to the next annual meeting of

our College Alumni Association, which will take place at the Southern Hotel on the night of the 20th inst.

ship. Come, brethren, one and all, and we will do you good.

FOUR YEARS' COLLEGE COURSE.

host" of the Southern, will cater to the wants of the inner man after a fashion in full keeping with the reputation of that elegant hostelry. The committee of arrangements may safely be trusted to provide amply for the intellectual and æsthetic enjoyment of our friends in the way of music, eloquent addresses, etc. It is fit and proper that every member of the association should be present with his "better half,"-present or prospective one, and so contribute his mite to make the occasion a good time all round. We especially urge our country and village members to drop drudgery and dull care, and join us for the nonce.

Such meetings are fraught with great good to each and all, by rubbing off the angles of rivalry and

American Institute a resolution was adopted requiring our medical colleges to give a four years' course of instruction to students before graduation, after the present winter's

course.

We desire to place this journal squarely on record as in favor of the highest attainable standard of qualification for the practice of the profession. We seriously doubt the propriety of attempting such a radical change just now. A few years ago our colleges inaugurated the three years' course while our allopathic neighbors and rivals required a two years' course. The result was most obvious in the loss of student attendance in our classes. Now that we have somewhat recovered attendance in our colleges, it does seem question

able, at least, to make the proposed change just at this time. Let us go a bit cautiously and slowly in this matter. If the old school will adopt a four years' course, let us by all means have a four years' course. Most of our colleges are without any amount of investment or endowment, and must of necessity rely upon student attendance for revenue to meet current expenses. It does not require large sagacity to see that a four years' course in our colleges just now will drive a large percentage of student attendance over to the old school where a three years' course is sufficient to obtain the degrees to practice medicine.

We hope to see this topic suitably discussed by our scribes, in order that we may go to the next Institute meeting prepared to take wise action on a subject so vital to the best interests of our colleges.

DR. JAMES A. CAMPBELL.

Whilst up to the highest mark of skill in local management, he is thoroughly vigilant in his hygienic and therapeutic treatment of his cases. In consultations with his professional brethren, he is the very soul of honor and prudence. He is in a certain sense a doctor by inheritance, his father having filled an important station in professional life in this city. To such inheritance he has added all the advantages of a liberal academic course, a full course in medical education, all of which he has supplemented by various courses in the best special establishments in Europe and America. In college work he is the idol of his class, where his eye and ear clinics are always eagerly attended. He is ex-President of the Missouri Institute, oft ex-President of our local Society, oft ex-chairman of the eye and ear bureaus in the American Institute, and of the Missouri Institute, and specialist in the St. Louis Children's Free Hospital. Socially, he

to the entertainment and inducements of the present number of the JOURNAL, by presenting a likeness of our friend and fellow-citizen, who is this year's President of our Alumni Association, and will there

fore preside at the annual meeting and banquet at the Southern Hotel on the evening of the 20th inst. Dr. Campbell, by dint of industry and ability, is fairly entitled to much more than a passing notice. Indeed, we make bold to affirm that his honorable course, his industry and skill, render him the peer of the very best specialists, either in Europe or America. As a specialist, he is thoroughly consistent in that, that he confines himself to his specialty.

and father, a consistent member of the Methodist Episcopal Church, a liberal, useful citizen.

"A QUESTION ABOUT THE MECHANISM OF LABOR."

THIS is the title of a paper in the February number of the "Med

ical Arena".

It seems that during the late meeting of the Southern Homœopathic Convention there was a lively tilt between several members, as to which shoulder should be born first in a case of normal labor. Dr. Comstock being appealed to in a letter from Dr. Green, of Arkansas, has made reply in the paper alluded to. We confess the paper brings us two sur

prises: A surprise that there should be any quality of question or doubt in the case; a surprise at the amount of literature and authority which Dr. Comstock has been able to bring to bear on both sides of what we had supposed to be without controversy.

