xt7m639k4379 https://exploreuk.uky.edu/dips/xt7m639k4379/data/mets.xml Gross, Samuel D. (Samuel David), 1805-1884. 1879  books b92-96-27764313 English J.P. Morton, : Louisville, Ky. : Contact the Special Collections Research Center for information regarding rights and use of this collection. McDowell, Ephraim, 1771-1830. Memorial oration in honor of Ephraim McDowell  : "The father of ovariotomy" / by Samuel D. Gross ... delivered at Danville, Ky., at the dedication of the monument erected to the memory of Dr. Ephraim McDowell by the Kentucky State Medical Society, May 14, 1879 ; published by the society. text Memorial oration in honor of Ephraim McDowell  : "The father of ovariotomy" / by Samuel D. Gross ... delivered at Danville, Ky., at the dedication of the monument erected to the memory of Dr. Ephraim McDowell by the Kentucky State Medical Society, May 14, 1879 ; published by the society. 1879 2002 true xt7m639k4379 section xt7m639k4379 



                   IN HONOR OF






            )lubliubtb by tot 2ocittq.

                LOUISVILLE, KY.:




  That Dr. EPHRAIMI MCDOWELL, of Danville, Ky.,
was the first to perform the operation of ovariotomy,
and by his successful cases make the extirpation of
diseased ovaria a legitimate surgical procedure, has
long been conceded both in this country and in Eu-
rope.  To Dr. S. D. Gross, of Philadelphia, is due
the credit of successfully establishing the claims of
McDOWELL to priority in this important field of sur-
   The idea of marking the last resting-place of the
first ovariotomist with some memorial commemorative
of his great services to humanity originated with the
late Dr. John D. Jackson, of Danville, and was brought
by him to the attention of the Kentucky State Medical
Society, and from thence before the American Med-
ical Association.  Quite a number of subscriptions
were made to this object by members of the National
Association, but at the meeting in Louisville, in 1875,
the Association adopted a resolution creating a Prize-
essay Fund for the perpetuation of McDOWELL'S great



achievement. The resolution left to the profession of
Kentucky the work of placing some local memorial
over his grave. The death of Dr. Jackson occurring
soon afterward, the Kentucky State Medical Society
intrusted the work to Dr. Lewis S. McMurtry, of
Danville, the pupil and friend of Dr. Jackson. To
his energy and perseverance, under many discouraging
circumstances, the complete and perfect success of the
enterprise is attributable. In addition to those made
by the members of the Kentucky State Medical Society
subscriptions toward the erection of a monument to
McDOWELL were made by Dr. Samuel D. Gross and
the late Dr. Washington L. Atlee, of Philadelphia,
the late Dr. Edmund R. Peaslee, of New York, and
Dr. J. A. Murphy, of Cincinnati.
   The monument is a handsome shaft made from
Virginia granite. Midway on the shaft is a bronze
medallion of McDOWELL, and beneath the medallion
his monogram with the motto, "Honor to whom
honor is due." Upon the front face of the monu-
ment is the following inscription, encircled with a lau.
rel wreath: "A grateful profession reveres his memory
and treasures his example." On the opposite side is
inscribed, "Erected by the Kentucky State Medical
Society, 1879." On the eastern face this inscription:
"Beneath this shaft rests EPHRAIM MCDOWELL, M.D.,





the 'Father of Ovariotomy,' who, by originating a great
surgical operation, became a benefactor of his race,
known and honored throughout the civilized world."
The western face is devoted to the historic inscrip-
tions as follows, being encircled with the .Fsculapian
serpent: "Born in Rockbridge County, Virginia, 177I;
attended the University of Edinburgh 1793; located
in Danville, Ky., 1795; performed the first ovarioto-
my 1809; died I830." The monument is beautifully
located near the center of the city of Danville, in a
park of several acres, which, by subscription of the
citizens of that place, has been beautified and made
suitable for the purpose.
   The dedication of the monument occurred on the
i4th of May, during the session of the Kentucky State
Medical Society at Danville. These services, which
were unusually interesting and imposing, this volume
is intended to perpetuate. An immense audience as-
sembled to witness the dedicatory services, and thus
honor the memory of a great man, being composed
of the members of the Society, and ladies and gentle-
men from all parts of the State. In addition to the
members of the Kentucky State Medical Society, the
speakers, the Governor of Kentucky, the Secretary of
State, and other officials, the following well - known
physicians and surgeons of other States occupied seats






