modesty or fastidiousness, treating women patients and neglecting such examinations until, at last, the patients go into the hands of others, who find out the ailment and relieve them. It is as much our business to know what is not the matter as to know what is the matter with our patients. We male physicians commonly talk from a very lofty standpoint, in our meetings, in relation to female patients in contradistinction to male patients. We talk of keeping our wives, daughters, and sisters innocent, of the demoralizing effect of their becoming conscious of having generative organs and functions, or having a knowledge that they may have genito-urinary troubles, and we ridicule their "mania" on these subjects. I think if we consider the known experiences of males, and the feared or suspected experience of females, the latter are not a bit worse or more unreasonably anxious about troubles with themselves of which they bear so much in the case of others. It is often of the greatest use to assure a woman from actual examination, that she is entirely free from dangerous genito urinary lesions or troubles. I believe it is the duty of every mother to teach her daughters-she will oftener teach some other mother's daughterswhat pertains most vitally to their virginal and marital relations. I repeat in proportion as the profession is honest and intelligent, such evils will pass away, but they are as rife with neurologists as with others, and are by no means confined to gynecologists.

DR. GEO. F. HULBERT.-I think Dr. Bremer has taken the correct stand. He has taken a position in regard to a special class of cases; he has not included every case that comes to the gynecologist. Give to the gynecologist a level-headed woman and there is not going to be any difficulty about treating her for that complaint, because she is in a position to discriminate. But in the case of a young inexperienced girl, there is no doubt in my mind that that girl is demoralized in a manner in which the future will show the results. I have seen cases; and,notwithstanding Dr. Cole's remark about citing cases, I will relate two: one was a young girl 14 years of age, who was at the hospital after being treated by gynecologists in the city for some length of time, and got so bad that it was necessary for her to go to the hospital. I saw the patient the next morning, and she struck me as being such a child that I asked her "my child, what brings you here ?" "I have pelvic celluli tis" she said. I asked her what that was, and she said "I don't know, but they have been treating me for it." I told her I did't think there was anything the matter with her; there

was nothing about her face that would indicate that trouble; and made up my mind that I was not going to handle her. She staid in the hospital about a week, and became very much dissatisfied because I didn't treat her locally. I told her there was nothing to do but to take the medicine I was giving her. She left in about three weeks. There was a case that if I had done what some people would have done, I would have saddled an invalid on the community that would have staid there several years.

I have another case, one of hystero-epilepsy; girl 18 years of age, who had menstruated two years without trouble, and who, during one of the attacks was examined by a physician who told her that she had a prolapse of one ovary. She came to the hospital, and when I went to see her, she said she had a prolapsed ovary; she was satisfied that that. was the cause of the trouble. There was another case that I refused to examine or treat locally. By disciplining the patientand I went to the extreme of putting a straight jacket on her-I conquered her, and when I got through with her she was satisfied that there was nothing the matter with her ovary.

I believe they are the kind of cases Dr. Bremer refers to in his paper, and I think his position is perfectly correct. I feel that we are too prone to making vaginal examinations especially in unmarried women.

DR. J. M. SCOTT.-I second the last remark of Dr. Hulbert, but there are times that it is necessary to make examinations of young girls, when we have exhausted every effort to relieve them. And then it should be made in the most conscientious manner. I am in accord with Dr. Bremer's paper. That there are too many gynecologists who are too prone to look at the case through their own specta cles-or speculums, if you will admit the corrections-so they are apt to be misled. The first thing they do is to inquire in regard to the part of his own specialty. A specialist should first be a general practitioner. In the very cases spoken of, the fact that they went from one man to another, is evidence that they were crazy already, and the sooner they were in the asylum the better. We know that there are women who have the peculiar speculo mania. I have cases in which, after finding everything else futile, I have been compelled to make examinations, as an honest physician and honest man. And I would not hesitate any more in this case than I would in making an examination of the heart. While I admit that there is a good deal in it, must I admit that we are to let that young lady go for years with such a disease simply

because we are afraid to make the examination? No, sir! I will make the examination and stand before Heaven for my conscience. DR. W. G. MOORE.-I want to express my personal debt of gratitude to Dr. Bremer. Woman is essentially a creature of fashion. Fashion is the one to blame. I make it a rule never to make a vaginal examination (?) There are practitioners who use their specula merely for the sake of gratifying their patients or themselves.

I remember being very much impressed with the routine practice that is adopted in the clinics of nearly all specialists. I speak with the greatest deference to them. At a clinic which I attended in this town, when a young man, thirteen women were presented, and eleven of those cases were treated with a mop dipped in a little tincture of iodine, and I don't think the same diagnoses were given in three of those cases. Now from a moral standpoint, I don't believe there is a physician present who doesn't agree with the doctor. I do, to the extent that I believe it is a ruling, preying evil of the present day, and in calling the attention of such a body of men that are present, he is doing an incalculable benefit.

