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the ghastly figure of thirty per cent, and held up American surgery as a spectacle for all the world. The trained and educated surgeon has an idea that the public will find him out and keep away from him. The}- do not find him out, for we are a peculiar Buy Aygestin people, — a people of fads, and the pres- ent surgical fad is appendicitis. Of course the fad will die when the time comes, and we shall look back on it with shame, just as we do to-day on female castration ; but meanwhile he Aygestin Tablets and his type are working their malignant will about a dis- ease upon which no man thinks sanely. The surgeon estimates a man's fitness as a sur- geon by the number of his recoveries, but the pub- lic has another standard which appears to be the number of his operations and his success in boast- ing of them. I know of one man who has the ability 'to achieve a very respectable death rate in repairing birth rents in the perinaeum and cer- vix, which is openly discussed in his community, without any impairment of a considerable prac- tice. I trust that Dr. Kelsey will perceive that we have not only the postgraduate school grad- uate, but that we have a public prepared to re- ceive and put faith in him. If we are going to find a remedj' for this we must begin at the bot- tom and Aygestin 5mg work up. While we have been advanc- ing the cause of medical education we have neg- lected to educate the people in discrimination and good medical and surgical judgment. Until we do this the unfit and belated surgeon will do his share of work along with better men. In the text book graduate we have another phase of the belated surgeon. He is the product of social conditions which have developed with great rapidity in a few years. Small towns and villages, with populations ranging from 1,500 to 5,000 inhabitants, have organized local hospitals. The women have raised the money and been fore- most Aygestin Price in erecting new buildings or in converting old ones to hospital use. They have Aygestin 5 Mg done this out of the goodness of their hearts and from a most commendable philanthropy. But they have cre- ated in their midst an evil which is active in a ratio proportioned to their means of doing good. The best men of the town, as a rule, have been selected for the staff. Those who were the Buy Aygestin Online most popular have become surgeons, while others have received places on the medical side. In little hos- pitals of from five to fifteen beds every Norethindrone Acetate Tablets important surgical specialty is represented. With rare ex- ceptions they are text book specialists at or past middle life. The most radical surgical methods are followed. Appendicitis is never Aygestin Cost given medi- cal treatment. The infirmities of women afford ample scope for surgical intervention. The Buy Norethindrone Acetate most difficult genitoplastic operations are undertaken with results not necessary to describe. Buy Cheap Aygestin When they are in doubt the textbook is brought into use and from which very singular procedures are undertaken. One of the best of these surgeons had a case of bladder incontinence which he treated by doing Emmet's buttonhole operation and afterwards found that he was unable to do the simple Aygestin Online operation of closing it. This is only one illustration of what the text book will do for 1056 VAX' DE IVARKER: SURGICAL PARADOX. the text book surgeon. The ophthalmologist, hitherto content to do his best in adjusting glasses, does iridectomy and operates for cata- ract, while the rhinologist finds ample recompense for belated opportunity in diverted ssepta. If any one among our readers is familiar with these rural hospitals and believes that I hav.e over- c»lored the picture, if he will take the trouble to state it I will submit cheerfully to the correction. I am simply giving my own experience of the work done, for many of the unfortunates drift afterwards into Generic Aygestin my own hands in the central New York region. I regret to say that I do not be- lieve that the special surgery will ever improve, as there is not material enough to build up the ex- pert, nor would it pay for a well qualified young man to locate in one of these small towns. Dr. Kelsey's theory fails to explain the situa- tion in the rural hospitals. These men are rarely the product of the postgraduate school. They do not resort to these schools, because they cannot afford it. After the appointment to the surgical side of a rural hospital the only way to hold it against all rivals is by showing the best front that he is able to. It would be a confession of weak- ness to seek knowledge for two months, or so, at a polyclinic. He is obliged to stand by his work

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