Three children-viz., the baby first affected, and.two othe who had previously escaped-fell ill together with i flammatory swelling of the cervical glands. had one ,th went on to suppuration and abscess, as in Mr. Owen cases; in all there was persistent purulent discharge fro, the nose. At this juncture I was called down to see tl children, and found a source of pollution of the air amp] sufficient to account for the long succession of a/ilmen which had afflicted the unfortunate household. In
... roa running in front of the house, and some twenty yards fro the windows, a main-drain was in course of constructioi From a wide opening in this great volumes of sewer-gs were pouring forth, tainting the air with sickening odou: With the prevailing wind the foul stream was carrie straight to doors and windows, flooding house and gardei The inhabitants lived in and bathed in a continuous streal of this pestilent air. On inquiry I found other evidence ( its influence -a simple wound in one, which refused t heal, in spite of all treatment; malaise and languor i: another; and so on. Before long, however, the sewer was completed, th house drains themselves examined and put in orde under the direction of the highest sanitary experts, an< E a pure atmosphere, it was presumed, completely re established. But full health has not returned to thj household. The children coming home fall ill witl swollen glands, or nasal discharge, or general malaise, anc (going, away again get as rapidly well. That similar case: occur in neighbouring houses is shown by, Mr. Owen'i letter. There is evidently something still wrong, and what that is will seem clear enough to anyone -who .takes a walli along the roads of this odoriferous region. The foul all formerly poured out in a mighty column from the wide opening in the sewer, now issues forth in smaller streams from many a ventilating-pipe and open grating. The improved system of drainage lately carried out has reproduced the old evil in a fresh form, and this is the point to which I wish specially to draw..attention. Under such a plan of drainage and sewer-ventilation, the lower levels are relieved at the expense of the higher. The locality of which I speak appears to be air-poisoned in this way. Lower Ealing is saved from the pressure of sewer-gas by the ventilating openings, which draw it off and flood with foul air the neighbouring height. T remain Sir your obedient servant How any man, or set of men (as pure surgeons), can be so foolish as to claim the right of performing the operation of ovariotomy I am at a loss to imagine. If the history of this operation be inquired into it will be found it has been performed most frequently by obstetric physicians and surgeons, or by the medical officers belonging to the hospitals specially appropriated to the treatment of the diseases peculiar to women. The performance of it, as you most justly state, legitimately belongs to those practitioners who are most intimately acquainted with the functions and organic structures of the pelvic viscera, and who treat the diseases which these organs are subject to. An obstetrician knows, or ought to know, how to distinguish the natural changes which the uterus undergoes by pregnancy, from its enlargement by tumours, and also from ovarian tumours. The education of the hand and fingers of an obstetric practitioner enables him to ascertain, by vaginal and abdominal examination, with great diagnostic certainty, morbid changes in the pelvic and abdominal viscera which one unaccustomed to these delicate inquiries would overlook or form erroneous opinions on. I t i s my solemn conviction that no obstetric physician or surgeon ought to flinch from his duty in the performance of ovariotomy. It is obviously his duty, and reflects discredit on him if he hands over such cases to a professed "pure surgeon." Are there no cases to be found in which hospital surgeons have had pregnant women placed on the table for the supposed, purpose of extirpating tumours ; and in other cases in which the enlarged pregnant abdomen has been punctured by a,trocar with the intention of withdrawing ascitic fluid ? Mr. Lizars performed his last ovariotomy operation ill the year 1825, after which period, until about the middle part of 1842, this large abdominal section was as it were unknown, and was treated as one of the opprobria of surgery. About the period above-mentioned Dr. Clay wished me to visit a patient of his who was, suffering from an abdominal tumour, for the purpose of ascertaining its nature and of giving an accurate. diagnostic opinion. I at once acceded to his request, and visited the patient the following day. I found the tumour of great size, occupying the abdominal cavity, and also completely filling the pelvic cavity. After a very careful examination I was convinced it was an enlarged ovarium. The uterus had been displaced and pushed up above the symphysis pubis. Dr. Clay afterwards obtained the opinion of the late Mr. Wilson, who confirmed my statement. The operation was afterwards successfully performed by,Dr. Clay, at which I was present. I afterwards, at Dr. Clay's request, saw and examined a number of such oases, and attended the operations which he performed. About the same period the late Mr. George Southam requested me to visit several, of his patients who were suffering from abdominal tumours, which proved to be enlarged ovaria. He op.erated on these patients, at each of which I was present. I have noted these eases of ovariotomy in order to show that this operation (the large abdominal section) was then revived, and has become substantially a recognised procedure by the whole of the profession. It is now practised by medical men in the whole civilised world. I remain. Sir. vours trulv.