The pendulum of specialty is swinging the other way, because it has swung too far in the opposite direction.

The sooner it strikes its proper equilibrium the better.

DR. BREMER.-I am gratified at the fact that I have been correctly understood. Of course it was not my intention to make an onslaught on gynecology; I appreciate the fact that it does a great deal of good. But there are two states of every method; there is the legitimate specialism and the spurious specialism; it is to the abuse that I have called the attention of the society. One case I have in mind is that of a woman who had been divorced from her husband. She had an erectile tumor of one of the labia majora; this tumor would swell up at certain times and give her intense pain, which was associated with a feeling of great voluptuousness. It was not pleasurable, however, and made her miserable in the extreme. She went traveling in European countries, where she was treated also locally, and whenever she was under treatment, she had two or three orgasms every night. She called the attention of a very distinguished gynecologist to that fact, and yet he continued the treatment. This woman is now perfectly well; is living in Canada and keep ing away from gynecologists. She would eat meat, and drink alcoholics in addition to the local treatment. Since she has changed her

diet, drinks butter-milk and eats farinaceous diet, all those symptoms have disappeared. It is, then, only a certain class of cases in which I take exception to the gynecological treatment. I don't know any gynecologists personally against whom I would bring these charges, but I do know of such men.

CHICAGO MEDICAL SOCIETY.

[CONCLUDED.]

Dr. F. E. WAXHAM.-In regard to the instrument presented, it wonld appear to me that the blades were a little large for small children. We all know that the post-nasal space is very small, particularly in young children, and it strikes me that perhaps the blades are a little too broad to enter nicely and readily to the vault of the pharynx. However, this objection is only a theoretical one, as I have never used the instrument. would like to ask Dr. Gradle if he has found any difficulty in using this instrument young children.

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In regard to the last paper, a statement which it seems to me should hardly go without challenge, is in regard to the removal of these hypertrophies of the turbinated bodies without seeing them, the statement being made that the smyptoms are a guide to their presence. We cannot always be guided by the symptoms in regard to their presence, for, as Dr. Gradle has already stated, we may get the same obstruction to respiration from hypertrophy of the pharyngeal tonsil, and it seems to me it would hardly be good surgery to pass a cautery into the post-nasal space and endeavor to remove a hypertrophy which may not be there.

Dr. A. P. GILMORE-I unfortunately was not in in time to hear Dr. Gradle's paper. Ref erring to the second paper in regard to the use of the snare, it seem to me that it is not so simple an operation in every case, but it is sometimes quite difficult to introduce the platinum wire into the posterior nares through the nose, because the wire is so flexible that it bends easily and the passage is sometimes small. I have not had such universal happy results follow the removal of these growths, and do not believe they cause deafness by their presence, always. We all have seen casesof polypoid growths, for example, in the posterior nares filling both nostrils, wherethe hearing is perfectly intact, also cases where the tonsils are very much enlarged, and the breathing is interfered with, the patient being obliged to breath through the mouth, and yet the hearing is intact. Dr. Coleman's remarks

about the use of the galvano cautery I think were very good, in regard to the reflex action on diseases of the eye and possibly of the ear. Sometimes patients faint after the application of the cautery ;I believe this is due to the same reflex causes that would produce congestion of the ciliary body.

The use of coeaine in a majority of these large turbinated tissues I do not find of any special advantage. I snare the tissues with the galvano cautery. In children, I use the galvano cautery snare to remove enlarged tonsils iu preference to the tonsilo tome, because it is so much easier to adjust the wire; there is no blood accompanying the operation, it is quickly over and is less painful than the tonsilo tome. I always hesitated to use chloroforn in the middle ear, although I know it is recommended and sometimes overcomes a spasm, but I believe the spasm can be overcome if the tube is properly adjusted, and allowed to remain quietly for a momeut in situ.

Dr.HENRY GRADLE in closing the discussion said: As to the question concerning the size of the instrument, I might say that in children about 1 year old the distance from one eu stachian tube to the other has been measured and is from 10 to 20 mm., similarly the distance from the vomer to the rear wall of the pharynx; this instrument has the largest diameter of 13 mm. Since I have had it made I have not happened to have any patient of aless age than five years and have had no trouble in introducing it. But I know by previous experience with curettes, that I could use it in children of the second year, and on younger children one is seldom called upon to opertae.

