and both these conditions are indispensable to a union by first intention, to a process of repair without suppuration and its usual consequence of cicatrization with marred contours and impaired functions. Schede reports two-hundred and forty-one operations in which he followed this novel plan, and nearly all healed under one dressing by primary union. We learn that among these operations were such formidable ones as excisions and resections of joints for fungoid mischief, removal of large sequestra, etc. The Boston Medical and Surgical Journal recounts the careful and methodical plan laid down by Schede for operative procedure in the following terms: "For example, a limb is exsanguinated by an Esmarch's bandage, the knee-joint is resected, visible arterial lumina are secured, the tourniquet is loosened and spurting points are ligated, and the cavity of the wound is allowed to fill with blood. Then all tissues from the periosteum to the skin are carefully approximated. No drainage-tube is used. The wound is covered with silk protective, which must lie perfectly smooth, and this is covered with a sublimate gauze dressing, interposed with layers of cotton batting, which is secured in place by rollers of antiseptic |