on the platform: Dr. Gilman Kimball, Lowell, Mass.
(who has performed ovariotomy two hundred and thir-
ty- nine times); Dr. V. P. Gibney, New York; Drs.
Whittaker, Seely, Ayres, and Stevens, of Cincinnati,
and McDowell, of St. Louis.
  The committee regrets exceedingly that a letter
addressed it by Dr. Fordyce Barker, President of the
New York Academy of Medicine, failed to reach its
  The committee take pleasure in expressing thanks
to D. Appleton  Co., publishers, New York, for
their kindness in furnishing at cost the engraving of
Dr. McDOWELL, which serves as a frontispiece to this
                           COLEMAN ROGERS,
                           PRESTON B. SCOTT,
                           J. W. HOLLAND,
                               Committee of Publication.



LOUISVILLE, KY., May 17, 1879.


   Dear Sir-In accordance with the resolution
adopted by the Kentucky State Medical Society
on the I5th of May, I would respectfully request
you to forward me for publication the Proceed-
ings of the McDowell Memorial Exercises, held
in your city on the I4th instant.
       I am, very respectfully,
                          COLEMAN ROGERS,
                   Chairman Commtvittee tef Publication.

                        DANVILLE, Ky., June 19, 1879.


   Dear Sir-I have the honor to send herewith
the Proceedings connected with the Dedication
of the McDowell Monument, as requested in
your favor of the I7th instant.
            I am, yours, etc.,
                         L. S. McMURTRY,
             Chairman AfcDozvell Monument Coznnittee.





             BY PROF. SAMUEL D. GROSS, M. D.

   Nearly fifty years ago the citizens of Danville, then
a small, obscure village, carried to its last resting-
place all that was mortal of the man whose monument
will henceforth mark an era in the history of the med-
ical profession and of the people of Kentucky. The
announcement of his death, after a brief illness, in the
fifty-ninth year of his age, on the 20th of June, i830,
caused deep and wide-spread grief in the community in
which he had so long lived, and of which he had been
so conspicuous, honored, and beloved a member. By
none was his loss more profoundly deplored than by
the poor of Danville and its neighborhood, who had
been so frequently benefited by his skill and so fre-
quently the recipients of his bounty.  Many a tear
was shed as the body was tenderly laid in the earth,
and many a sigh was heaved as the reflection came
that the mantle of such a man would be long in find-
ing worthy shoulders. Of those who were present on
that melancholy occasion, one after another has dis-
appeared. New generations have sprung up, and a
scene that wrapped a whole community in sorrow and



caused general regret in the American medical pro-
fession is with most of the people of this section of
Kentucky a mere tradition. The marble slab erected
by the hand of affection over the mortal remains
bears the simple but significant inscription, EPHRAIM
  Who was this man, this EPHRAIM MCDOWELL, in
honor of whose memory we have assembled here this
evening Was he a hero whose body was scarred as
he was leading his armies in the defense of his coun-
try Was he a great magistrate, meting out justice to
his fellow-citizens, protecting their rights, and wisely
interpreting their laws Was he a legislator, devising
means for the development of the resources of his
state, and the promotion of the happiness of society
Was he a great senator, like Clay or Crittenden or
Webster, expounding the constitution and convulsing
the American people by the power and majesty of his
eloquence EPHRAIM MCDOWELL was not any of these,
and yet he was none the less a good or a wise man,
nor is he any the less entitled to the world's gratitude.
Following the noble vocation of a practitioner of the
healing art, liberally dispensing alike to poor and rich
the blessings of his knowledge and of his skill, he
silently pursued the even tenor of his way, a faith-
ful servant of his profession, with no ambition for mere-
tricious distinction. It was here, on this very spot,
that he achieved that renown which so justly entitles
him to be ranked among the benefactors of his race.
It was here, while engaged in the daily routine of his






