alters the appearance of the membrane and, in my opinion, it is unnecessary, certainly from the standpoint of relieving pain. Glycerine should be used as a lubricant for the tube, as vaseline will interfere with the action of drugs used in treatment.

Small wire applicators to hold the pledget of cotton for removing secretions and applying different medical agents are necessary. If the urethra is in a very highly granular condition, after inserting the tube there may be a slight hemorrhage that will temporarily interfere with the careful examination or proper treatment of the diseased surface, but at the next treatment there is usually such improvement that there will not be a recurrence of the hemorrhage.

In regard to drugs used, there are quite a number that are very useful, such as, Lugol's solution, carbolic acid and iodine, nitrate of silver, tannin, bichloride of mercury, sulph. copper, ichthyol, solutions of iron, and many others. While we may select from the above list the drug best suited for each individual case, I use nitrate of silver more than any other and with better results. It is best when using the silver solution to commence with about 20 grains to the ounce and increase to 60 grains to the ounce. The surface touched with the solution turns white, and there is usually a slight pain that lasts for several minutes. It is well to place a pledget of cotton over the meatus after the application and tell the patient there will be an increase of discharge which will usually pass off within twenty-four hours. It is best not to repeat the application oftener than every six or seven days. The day after the application the urethra should be irrigated with a solution of permanganate of potash 1 to 6000. This relieves the irritation and slight discharge that is usually seen. There is very little danger of producing epididymitis, urethral fever, or any other complication from the use of the endoscope. I have never seen the slightest bad result follow its use.

I could report quite a number of cases of chronic urethritis that had extended over a period of from one to fifteen years that have been permanently cured by the use of the endoscope, but I will not bore you with the history. It might be well to state that many of these cases had been intelligently treated, the stricture, if one had been present, was properly dilated or cut, the meatus was incised, the urethra injected or irrigated, but the chronic inflammatory condition remained, which was promptly relieved by proper endoscopic treatment.

It would be folly to hold that the endoscope is necessary to the successful treatment of every case of chronic urethritis, but the number of cases, which are not a few, that respond to this treatment after other means have failed, certainly demonstrates the value of the endoscope.

References: Prince A. Morrow, M.D., "A System of Genito-urinary Diseases, Syphiology and Dermatology." White and Martin, Genito-urinary and Venereal Diseases."

SOME OF THE FALLACIES IN THE MODERN

TREATMENT OF NOSE AND THROAT

DISEASES.

BY DUNBAR ROY, A.B., M.D.

Specialism seems to be the order of the day and not unjustly so. The knowledge and treatment of the human organism is not what it was some fifty years ago. To-day it is almost impossible for a physician to be skilled in the treatment of every portion of the human frame. This does not come from any lack of ability, but in a large measure from the lack of necessary apparatus which is needed for the thorough examination of the different organs of the body, with skill and experience in the use of the same. Specialism has its advantages and its disadvantages. A man who confines his practice to a certain region of the body, and therefore treats the diseased condition of these parts, is certainly more familiar with pathological changes in this region because of his daily contact with large numbers of such cases, than the man who but rarely has such cases to come under his observation. The man who treats 100 cases of typhoid fever in a year is certainly more capable of making a clear diagnosis and rendering the appropriate treatment, than the man who sees five cases. In other words, the larger the experience of any man is, in a special line of work, the more expert he becomes in that work, qualified of course by looking upon him as being a man of mediocre intelligence.

In viewing this statement as referring to medicine, certain qualifications must be made.

We may look upon physicians as composed of two attributes: first, the reasoning element; secondly, the mechanical element.

The first is innate and has very little dependence upon experience. The second, while in a measure governed by the first, is largely influenced by experience and opportunity.

Let me explain: Here is a surgeon who has great mechanical skill and beautiful technique. He operates with celerity and never makes an unnecessary cut. As a mechanical operator he has no superior, but he loses many of his patients by death. What is the matter? He is a magnificent operator and can do a laparotomy in ten minutes. The trouble is, he lacks judgment in making a diagnosis and in knowing when to operate. He has the mechanical element, but lacks the reasoning power or judgment. The more cases he has to operate upon the better perfected does his mechanical skill become.

On the other hand, the tendency of the specialist is to become narrowed. Most of them will deny this allegation, but nevertheless it is true. I feel that I may be permitted to speak freely in this way, since my own daily work for the last six years has been confined to a limited portion of the human anatomy, and I am better able therefore to see my own mistakes and those of my colleagues in the same field of labor.

A man can never become a successful specialist until he has become familiar with the whole human frame and the various diseases to which man is heir. This means of course that no man is prepared to become a specialist who has not been in general practice for a number of years, or has at least served as interne in a large general hospital.

No greater fallacy ever existed than the belief that a young man can commence the study or practice of a specialty immediately on his graduation. Such is the common belief of the laity, and so much so that they honestly think that you graduate as a specialist and know nothing whatever of general medicine.

Unfortunately this fact is too often true.

A man to be a successful practitioner or specialist, must be broad-minded and broader still must be his knowledge. He who limits his study exclusively to one portion of the human anatomy can never be successful. One organ of our body is but a small portion of the whole, nor does it functionate as a distinct entity. Every part is dependent upon some other part, and it requires the harmonious action of the whole for the well-being of each. Hence the truly successful specialist is he who looks beyond the region where his work lies and takes into consideration the relationship existing between every portion of the human anatomy.

You will please pardon this digression on my part from the subject-matter of this article, but these remarks show a correct prelude to those which are to follow.

The specialism limited to the diseases of the eye, ear, nose and throat, is perhaps the most popular of all to the young graduate in medicine. He sees in it the El Dorado of long hoped-for fortune. It is the specialty which seems to him to require the least amount of study, and for this reason one in which his mistakes will be the least noticeable. The cases which occur are not usually those of life and death, and with the exception of the eye they are all closed cavities, obscured from the patient's scrutinizing gaze and therefore well capable of shielding him in a mistaken diagnosis.