us to arrive at proper conclusions. And in this rule of action lies one of the secrets of success in ovariotomy. Show me a surgeon, who in other operations may have his share of success, but who has a summary way of examining his patients, and of dispatching his operations, and I will show you one who is unsuccessful in ovariotomy.

I am fully sensible of the importance, and the difficulties we encounter in obtaining such information as will guide us in the examination of ovarian disease. Less has been written about it, in proportion to its importance, than any class of diseases known to the "healing art." I shall therefore attempt, from my own humble experience, and that of others, so to classify the symptoms and means of examination, that "he who runs may read." I may say, however, that you may meet with cases, which for the time being may baffle your strongest apprehension and your most scrutinizing examination. I believe with Dr. Armstrong, that "when we find ourselves in the dark, it is better to stand still until the light returns," than to run the risk of going over a precipice. In other words, it is better prudently to wait for further developments. It is said that the "wise and active conquer difficulties by daring to oppose them," and in this age of wonders there is scarcely any thing insuperable. I remember to have read of or seen at some time, a picture representing a party of men, their hats and coats lying by their side, and with pick-ax in hand, attacking the base of a mountain, whose summit towers far above their heads. We look again, and the steam-horse, as though "the speed of thought were in his limbs," follows their footsteps through the bowels of the earth.

Before commencing the examination of a patient supposed to have ovarian tumor, or dropsy of the ovaria, it is important to have the bowels and bladder emptied. If there is much tenderness or soreness in handling the tumor, it is better to give the patient chloroform, as it will enable you, without pain on her part, to conduct a more complete examination. Prior to this, however, sit quietly down, as if the day was devoted to this particular purpose, and obtain from the patient a complete history of the case. How and when the disease commenced, of how long duration, whether painful or not, in what state the general health, whether the menstrual discharge is

regular, does the tumor move from one side to the other in turning, is it as far as you have observed moveable at all, has it by any course of treatment diminished in size, has it any time been accompanied with swelling of one or both of the lower extremities, etc., etc.

The patient should be placed upon the back, with the extremities flexed, so as to relax the abdominal muscles. Our aim must be, in the examination, to ascertain whether the tumor is ovarian or not, and then its pathological character. In two-thirds of the cases which I have examined, I have found the tumor to commence in the right or left iliac fossa; and the patient to describe it, when first noticed, to have been as big as a hen's or goose egg. In other instances it attains to considerable size before it is noticed. I operated on a case last summer, where the tumor attained the weight of twenty-four pounds in thirteen months. The patient did not know upon which side the tumor commenced, and was under the impression that she was merely becoming fleshy, so little was she complaining. In ovarian tumor there is generally but little disturbance of the general health. The stomach, liver, and kidneys generally maintain their usual action. So even with the menstrual discharge, except where both ovaries are diseased.

Dr. Frederick Bird has published a case, where the disease was of sixteen years standing, and during seven years of that time the menses disappeared-operation, patient recovered.

At

In fibrous or scirrhus tumors of the ovaria, the menses are oftener irregular than in encysted tumors. Occasionally you will meet with a case, where, in the early part of the disease, the patient suffers with what she supposes to be colic. such time, if the tumor (or bowels) is firmly pressed upon, the pain may be traced deep down in the right or left iliac fossa. At other times, from active exercise, or exposure to a sudden change of air while exercising, a diffused soreness will be felt over the bowels. A lady (Mrs. Burns), near Marietta, Ohio, came to Augusta to consult me for the treatment of "dropsy of the bowels." Soon after her arrival, she was attacked with violent pain and great tenderness of the abdomen, so much so, that no pressure could be borne upon the bowels. She was confined to her bed for ten days. I learned from her that such

attacks were frequent, and she attributed the present one to the travel in the cars, or from the walk from the boat to the hotel. When the pain and soreness of the bowels had subsided, I made a careful examination of the case, which convinced me that it was ovarian tumor. With the exception of these occasional attacks, her general health is good, and in consequence of this fact, I have not yet operated upon her.

May these attacks not originate from the friction of the tumor against the peritoneum, causing some degree of inflammation to set in? I merely mention this case, and may, by the way, mention others, where it will illustrate a fact or corroborate a principle.

(To be continued.)

SCIENCE AND SUCCESS, a Valedictory Address, delivered to the Medical Graduates of Harvard University, at the Annual Commencement, May 9, 1859. By HENRY J. BIGELOW, M.D., Professor of Surgery.