calling, that he performed an exploit which no one had
ever achieved before, and which, although for a long
time denounced and condemned by many otherwise
enlightened surgeons and practitioners as an outra-
geous, if not murderous, innovation, is now universally
admitted as one of the established procedures in sur-
gery; an operation which, in its aggregate results in
the hands of different surgeons, has already added
upwards of forty thousand years to woman's life, and
which is destined, as time rolls on, to rescue thou-
sands upon thousands of human beings from prema-
ture destruction.
  EPHRAIM MCDOWELL will be regarded in all time to
come as the "Father of Ovariotomy," and as one of
the master spirits of his profession. We are here this
evening to place upon his tomb a wreath of immor-
telles expressive of our admiration and respect, and
of the gratitude of more than two thousand women
rescued from an untimely grave by his operation. That
his claims to this distinction are well founded the his-
tory of this operation abundantly attests. For a long
time it was thought that other surgeons had antici-
pated him in this undertaking, but all the doubt that
had hung over the subject was at length completely dis-
pelled in i852 in an address which I had the honor
to read before the Kentucky State Medical Society at
its annual meeting at Louisville, entitled "A Report on
Kentucky Surgery."  In the prosecution of my in-
quiries I became deeply interested in the subject of
ovariotomy, and especially in the claims of McDOWELL





as its originator. With this end in view I engaged in
a long and laborious correspondence, in which I was
kindly assisted by Professor Daniel Drake, Dr. Wil-
liam Gait, and Dr. William A. McDowell, a nephew
and at one time a partner of the great surgeon.
Letters were addressed to physicians in different parts
of the State, and also to the surviving members of Dr.
McDOWELL'S family, asking for information respecting
the number and results of his cases, as well as the
names and residences of his patients, and any- other
intelligence calculated to throw light upon his life and
character; matters concerning which, up to that period,
hardly any thing definite was known. These docu-
ments are still in my possession, and will probably at
no distant day be given to the public.
  When this investigation was begun the origin of
this operation was generally ascribed to a French sur-
geon, L'Aumonier, of Rouen, who, it was contended,
had performed it in 1776, when McDOWELL was hardly
five years old.  More recently the honor has been
claimed by our British brethren for Dr. Robert Hous-
ton, of Glasgow, whose name appears in connection
with an operation upon the ovary as early as I771.
The operation, however, has been found upon a care-
ful examination of the history of the case to be en-
tirely different from that of the Kentucky surgeon.
The case was simply one of ovarian tumor, the con-
tents of which were partially evacuated by an incision
made through the abdomen, the cyst itself being left



               DEDICATOR Y ADDRESS.                13

  These and other pretensions that have been set up
by different nationalities are wholly unsupported by
facts; for a careful study of the cases which have been
reported by their respective operators will serve to
convince any unprejudiced mind that, so far from be-
ing examples of ovariotomy, they were simply instances
of cystic tumors, similar to those already mentioned in
connection with the names of L'Aumonier and Hous-
ton. Indeed a considerable number of such opera-
tions were performed during the last century, chiefly
by French, German, and English surgeons, or, as they
would now call themselves, if living, gynecologists.
  The first actual case of ovariotomy of which there
is any authentic account occurred in this town in De-
cember, I8o9, in the hands of EPHRAIM MCDOWELL,
and to him and to him alone is due the credit of
having devised and first successfully executed the op-
eration. All honor, then, we say, to the man who
thus paved the way to a new path of humanity, since
so nobly trodden by his successors! All honor to
the man who had the courage and skill to do that
which no man had ever dared to do before! All
honor, too, to the heroic woman who, with death lit-
erally staring her in the face, was the first to submit
calmly and resignedly to what certainly was at the
time a surgical experiment. To her, too, let a mon-
ument be erected, not by the Kentucky State Medical
Society or by the citizens of Kentucky, but by suf-
fering women who, with her example before them.
have been the recipients of the inestimable boon of



