able to examine all the different organs in the body, and have a tolerable degree of skill in the management of each. This is especially requisite for the great proportion of medical men, who live in the country, and in small towns, where there is no distinction of medicine into special branches, and each man has to treat every disease that may present itself.

In the abdominal mode of examining the ovaries, the patient lies on the back with the legs flexed, so as to relax the abdominal muscles. Unless however, the ovarian swelling be large, it will not be felt thus. In examining through the vagina, the patient lies in what is called the obstetric position, namely, on the side, with the legs drawn up. The fore-finger of one hand is introduced into the vagina, while with the other hand the examiner presses on the lower part of the abdomen, so as to bring the ovaries within reach of the finger. In examining by the rectum, the obstetric position should be used. The ovaries can be felt in this way, even in their healthy state, although with difficulty; but when enlarged by inflammation they are readily reached. The finger passed into the rectum can feel half of the posterior surface of the womb, bulging through its wall, and on each side the ovaries like two knuckles. When these bodies are healthy, pressure on them gives no pain, but it does, if they be inflamed. Increase of volume can also be recognised in this way. Another method of examining is by what is called the double touch, the fore-finger being in the rectum and the thumb in the vagina. This is very useful in recognising tumours between these two passages.

ACUTE OVARITIS.

OR acute inflammation of the ovary-(itis being the termination used to signify inflammation in any organ.) It used to be thought by physicians, that this affection was almost confined to the puerperal period, namely, that period which immediately succeeds child-birth, and during which inflammatory diseases in the sexual organs are most apt to occur, and to be of unusual violence. But ovaritis occurs not unfrequently at other times, as Dr. Bennett has shown, but is constantly overlooked by the medical attendant, who confounds it with inflammation of the womb, or with iliac abscess, or "inflammation of the bowels," a general loose expression for obscure and undetermined inflammation in some pelvic organ, of whose nature the, practitioner, from his inexperience in the examination of these organs, is uncertain.

Ovaritis may be spoken of along with the inflammation of that loose areclar tissue, which, as well as the ovaries, is contained between the fold of the peritoneum, called the broad ligament; for it is not possible to tell what exact part of these contained substances is affected. The general cause of this disease is the acute suppresion of menstruation, whether by cold, or violent mental emotions. The symptoms are very like those of acute metritis (inflammation of the womb,) namely, severe deep-seated pain in the lower part of the abdomen, with a feeling of weight and uneasiness in the pelvis; also pain in the loins, and tenderness on pressure in the abdomen. There is fever, with a hot skin and quick pulse. A digital examination through the vagina, is absolutely necessary here to learn what part is affected. It is very frequently neglected, and this neglect is the source of great evils. By the vaginal examination it will be found, that the painful tumour is not in the median line, but applied to the side of the womb. It is so closely applied, that it needs some tact to distinguish them. But it is very important to distinguish between the two, for metritis generally ends by resolution (or complete subsidence of the inflammation,) whereas ovaritis generally proceeds to suppuration, unless very active treatment be used. In this case matter forms, and escapes in time, either through the vagina or the rectum. Through the vagina is the most favourable method, for in this canal the pus causes but little irritation. If the abcess open into the rectum, much greater

irritation with griping and dysentery, frequently lasting for days, is produced. The bursting of the abscess, and discharge of pus, is rarely noticed by the patient, unless she be warned to expect it; or if noticed, is not mentioned, from the reluctance to communicate information spontaneously in sexual diseases.

After the discharge of the pus, there is a decided improvement in the symptoms, and the patient is thought convalescent. But the disease is by no means radically cured; a chronic state of inflammation still continues, and this is aroused anew by each return of menstrual congestion. Fresh matter then gathers, and the former symptoms in a subdued shape are repeated. In this manner may this lingering affection last for one or more years; the patient suffering all the time from the symptoms of chronic inflammation in the sexual organs, namely, pain and weight in the pelvis, tenderness in the ovarian region, pain in the back, inability to walk much, and disorders of menstruation. The reason of her state is a mystery to herself, as well as to her medical attendant, if the real nature of the disease have not been recognised at first.

From this description it will be seen, what great evils may arise from not distinguishing this affection from inflammation of the womb, or of the bowels; which so constantly happens at present, from delicacy and medical inexperience in these diseases, preventing the necessary examinations. If this affection were recognised at first, suppuration might in some cases be prevented by active treatment, and if it did occur, well-directed means might subdue the lingering remains of the inflammation.

