so many different shapes and wrinkled itself into so many possibilities of universal adaptation, that it is as often used at one end of the economy as is its distinguished and useful progenitor at the other. So with hooks, plain and clenching; scrapers, sharp and dull; scissors, flat and curved, long and short, thick and thin; pincers, rough and smooth, heavy and light; needles, long and short, flat or speared; squirts, hot and cold, insipid or salty, aseptic and antiseptic-all find their place on the operating tray, ready to pay tribute to the willingness and daring of the skillful hand that must use each device in turn, and christen each with an impartial benediction for necessary service rendered.

Of the ovary, in times past at least, it might be truthfully said, "the Lord gave, but man taketh away," and of the gynecologist, "Blessed is he who has his pathological jar full of them." Next came new quilting patterns for the perineum and the radical plumbing of pus tubes, and now the uterus, so long celebrated in toast and song,

has built a new reputation for herself and statistically smiles from a monument of hysterectomies. The race for novelties has been long and hot. The warning for a slower pace is timely and just. Let us hope that the time will soon come when we can realize the long-expected millennium of a broader and higher conservatism, when the uterus shall cease its troubling and the ovary be at rest.

We speak of unnecessary operations only, and would by no means detract from reputations worthily won and modestly enjoyed. But the line between the fashionably ambitious innovator and the judiciously conservative operator is not yet clearly drawn. However, the revenge of the ovary may be nearer than we suspect. Already, with retaliatory smirk, she appears willing to share her pressing burdens of distinguished consideration with her now anxious analogue, whose right to be is so seriously questioned in connection with the newly discovered reflexes focussed on a tumefied prostate.-N. Y. Med. Rec.

our

world which has within its walls such a variety of medical experience, such material for medical history as is daily furnished in this plunging cosmopolitan metropolis. There is no city on the face of the globe, not even excepting the mighty

has such a variety of populationsuch a panorama of disease as is seen in the city of New York.

The hospital facilities of the American metropolis are far beyond those of Europe. We state this categorically, for the reason that the greatest clinicians of the old world, who have visited our shores, without a single exception, so far as we know, have rendered the verdict of the Queen of Sheba on her visit to Solomon. told us.

"The half has not been

No

There is a differential method in New York hospital work, which, along with the system in the medical schools, places the medical organon of the metropolis upon a totally different plane from that upon which other systems of regular medicine rest, even the populous cities of the South and West. No man who has not completed his medical gymnasium course has any place in New York City. So intense is the race for advancement, so jealous of practical recognition, so intolerant of rivalry, so unyielding in private professional intercourse, that those who have assumed the role of teacher lose no opportunity to bring about in practical issues the results of personal experience. The student who comes as a child in science, asking for the milk of medical infancy, has his tender and delicate intellectual stomach glutted with diet which he is no capable of digesting than a six weeks old infant could attack and assimilate pork and beans. They ask for bread and are given a stone.

more

The faculties are made up of an indefinite number of specialists, each one of whom thinks more of flaunting the banner of his own practical success than of leading a young doctor through dangerous. and difficult paths in that part of his career where he needs encouragement, help and careful guidance. Clinical teaching has in New York almost entirely obliterated all the simpler forms of fundamental medical teaching. The culture of the student has been sacrificed to the glory of the teacher, and all of the elementary principles of medical teaching, which in years gone by formed the basis of the first years of study, have been relegated to underassistants, who are neither competent to teach nor acceptable as teachers to those who come here to sit at the feet of the great Gamaliels of medicine, and find them so far out of reach as to be but myths of medical lore.

On this account the Post-Graduate system, and the Hospital Clinic has well-nigh absorbed the elementary methods which lay the foundation for the higher practical methods. A medical student, who is just beginning his studies, becomes thoroughly bewildered, and really home-sick when he lands in New York. He is at once confronted by a professional array that utterly overwhelms him, if indeed, it does not discourage him entirely, and lead him to the utter abandonment of his professional career. There is no one to take him by the hand, speak words of encouragement,

.

map out his line of study, and

"Make every path of duty straight, And plain before his face." Oh, no; this system of teaching in the East has long since passed into "innocuous desuetude," and while the teachers are struggling for promotion among themselves, the student, in order to obtain any sort of recognition at the hands of his great instructors, must either pretend to a knowledge he does not possess, or be left like a wall-flower in the ball room of medicine, with no one "to love, none to caress," a mere looker-on in Vienna. In one college, with hospital connected, there are 2,000 professors and assistants, each one struggling for reputation or notoriety, the younger scrambling for the crumbs that fall from the tables of their masters. The faintest shadow of personal recognition in public print is sought after with the eagerness of starvation, and the ways and means. adopted to keep within the limits of even the most liberal interpretation of the Code is often amusing. The civil practice in New York has not escaped this baleful influence. No more does the "family physician" exist in the sociology of the metropolis. Specialism has sealed his doom. And it is this which has let down the bars between regular medicine and the various

sects.

Homœopathy is fashionable, and if a homoeopathic physician in charge of a wealthy patient finds it necessary to call in a surgeon whose fee may run up into the thousands,

it takes a great deal of moral or professional courage to say: "No, I cannot undertake the case unless you first retire." And they do not do it. It is not human nature to do it. And, indeed, it is difficult to see how this question is to be met under the great complications which exist in the metropolitan system.

But by far the most serious and calamitous result of professional environment in New York City is the direct relation existing between the physician and patient. This may be well-defined and explained by one word-perfunctory. There is none of that close personal contact, that confiding trust, that enters into the practice of medicine West and South. Perhaps we have not developed sufficiently to reach this autocratic absolutism which characterizes the city physician of the East, but we are compelled to say that we trust the day is far off when we shall take on the livery of metropolitan medicine.

A patient calls upon the doctor. Ten or twenty others are sitting in the ante-room waiting their turn. One by one they are ushered into the sanctum sanctorum by a liveried attendant, who feels his importance sufficiently to impress you with it either by impertinence or indifference. You enter; you are received with: "Well, what's the trouble with you?" Looking at his watch: "Make haste, I have to go to the hospital in thirteen minutes." You tremblingly state your case, forgetting, in the awe of your surroundings, the most important

symptoms. All the time he is writing the prescription. As soon as you are through with your statements of the case, he hands you what he has written. You look at it, and, perhaps, recognize a remedy which you had already tried with no avail, and you venture to suggest this fact. Then comes a thunderburst of bombastic bravado, informing you that he is the grand high cockolorum of the New York profession; that he is the grand mogul of medicine in all these parts, etc., etc.-that he knows his business, and you have no right to any suggestions whatever. So, in trembling fear and awe of his authority, you take the prescription, pay your five dollars, if you have not been required to lay it upon the silver plate before entering the holy of holies and depart, considering yourself fortunate to get away alive.

lordship from his lecture or his hospital. Some of our Western medical magnates are beginning to affect this style, but we have an abiding confidence that the people themselves will render such foppery impossible among us. There is one thing, however, in which our Eastern brethren get ahead of us smartly, and that is in collecting their fees. They certainly get the wealth, whether they earn it or not. If you get a prescription you have got to pay for it. It is easy to keep books in New York. Everything is cash and on the gold standard. By the way, everything else is thrown in the shade here but the gold question. Nothing else is talked of, naught else even thought of, but silver and gold. The question, to our minds, seems much mixed. To us it appears very much like the allusion in Owen Meredith's inimitable poem, Lucile:

Like that target discussed by the travelers of old,

Which to one appeared argent, to one appeared gold;

To him ever lingering on doubt's dizzy margent,

argent.

T. O. S.

but we