ovariotomy, with a new lease of their lives and with
immunity from subsequent discomfort and distress.  I
know of no greater example in all history of heroism
than that displayed by this noble woman in submit-
ting to an untried operation.  McDOWELL himself
must have been startled, if not absolutely abashed,
when he found how willing she was, after he had de-
picted to her, in the most glowing colors and in the
strongest and plainest language, the risks of the op-
eration. When a surgeon, however experienced or
skillful, meets with a desperate case, and finds that,
after having informed his patient, that if an operation
be performed, it will be likely to destroy him, he is
willing and ready to incur the risk, his heart often
fails him and he deeply regrets that the poor sufferer
ever fell into his hands. So no doubt McDOWELL
felt upon this occasion.  " Having never," he said,
" seen so large a substance extracted nor heard of
an attempt or success attending any operation such as
this required, I gave to the unhappy woman informa-
tion of her dangerous situation.  She seemed willing
to undergo an experiment, which I promised to per-
form if she would come to Danville, the town where
I live, a distance of sixty miles." She did come, and
the experiment, as McDOWELL very properly calls it,
was, as already stated, performed.  A rapid recovery
ensued, and the patient, Mrs. Crawford, a Kentucky
lady, survived the operation thirty-two years, enjoying
for the most part excellent health, and dying at length
in the seventy-ninth year of her age. Thus, it will be






seen, this heroic and courageous woman owed nearly
two-fifths of her life to the skill and care of her sur-
geon. Our admiration of this noble woman is greatly
enhanced when we reflect that the operation was per-
formed without the aid of anesthetics, which were not
introduced into practice until a third of a century af-
terward, as is our admiration of the surgeon when we
recall the fact that he had no trained assistants to aid
him in his work, executed despite the most strenuous
and persistent efforts to persuade him from undertak-
ing it.
   It is not a little remarkable that no account of this
operation was published until eight years after it was
performed. Whether this was due to inherent mod-
esty on the part of McDOWELL, to indifference to
fame, to sheer apathy, to an aversion to writing, or
to fear of criticism, to which such an undertaking,
without a precedent in the annals of surgery, would
necessarily expose him, it would be idle to conject-
ure. It is sufficient for my purpose to know that
the first notice of it appeared, in I817, in the Philadel-
phia Eclectic Repertory and Analytical Review. The
communication, which covered not quite three octavo
pages of printed matter, was entitled "Three Cases of
Extirpation of Diseased Ovaria," and was drawn up
so loosely and carelessly as to be-well calculated to
elicit adverse criticism, as indeed it speedily did both
at home and abroad in a way not at all calculated to
reflect credit upon the author as a literary and scientific
man. The details of the cases were singularly mea-

I 5



gre; there was nothing said respecting their origin,
progress, or diagnosis, and even the operations them-
selves were very imperfectly described. If such op-
erations had been performed in our day the most
minute circumstances would have speedily found their
way into print. The fact is McDowELL possessed no
facility as a writer, and he lacked that grace of dic-
tion and power of expression so well adapted to
impart interest even to the driest details, and which
can be acquired only by long practice. In a word,
he was a stranger to the pen and had no fancy for
its use. Writing was a great bore to him; a compul-
sory necessity. The report of his cases soon after its
publication was severely criticised, and an attempt was
made to throw discredit upon his statements, or, in
other terms, to impugn his veracity. Had McDOWELL
lived in our day, when intelligence flashes with light-
ning speed, not only from one section of the country
to another but from continent to continent, such an
occurrence would not have been possible.
   Dr. James Johnson, the very able and learned editor
of the London Medico-Chirurgical Review, a journal
widely circulated both in Great Britain and in the
United States, was especially savage and satirical. He
could not imagine it to be possible that an American
surgeon, living in a small, obscure village in the wilds
of Kentucky, or in the backwoods of America, as he
expressed it, could perform such an operation, or be-
come a pioneer in a new branch of surgery.   In
commenting upon McDowELL'S first case, especially



