in these cases, there is practically no dangernature is equal to the emergency and the patient's endurance is not by any means put to the utmost test. When, however, the membranes have broken prematurely and the amniotic fluid has escaped, and, I may add, this is the rule in the pathological states of the os to which I have just alluded, and we are satisfied that we have to do with a rigid os, recourse should be had, first of all, to the faithful trial of the ordinary means for promoting a

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... nued dilatable condition. These having been fairly tried, but without success, we should at once resort to artificial dilatation, having first administered an opiate, or better, chloral, either alone or in conjunction with anoesthesia, in order to develop a temporary yielding condition. This latter procedure, I repeat, I offer as an important and essential factor to the easy and safe performance of the mechanical process which we seek to effect by the dilating efforts we decide to employ. Following these methods of practice which, I have endeavored to show, are based upon sound common sense, regard for the well being of our patients and respect for the obstetric art, I believe we shall be more successful in avoiding unnecessary suffering and iu saving human life. Of all the major surgical operations, ovariotomy has received the greatest attention with regard to its statistical results. The reason for this is very apparent when we recall its early history. It was an operation very bitterly condemned and assailed by the profession at large at the time of its first performance by McDowell, and for many years after. Those who believed in its promise of usefulness presented to its opponents their lists of lives saved from a disease otherwise hopeless, and usually soon fatal, as an unanswerable argument in its favor. Although these statistics have long since silenced all question as to the propriety of ovariotomy, still the prominence given them has continued and increased, so that, to-day, the ovariotomist, as a rule, simply presents to the profession his number of operations and the percentage of recoveries, as representing in an exact measure his skill in making the operation, and his wisdom in the details of after-treatment. The various conditions that determine the result of an ovariotomy, and, at the same time, are beyond the control of the operator, are so much in the background, that the unsuccessful cases gives the profession and the surgeon as well, the feeling that there must have been some fault of omission or commission on his part. That is, such prime importance has been given to the bare statistics as almost to persuade one that the skill of the operator alone is the sole factor in determining the result, and that an ovariotomist of perfect skill and wisdom would save every case. The effect of this tendency to regard the operator as entirely responsible for every unfavorable result has been to stimulate him to the most careful study of every detail of the operation, and, in consequence of this care, the modes of operative procedure have become well-nigh perfect. This weight of responsibility loaded upon the shoulders of the ovariotomist has contributed, therefore, to his success. It may also have had its effect, not quite so salutary, upon the statistics that have been recorded. It is not unreasonable that the specialist in abdominal surgery, where every failure, in a certain way, reflects upon his skill, and is charged up to his discredit, should present his statistics in the most favorable light that they can bear. Cases in which he may have avoided an operation can be omitted ; also those cases of incomplete operation : that portion of his entire list which gives the best percentage of recovery may alone be published. In other fields of surgery, and in medicine as well, the unreliability of statistics is conceded ; but in ovariotomy, for the reason I have given, they are, perhaps, more at variance with the actual results than in the case of other operations. " Statistics alone seldom prove anything, certainly they never explain anything," says Lawson Tait. This, I believe, is not quite true, and, although I am criticising the statistics as not always representing the full proportion of deaths to the recoveries in abdominal surgery, yet I believe they are sufficiently affected by the real results to afford absolute proof of the rapidly-increasing success of ovariotomy. At the present time, the statistics of ovariotomy in America, when compared with those of our English cousins, seem to show a very decided balance in their favor. One possible reason for this may be that comparatively fewer men operate there than here, and, consequently, that there is a much smaller proportion of operations by inexperienced surgeons, while those who do operate have a much larger experience than falls to the lot of any American. Another reason, and, I believe, the main one, is this, that every standard text-book, at least, so far as I know, except the last edition of Emmet's work, that has been published in America, and which treats at all of ovariotomy, advises postponement of surgical interference, except tapping -" with rare exceptions, a criminal procedure," says Stilling, and assents Thornton until the failing health of the patient demands it. While in England, formerly. Dr. Clay, Mr. I. B. Brown, Bryant, Hutchinson and Wells advocated early operation before any failure of the patient's strength was apparent. Mr. Wells, however, in 1872, advised delay until considerable impairment of the general health had occurred. Yet in the last edition of his work upon ovariotomy, and in his later utterances upon this subject, he is in accord again with the prevailing English teaching, which favors early operations. In short, I believe that this difference between the English and American authors, in their recommendations given the general practitioner as to the proper time for ovariotomy, has, in great measure, determined the difference in the statistics of the operation in this country and England. While admitting that in no other operation does so much depend upon the skill, experience, and care of the operator as in this, still it may be worth our while to consider briefly some of those conditions, independent of the surgeon, that may make a disastrous result inevitable. Taking the ovarian cases together, as they present themselves to the ovariotomist, in this country, at least, a certain proportion of them will be found to have in themselves an element of essential fatality. That is, the moment these cases are subjected to operation, they become necessarily fatal, and that,