tigating uterine diseases, can not be held guiltless of culpable ignorance who pronounces falsely upon the presence of grave lesions. He has no excuse for diagnosticating an ulcer when there is none; or prolapsus, when the organ is in a normal position; or anteflexion or retroflexion, when neither exists. And yet these false opinions are, it must be admitted, daily given, greatly to the discredit of many a physician in the eyes of an honest and competent expert. We believe that these errors are generally the result of carelessness. There is in many, also, a disposition to give always a definite opinion, especially in an obscure case; and it is convenient to fix upon an organ which has the popular acknowledgment of being the happy abode of all the undiscovered maladies of the female organization. The uterus has now come to enjoy the relative position of the liver in its ability of concentrating within itself all the undefinable diseases to which the sex are subject. Although the term "liver complaint" has now become obsolete in the nomenclature of many practitioners, yet its place is more than supplied by the phrase "uterine disease.' Aside from the humiliation of professional character which results from such ignorance and carelessness, there are other evils of a very different kind that must not be overlooked. We have thereby opened a large and fertile field for the special advantage of quackery in its lowest and most revolting forms. It is not strange

that the interesting and interested subjects of these affections have become alarmed at the almost universal prevalence of the belief in the disabilities peculiar to their unfortunate sex. Thousands of nervous ladies suffering from some slight and obscure derangements of digestion, or other departure from health, are secretly informed by friends that the womb, that mysterious organ, with its innumerable susceptibilities, is liable to an infinite number of strange disorders. At once a mania for an investigation seizes the individual victim, which nothing but the manipulations with the speculum can relieve. And alas! too often instead of relieving a proper apprehension on the part of the patient, even though she is correctly informed that the womb is not diseased, a new source of excitement is established which is far more dangerous to her happiness than actual disease. If her ailments are lightly treated by her medical attendant she readily falls into the hands of a vulgar irregular, and becomes the dupe of his villanous machinations. In more than one instance has the profession of this city witnessed a uterine furor, created by an unblushing quack, which neither, reason nor modesty could control. And but recently we noticed an instance in which a most ignorant pretender opened a hospital for the treatment of uterine tumors, in one of the most intelligent and moral communities of an interior State; crowds of women flocked to him, and all were found to

be suffering from tumors of the womb. By accident a patient more intelligent than others, discovered that the tumor was a piece of raw meat, which was introduced at the first examination, and which, after long treatment, was removed to the great relief of the patient. It is time that uterine pathology was thoroughly understood by every practitioner. It is not, as we have already intimated, difficult to learn so thoroughly that mistakes in diagnosis will be only exceptions, and not, as now, the rule. And physicians should exercise the most scrupulous care in the management of such diseases where they really exist, especially in the unmarried. He has then not only to deal with a local disease which may be readily cured, but with temperamental conditions not apparent, yet existing, and liable to be developed into dangerous activity. The term "Speculum-mania," used by medical practitioners, may yet pass into the nomenclature of the alienist. It is certain that in some instances, and they may be far more numerous than we suspect, the local treatment has been regarded as the origin of a moral obliquity which terminated in abandoned lives, and occasionally in confirmed insanity. In no branch of practice, therefore, has the daily practitioner a more delicate and responsible duty to perform than in the treatment of the victims of uterine disease.

XX.

HOSPITAL

CONSTRUCTION.

H

OSPITALS are great public necessities which have always commanded the regard and support of the Christian world. No appeal to the benevolent is more likely to be cheerfully responded to than that which seeks to sustain these institutions. Governments have also generally recognized their value; some have endowed them liberally, and others have taken them under their fostering care, and lavished upon them untold sums of money. They are, in some measure, the criteria of a nation's progress in civilization, and the measure of its cultivation of those benevolences which spring from the heart of a people imbued with philanthropic sentiments. And yet how often is this benevolent intention frustrated in its endeavors to benefit the unfortunate by the faulty construction of the costly structures reared for their benefit, and consecrated to the holy purpose of relieving human suffering, and providing a home for the homeless and destitute sick! Nay, how often do these very buildings become the sources of disease and the causes of death to those who enter them as asylums for the relief of their individual

maladies! Every physician, who has long been attached to one of these public charities, must have felt that our hospitals are too often the great foci of endemic diseases. Typhus, erysipelas, scurvy, hospital gangrene, and all those affections which are generated and always intensified by the congregation of individuals, here prevail from year to year, with no other alternation than that which is produced by the change of seasons. Surgical injuries and operations here reach their maximum of mortality, always greatly in excess of that in private practice. Lying-in women are decimated with a pestilence, so palpably the result of local causes, that it seems barbarous to continue these departments in public hospitals. Foundling institutions are little better than receptacles where these unfortunates are prepared for early death, or imbecile youth, or premature old age. In military practice the evils of the faulty construction of hospitals stand out so vividly that they have long since attracted public attention. The remark of Sir John Pringle that "hospitals are among the chief causes of mortality in armies," was confirmed in the Crimean war, where in the early part of the campaign nearly one-half of those treated in hospitals died. Says Rush, an active and intelligent participant in the management of the hospitals in the war of the Revolution: "Hospitals are the sinks of human life in an army. They robbed the United States of more citizens than the sword." With