upon the wonderfully rapid recovery of the patient, he
exclaims, apparently in holy horror and with uplifted
hands, " Credat Judwits, non ego."  In a subsequent
article, published in 1827, Johnson again calls atten-
tion to MCDOWELL'S cases, adding that of five cases
reported four had recovered and only one had died.
"There were circumstances," remarks this Cerberus,
" in the narratives of some of the first cases that
raised misgivings in our minds, for which uncharita-
bleness we ask pardon of God, and of Dr. EPHRAIM
McDowELL, of Danville." It is presumable that this
frank and manly recantation on the part of a man
who occupied so elevated and influential a position
as the editorship of the most widely read medical
journal in the world had some effect in controlling
professional sentiment and inspiring confidence in the
declarations of a surgeon whom he had only a few
years before denounced as a backwoods operator un-
worthy of credence. Nevertheless Dr. MCDOWELL had
for a long time no imitators. Among those who, on
this side of the Atlantic, had the courage to follow in
his footsteps, were Nathan Smith, of New Haven, in
182I, Alban G. Smith, a partner of McDOWELL, in i823,
and Dr. David L. Rogers, of New York, in 1829. All
of the cases terminated favorably. MCDOWELL him-
self, as clearly as I could determine in preparing my
report on Kentucky Surgery, operated altogether thir-
teen times, with the result of eight cures, four deaths,
and one failure, due to an inability to complete the
operation on account of extensive adhesions of the




tumor; a degree of success which, considering the fact
that he had no precepts except his own experience to
guide him, was eminently creditable to his judgment,
care, and skill, and which, although exceeded in recent
times, was for a third of a century pretty much the
average in the hands of his followers, both in America
and in Europe. If we go to the other side of the At-
lantic we shall find that the first attempt at ovariotomy
in Great Britain occurred in the practice of Mr. John
Lizars, of Edinburgh. This gentleman in i825 pub-
lished a beautiful monograph upon the subject, in
which he gave a detailed account of four cases, with
two recoveries, one death, and one an utter and dis-
graceful failure, due to an erroneous diagnosis, both
ovaries being perfectly sound.  Mr. Lizars, who was
a surgeon of considerable note in his day, was led to
turn his attention to this subject from having read an
account of McDOWELL'S operations, which had acci-
dentally fallen into his hands during the absence of
Mr. John Bell, McDOWELL'S old preceptor, upon the
continent, from which he never returned.  The bro-
chure here referred to was, there is reason to believe,
of great service in calling to the subject the attention
of European surgeons generally, the more especially as
it embraced a full report of the Kentucky cases, which,
up to that period, had lain, as it were, in a state of
dormancy.  Nothing, however, of any moment was
done any where, either at home or abroad, until 1842,
when ovariotomy received a new impulse at the hands
of Dr. Charles Clay, of Manchester, England, followed