The general cause of this disease in the unimpregnated womb is sudden arrest of menstruation. It is very rare that acute ovaritis, or acute metritis, arises during the menstrual interval. After confinement however, acute inflammation of these organs is apt to arise from various causes, especially from too early exposure to cold, arrest of the secretion of milk &c.; and in this case the peritoneum is very apt to be involved, constituting a most dangerous and general fatal disease. But in the unimpregnated condition, the peritoneum is very seldom implicated, and a fatal result rarely, if ever, occurs.

SUBACUTE OVARITIS.

THIS is a much more common disease than the preceding. Dr. Tilt, who has lately directed the attention of the profession to the subject, says, he believes no disease is more common than, though so little understood as this. In subacute ovaritis, in general, the whole ovary is not affected, but the inflammation is limited to certain parts, as the Graafian follicles, &c. The symptoms of this important affection are, a dull pain in the ovarian region, increased by walking, riding, or pressure on the part, and also by straightening the leg. The pains radiate from the ovary to the loins, thighs, and anus, and are of a dull, dragging, and sometimes overwhelming character. But they are seldom so acute as to make advice be early sought, and are thus often endured for years. Sexual intercourse increases the pain. This wearing affection, like other inflammatory states of the ovaries and womb, deadens the sexual feelings. It very frequently gives rise to hysteria. It also frequently causes the various disorders of menstruation, which it produces either directly, or by occasioning a secondary congestion or inflammation of the womb, whose health depends greatly on that of the ovaries. It also gives rise to sterility, which Dr. Tilt believes to be much oftener connected with disease of the ovaries, than of the womb, although the contrary is the general opinion.

The morbid appearances so commonly found in the ovaries after death, and which have been caused by subacute ovaritis, are a red and inflamed state of the Graafian vesicles, which are sometimes full of pus. They are also frequently swollen to the size of a pea, denoting a state of chronic inflammation. The fallopian tubes are frequently found bound down by adhesions, so that they could not be applied to the ovaries. This appearance is very frequent in prostitutes, and is one cause of their general sterility.

The chief causes of subacute ovaritis, according to Dr. Tilt, are, "excessive venereal indulgence, which sometimes produces it in newly married women, but particularly in prostitutes, whose ovaries after death almost always present some morbid lesion; privation of the sexual stimulus, whether its absolute privation, as in single women, or sudden withdrawal as in widows, both of which leave the ovaries in a congested state;

late marriages, in which the venereal stimulus is liable to prove too powerful for the ovaries, unused to it; the decline of menstruation, both in the case of the involuntary nuns of a society over-stocked with women, and in those who have indulged in venereal excesses; moral emotions and ungratified desires, which are known in the male sex to have the effect of increasing the seminal secretion, and naturally have an analogous action on woman; arrest of menstruation, which is apt to be followed by this disease, along with dysmenorrhoea and hysterical symptoms; gonorrhoea, leucorrhoea &c." Dr. Tilt remarks, that the want of the appropriate stimulus to the ovaries, which should promote their healthy action, is often the cause of their becoming the seat of morbid affections.

Subacute ovaritis is thus a most important affection, from its great frequency, and from its obscure nature. There are doubtless very many such cases existing unknown at present, the hidden root of various miserable diseases, which cannot be cured without the prior removal of the ovaritis. Thus very many cases of amenorrhoea, menorrhagia, dysmenorrhoea, sterility, and hysteria, are owing to this disease, and in all these affections a careful examination should be made, if there be any symptoms of ovaritis.

The treatment recommended by Dr. Tilt is, leeches applied over the ovarian regions, succeeded by successive blisters to that part, so as to break the morbid chain of nervous action, and lastly to rub in an ointment composed of mercury and belladonna. The bowels should be kept open by aperients; and emollient injections into the rectum, with the chill taken off, should be used thrice a-day. Three or four cunces should be injected at a time, (the pelvis being elevated,) and retained as long as possible. They bathe and soothe the parts affected. By these means, which can be used only in the menstrual intervals, a radical cure may generally be effected; and after it, cold water injections, morning and evening, should be used. Sexual abstinence and a regular healthy life should be enjoined during the treatment; and for some time after the cure, sexual intercourse should be taken in moderation. Sterility and the various menstrual and hysterical affections, connected with subacute ovaritis, frequently cease after its cure.