That the sub pubic shoulder should be born first we have always accepted in the light of what the mathematicians call a self-evident proposition; from the fact that, having the shortest route to make, it is more easily delivered and got out of the way; and from the other fact that a diameter anywhere from one-half inch to one and one-half inches shorter, according to the size of the child, will be presented to the outlet, than if the supra-pubic shoulder should pass first or simultaneously with the other.

We quite agree with Dr. Comstock that a rigid non-yielding vulva endangering the life of the child and the integrity of the perineum, fully justifies lateral incisions into the rigid parts. rigid parts. (Episiotomy.)

By the way it is a matter of surprise to find the literature of this latter subject so very scant. It is certainly a very important and helpful proceedure when indicated by the state of the parts. The operation is perfectly easy and simple. The incisions heal quickly, with or without suturing, and leave no disfigurement of parts. A probe pointed bistory or blunt ended scissors is the only instrument needed. Doubtless the life of many a child and the integrity of many a perineum have been sacrificed for want of timely management of this kind.

DIAGNOSIS AND TREATMENT OF APPENDICITIS.-Monod (Paris), from a study of twenty-two cases of appendicitis seen in both hospital and private practice, holds that surgical interference is nearly always indicated, and that as early as possible. Amongst these cases he had seventeen recoveries and five deaths; three of the latter were due to deferring the operation too long, and the other two to complications. In all cases he found pus either saculated or not, in and about the appendix, in three cases forty-eight hours after the beginning of the symptoms; in four cases two days after, and, finally, twice on the fourth day of the disease. Operation being indicated early, an early diagnosis naturally must pre

cede. This is possible. It is not necessary to wait for the evident tumor, cedema and redness, for the history of a previous attack, the sudden beginning of the symptoms, the rigidity of the abdominal wall and the violent pain and tenderness at McBurney's point are sufficient. Absence of fever may mislead, for it may be wanting or decline early. As to the operation he prefers an incision quite like that for ligation of the iliac artery near the crest of the ilium to avoid eventration. If the appendix is easily found it may be resected, if not the purulent collections alone may be evacuated, taking care to look for secondary foci. He does not suture the wound, but drains it. -La Semaine Medicale.

ACCIDENTAL injuries to the small

bones of the hand and foot are often met with, and, for the most part, viewed with apprehension on account of their ultimate results, since it often happens that a trivial wound in these regions will cause weeks of suffering, sometimes the loss of a limb and occasionally the life of the individual.

These disastrous consequences are for the most part brought by two factors; first, the lack of proper surgical treatment. By this I mean sufficient drainage. Second, the want of proper attention to medical treatment.

This evening we give a report of two cases which came under our care, the one a seemingly slight wound to the hand; the other a most severe case of injury to the foot.

The subject in the latter case is a child two years old who, until five months ago, was the possessor of the specimen here presented.

At the time mentioned the child was run over by a horse car. He was thrown down by the animals in such a manner that the flange of the car wheel passed over the left foot, crushing it from behind forwards and from without inwards. The foot was laid completely open from the point of the internal malleolus to the bone of the great toe, which was amputated, as you see.

*Read before the St. Louis Homopathic Medical Society.

The strong shoe counter saved the oscalsis, but the astragulus was broken, the cuboid torn from its attachments, the middle cuneiform broken as were the second and third metatarsal bones, the second toe being almost torn off. The whole wound was ground full of grime and filth from the street and presented no very promising appear

ance.

After examining the parts I decided that nature might in some measure repair the damage done, but I greatly doubted the wisdom of risking this instead of amputating the part, which course was advised at the time by a consultant.

Asepsis was out of the question, but we ænestheized the little one, meanwhile remembering the danger of gangrene, tetanus and scepticaemia.

With a pair of scissors the parts were then scraped and clipped so as to remove as much of the dirt as possible, after which the tissues were thoroughly washed, the broken and distorted bones pushed into their places, a small strip of iodoform gauze laid over these and over this the torn and bruised skin held in place by a continuous silk suture. The tent or drain was allowed to protrude at the anterior and posterior ends of the wound, the second toe stitched in its place, but no attempt made to replace the great toe. The foot was now dressed with iodoform