shortly after by Dr. Frederick Bird, of London, and the
two brothers Atlee, John and Washington, of Pennsyl-
vania, the first case of the former having occurred in
i843 and that of the latter in 1844.  To these gen--
tlemen is unquestionably due the great merit of reviv-
ing the operation and of placing it upon a firm and
immutable basis as one of the established procedures
in surgery. Their attempts to generalize the opera-
tion met every where with great opposition and even
obloquy. Dr. Clay, who introduced it into England,
in referring to the subject, states that he had to wade
through much vexatious opposition, great misappre-
hensions, and gross misunderstandings; and the expe-
rience of Dr. Washington L. Atlee was still more
trying and annoying. In an address which he de-
livered in I872 before the Philadelphia County Med-
ical Society, entitled "A Retrospect of the Struggles
and Triumphs of Ovariotomy in Philadelphia," he de-
picts in glowing language the obstacles which this
operation had to encounter in this country and in his
own city.  "Ovariotomy," he exclaims, "was every
where derided. It was denounced by the general pro-
fession, in the medical societies, in all the medical col-
leges, and even by the majority of my own colleagues.
I was misrepresented before the medical public, and
was pointed at as a dangerous man, and even as a
murderer.  The opposition went so far that a cele-
brated professor, a popular teacher and captivating
writer, in his public lectures, invoked the law to arrest
me in the performance of this operation." This ran-




corous opposition, however, founded as it was upon
ignorance and prejudice, gradually wore away, and
the men who were most clamorous in keeping it up
either disappeared from the active scenes of life, or
yielded gracefully to the light of reason and experi-
ence.  Dr. Clay, writing in 1874, states that he had
operated upon two hundred and seventy - six cases,
while those of Dr. Atlee, at the time of his death,
less than a year ago, amounted to three hundred and
eighty-seven. Mr. T. Spencer Wells, of London, whose
brilliant career as an ovariotomist began in 1858, wrote
to me on the 29th of April, I879, that he had just
had his nine hundred and thirty-eighth case.  Mr.
Thomas Keith, of Edinburgh, whose career in this
field of surgery is also wonderfully brilliant, informs
me, in a letter written a short time previously to that
of his English confrere, that he had operated up to
that date two hundred and eighty-four times. Dr. John
L. Atlee has operated fifty-seven times; Dr. Alexander
Dunlap, of Ohio, one hundred and forty-three times;
Edmund R. Peaslee, seventy-seven times; Professor T.
Gaillard Thomas, one hundred and twenty-six times,
and Dr. Gilman Kimball, the oldest and most renowned
American ovariotomist since the death of Dr. Washing-
ton L. Atlee, two hundred and forty times. Professor
Briggs, of Nashville, who has operated upwards of fifty
times, recently had three cases of ovariotomy on the
same day, the patients living within a short distance
of each other.
  It is an interesting fact with regard to the history




of ovariotomy in this country that Dr. John L. Atlee's
first operation, performed in 1843, was also the first
operation in which both ovaries were removed. In
the report of this remarkable case, an unusually elab-
orate one, in the American Journal of the Medical Sci-
ences for January, i844, after instituting a comparison
between this and other capital operations, Dr. Atlee
makes a strong appeal in favor of ovariotomy. "Let
this operation," he says, "but be placed upon its legiti-
mate basis, and let it receive that attention from the pro-
fession which has been devoted to other departments of
surgery, and we shall soon arrive at such a knowledge
of the proper time and manner of operating, and before
those complications exist which render it impracticable,
as will be the means of saving many unfortunate and
hopeless victims." When this operation was performed
Dr. Atlee was not aware of the cases that had occurred
in England in the practice of Dr. Clay and Mr. Walne,
and he informs me that he would never have performed
it if he had not studied with great care the report of
McDOWELL'S cases. The success of his operation, one
of the most brilliant on record, induced him and his
brother to repeat it on the first favorable opportunity,
despite the opposition and clamor of their professional
brethren. Up to i85o only eighteen American sur-
geons, including the originator, had performed this
operation. In i 85 5 it received a new impulse from
the publication of Dr. Washington L. Atlee's first
thirty-five cases, and in the following year appeared
the admirable prize essay of Dr. George H. Lyman, of