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As regards the paper by Dr. Webster, I agree with him as to the essential point that disease of the middle ear is so largely produced by diseases of the naso-pharynx. fact some time ago I read a paper on the sub, ject, in which I tried to defend the view thatwith possibly one exception, diseases of the middle ear result invariably from some anomaly of the naso pharynx. The one exception was sclerosis or atrophy of the middle ear. I may be allowed to correct Dr. Coleman as to my remarks which he quoted, namely, that I attributed every thing to micro organisms. I tried to distinguish between diseases of the middle ear which we must considerin fectious, snch as suppuration of the middle ear and acute catarrh accompanied by secretion, and secondary disturbances. The former conditions we must necessarily recognize as infec. tious and trace them to micro organisms which have gained entrance to the middle ear

through the eustachian tube or probably, but not likely, by embolism of the vessels. A second class of middle ear disease commonly included under the term chronic catarrh, I regard as secondary disturbances, of which the infectious origin does not seem clear to me,and I consider them secondary changes in the pharynx or the mucous membrane of the eustachiau tube. These secondary changes of the middle ear we have no reason to attribute to microorganisms. Dr. Coleman referred to other causes, the use of the nasal douche and the entrance of water into the middle ear while bathing, but their significance may be somewhat differently interpreted. We do not ordinarily use the uasal douche, except there be a disease of the nose or pharynx present, and hence there is a good chance for the transfer of flakes of pus or the infective matter into the middle ear. It is an open question at present whether suppuration is at all possible without micro-org anisms; it is certainly considered impossible,in the absence of microorganisms, without the presence of some acrid chemical substance, and it seems hardly logical to attribute the suppuration of the middle ear simply to the entrance of water.

CORRESPONDENCE.

NEW YORK LETTER.

NEW YORK, August, 1, 1887. EDITOR REVIEW: The most important announcement of the last few days in medical circles, has been the issuing of the annual catalogue of the College of Physicians and Surgeons. It contains an account of the new buildings which are claimed to be the finest for medical instruction anywhere existing in this country. A short description of them may not be devoid of interest."

The college building proper consists, first, of a southern portion 140X43 feet. In this is the main entrance, flanked by the administrative offices. Coat room, large reading room, conversation and smoking room and a "bone" room.

This last unique feature is an apartment to contain a large number of disarticulated skeletons, portions of which will be loaned to students as books are loaned from a circulating library-many students are unable to purchase an entire skeleton, and such an arrangement as this will prove of very

did before-in the old building-except the privilege of pursuing his studies under more agreeable surroundings. However we are not disposed to criticise, for we believe that the directors of the institution are wise and carefui men, who will expand its sphere of useful ness as fast as circumstances will warrant.

The old institution founded in 1807, and made a department of Columbia College in 1860, enters upon a golden age of usefulness and influence in 1887. J. E. N.

NOTES FROM THE WEST.

PUEBLO, COLORADO, Aug. 1, 1887. A night's ride and part of a day's, brings us to the flourishing city of Omaha, whose broad streets (granite and asphalt paved), cable railways and towering buildings, bnstle and stir, make one feel as though he was not away from the great city of St. Louis.

This city with its hundred thousand inhabitants, great smelting works and pork packing establishments, the third pork city in the Union, when but three years ago but a few hogs were packed here,is a marvel of progress, and bids fair some day to equal or outstrip in business prosperity its great Missouri rival, Kansas city.

But the greatness of our neighbor western cities is not the purpose of this letter.

Your readers will be interested to know the medical status of Omaha. Omaha as elsewhere, has its full share of physicians,and apro pos of this subject the following story is told.

Omaha Man (in Philadelphia)-Five hun dred medical students graduated this year. My gracious! What are you all going to do? Recent graduate-We had a mass meeting lately to discuss that matter, and concluded that we would all locate in Omaha. "Great Esculapius! In Omaha ?"

now, for the city is well sewered where it is thickly settled, and sewer pipe is being laid in anticipation far beyond the present population. With true sanitary principles the city authorities are effectually sewering the city far away from the present century of population. But it will be a difficult matter for the health department to sewer this growing city fast enough to keep up with the extension of Omaha additions, which would soon take in all the earth, if the Missouri river and other state lines did not intervene.

The city authorities may by timely sewerage, as they are doing, keep out prospective typhoid fever, pneumonia, etc., but they will not likely ever circumvent the terra mania which has so lately broken out in a real estate fever over the town and county.

The city limits of Omaha are now practically boundless, for they extend as far as a real estate man's voice can be carried on a

copper telephone wire.

The following colloquy is said to have occurred in Omaha lately.

A veritable gold mine. Stranger-Want to buy some real estate?

Omaha agent-In Omaha ?

"No, 200 miles away, but there is a railroad along side of it."

"Yes, it was reported at the meeting that in Omaha the people let kitchen garbage stand around anywhere until they get rich enough to hire a team to take it away."

Omaha World.