Several American surgeons followed M’Dowell, but the operation did not come rapidly into vogue, partly because anæsthetics had not yet been introduced. Lizars of Edinburgh had one successful and one unsuccessful case in 1825. Dr. Granville attempted it in London in 1827, but the operation was abandoned on account of the difficulties met with: fortunately the patient recovered. In 1836 Dr. Jeaffreson of Framlingham first operated successfully by means of the short incision recommended by William Hunter; the patient recovered and bore a family afterwards. In the same year several other provincial surgeons were equally successful. In 1840 Mr. Benjamin Phillips operated unsuccessfully at the Marylebone Infirmary. In 1842 Dr. Charles Clay of Manchester commenced a long series of operations, operating four times in the year, three times successfully. The first successful case in London was by Mr. Walne in November 1842. From this time operations were not infrequent. In September 1846 Mr. Cæsar Hawkins proved for the first time that success was possible in a London hospital; his precautions and his directions were most excellent. In June 1848 Dr. Charles Clay published a series of 32 cases with only 10 deaths, and he continued to operate for many years until he had performed 395 operations with only 101 deaths, slightly above 25 per cent. He used long ligatures. In 1850 Mr. Duffin, in London, employed an important improvement in procedure. Sir Spencer Wells’s medical education and study in all these years had not led to his paying any attention to the subject. It was evidently outside the prevailing ideas of most of the medical schools. His opinion in 1848 was certainly against the justifiability of the operation. In 1853 or 1854 he became acquainted with Mr. Baker Brown, and in the latter year assisted him at the Middlesex Hospital in his eighth case of ovariotomy. This was the first time he had seen the operation attempted, but the patient died. Several unsuccessful cases led Brown to give up his attempts entirely from March 1856 to October 1858. When the Crimean War broke out, Sir Spencer Wells betook himself to the army in the East. There he learnt much of the freedom with which the abdomen might be injured and yet recovery take place if the constitution was good and other things were favourable. He saw frightful cases of laceration by fragments of shell recover after careful cleansing and accurate closure of the wounds. He returned to London much less afraid than before of abdominal wounds. Renewing his work at the Samaritan Hospital, he at first saw very little of ovarian disease, and it was not till December 1857 that he made his first attempt to perform ovariotomy, which, however, on Baker Brown’s advice, he did not carry to completion. His second attempt was completed, with Brown’s assistance; but the latter did not recommence to operate himself until after an interval of more than two years and a half.