2 1



Boston, entitled "The History and Statistics of Ovari-
otomy," embracing a summary of three hundred cases,
being all that were then known as having occurred in
different parts of the world. On the continent of Eu-
rope ovariotomy made, until recently, very slow prog-
ress, although Chrysmar, of Germany, had performed
it three times before the close of I820, and conse-
quently several years before it was attempted by Lizars,
of Edinburgh. In France it was performed for the
first time in i847. In these countries, as in the United
States and Great Britain, it was long denounced as an
unsafe and improper operation, and that this should
have been the case is not surprising when we consider
the enormous mortality which attended it, even in the
hands of many of the most accomplished surgeons.
The results of late years, however, have been more
encouraging, and have been particularly flattering in
the hands of Koeber]6, of Strasbourg, Shroeder, of
Berlin, and Skoeldberg, of Sweden, not to mention
others. Ovariotomy is no longer on trial; it has suc-
cessfully passed that ordeal, and is now performed in
every country of the earth where civilization has car-
ried the blessings of scientific medicine.
  The frequency of ovarian diseases is appalling; far
greater, indeed, than it is generally supposed to be.
One surgeon alone, Dr. Clay, of England, declares
that he had examined within a single decade eight
hundred and fifty cases ! Who, in view of these oc-
currences, will deny the blessings of ovariotomy, espe-
cially when we take into consideration the fact that




few women laboring under maladies of this kind live
longer than about four years, unless relieved by sur-
gical interference
  The mortality of this operation is worthy of brief
notice in connection with Dr. McDOWELL's name and
fame. His own cases-thirteen in number, with eight
cures, four deaths, and one failure to complete the
operation on account of extensive adhesions-show an
astonishing degree of success when we recollect all
the circumstances attending them, especially the oper-
ator's own inexperience, and the absence of any rules
to guide him in his undertakings. For a number of
years after McDOWELL's death the mortality in the
hands of different surgeons exhibited but little im-
provement upon that in his own practice. Thus, of
one thousand four hundred and eight cases collected
by me in I872, from various sources, native and for-
eign, four hundred and fifteen died, affording a mor-
tality of twenty-four per cent, or one death in every
three and two fifth cases. That the results of the
operation are materially influenced by the manner in
which it is performed, and by the previous and sub-
sequent treatment, is a fact long since fully estab-
lished. Thus, if we take the statistics of one hundred
cases in the hands of so many different surgeons, men
who have no experience in such cases and who follow
the ordinary method of operating, the mortality will
be found to be enormous, just as it would be likely
to be under similar circumstances in any other grave
operation, as lithotomy, the larger amputations, tre-




phining of the skull, and the ligation of the larger
arteries. No one will deny that experience is a most
important factor in saving or destroying life in all the
more serious, severe, or capital operations. The re-
sults of ovariotomy in the hands of professed or skilled
ovariotomists, men who make a specialty of abdominal
surgery, are among the greatest triumphs of our art,
entitling them to be ranked among the noblest bene-
factors of the present day, or indeed of any day. The
cases of Washington L. Atlee, -Charles Clay, T. Spen-
cer Wells, Thomas Keith, Gilman Kimball, Alexander
Dunlap, T. Gaillard Thomas, and others, are counted,
not by tens or twenties or thirties, but by hundreds.
It is this enormous multiplication of cases that makes
these men such experts and that gives them such a
superiority over those whose practice is comparatively
limited. One of the most gratifying circumstances con-
nected with this operation is the gradually decreasing
mortality even in the hands of the most successful
surgeons. This is strikingly shown, to go no farther,
by the statistics of Dr. Clay, of Manchester, who, as
previously stated, introduced ovariotomy into England.
Of the first twenty cases the death-rate was one in
two and one half; of the second twenty, one in three
and one third; and of the last thirty-one, one in four.
In Mr. Wells's cases the same gratifying results are
apparent, and so also in those of Mr. Keith, of Edin-
burgh. Who will dare to assert that these triumphs
are not due to superior skill in operating, and to in-
creased care and experience, and not to the selection




of the cases, although this will doubtless, now that the
diagnosis between innocent and benign ovarian dis-
eases is so well established, have its influence
   The attention bestowed upon the after - treatment
must necessarily exert a powerful influence upon the
patient's fate. All