This is a high order of valedictory literature. The usual routine of such discourses is departed from, and we have presented to us truths verified by daily observation, expressed in an elegant, bold, and vigorous style. However unpalatable to our professional pride, we must admit the correctness of this annunciation: "Let me at the outset explode any lingering belief that what is usually called eminence in science necessarily produces medical practice; or that large medical practice implies any thing in respect to medical science." The ardent pursuit of science in its higher walks seems incompatible, as a general rule, with those qualities that secure a very large medical practice. Many elements must unite in making up the character of the popular practitioner. High reputation which so often pours its golden flood upon its possessor, is not necessarily the gift of extensive scientific attainments. In the language of our author: "There is a machinery to fame. It is one thing that a quality should exist, and another that it should come to be known. In civilized centres, talent and attainment generally make their mark; but sterling, sound sense and excellent medical acquisition may be sown through every village VOL. 1, No. 15-30.

in the land, unambitious and unobtrusive; while on the other hand, men upon whose medical judgment you might justly hesitate to rely, may by adventitious circumstance or a thirst for notoriety or gain, be urged into a really conspicuous position."

There are many other points in this excellent address to which we would gladly make reference, but our diminishing space admonishes us not to indulge our inclinations further.

An Anomalous Case of Acute Rheumatism. By E. W. LANE, M.D., of Scarboro, Ga.

Ann C., æt 16, of sanguine, nervous temperament and good constitution, was attacked with acute articular rheumatism about the 22d of January, 1858. She had been walking about the yard, and her feet became wet. She slipped off her shoes and held her feet to the fire to dry them, and, on attempting to walk, discovered that her right foot was sore. It continued to grow worse until the 26th, when, on attemping to walk, she was seized with severe pain in the right ankle, and was compelled to refrain from any further attempt at walking. She was lifted up and carried to bed, and I was called to see her.

Symptoms-Ankle somewhat red and slightly swollen; very little fever; tongue slightly coated; bowels constipated. I prescribed calomel and jalap, each ten grains.

27th, M. Light fever; pulse 95; pain increased; ankle much swollen, red, and glossy; tenderness in sacral region, with some pain in right hand;-applied cups over sacrum; drew about three ounces of blood; ordered Dover's powder, ten grains, to be repeated in three hours, should the first not allay the pain. (Bowels had been acted upon freely by yesterday's prescription).

28th. Found patient same as before, though right hand more involved; bled from the arm ten ounces; epsom salts, with 38s of the wine of colchicum seeds.

28th, 10 P. M. Called in haste; parents supposed her dying; found her suffering from effects of a severe attack of nightmare, and, on inquiry, learned that she was subject to it.

29th, M. Some fever; pain and swelling in her foot entirely subsided, but had increased in her hand.

29th, P. M. Left foot somewhat involved; patient grows worse continually; determination to head.

30th, P. M. Saw Dr. B. Ayer in consultation; discovered symptoms of chorea sanctiviti; also found tenderness from narcka to sacrum; we further learned from her mother that her catamenial discharge had last made its appearance about Christmas, and that she had never been regular, sometimes missing two or three months. This night was spent in trying

to allay the chorea by giving Hoffman's Anodyne, Spts. Nitre, Camphor, etc., but with no effect. She grew worse.

31st, M. Ordered calomel and aloes, each twelve grains, to be followed in four hours with a dose of castor oil and spirits turpentine.

Feb. 1st, M. Bowels had been acted upon freely; pain and swelling entirely subsided; some fever; chorea increased. Same cathartic, to be followed as before.

Feb. 2d, M. Bowels had been moved twice; symptoms, same as yesterday; R opium gr. j camphor gr. iij, to be given every two hours, to commence at 7, P. M., and to be continued until four doses had been taken, or it had procured sleep. At 10 o'clock patient fell asleep for the first time since the night of the 29th January; chorea same as when awake, principally confined to right side.

Feb. 3d. Patient somewhat refreshed; fever not so high, though left side involved in the dance; treatment same up to 9th; no abatement of chorea; has slept but little since the night of the 2d; has been in continual motion without a moment of intermission since 30th Jan.

Feb. 10th. Saw Dr. Ayer again in consultation; ordered Tinct. Ferri Mur gtt xv three times daily.

Feb. 11th. The patient worse; great determination to the head.

Feb. 12th. Symptoms of Pericarditis, with great determination to the head; discontinue iron; wet cold cloths kept to her head, and the following mixture to be given: camphor water zij, wine of colchicum seeds 3ss, tartar emetic grs. iii, a teaspoonful to be given every three or four hours.

Feb. 13th. Patient had rested better last night than usual; tever not so high; skin moist; same treatment, and wet cloths applied as before, should there be determination to the head.