Some writers attempt to subdivide the various modifications of oöphorectomy and apply to them special terms: for example, the removal of the ovary and tube would be termed salpingo-oöphorectomy. Removal of the tube would be called salpingectomy, and the excision of the ovary, oöphorectomy. This terminology may be precise, but it is certainly clumsy. A few writers designate these operations as ‘removal of the uterine appendages’; this phrase, though comprehensive, is neither precise nor elegant. =Operation.= The patient is prepared in the same manner, and the same instruments are required, as for ovariotomy. In many of these operations the Trendelenburg position is of the greatest advantage. [Illustration: FIG. 3. AN INFECTED FALLOPIAN TUBE. The cœlomic ostium of the tube is unoccluded and is in the process of slowly engulfing the fimbriæ. Removed from a woman in the acute stage of salpingitis. Three-quarter size.] In a case of prolapse of the ovary, or a gravid tube or ovary in the earliest stages, the operation presents no difficulty and can be carried out with the ease and safety of the simplest ovariotomy; but there are many cases where the tubes and ovaries contain pus and are distended into cysts as big as a fist, or even as large as the patient’s head, which are adherent to bowel, uterus, bladder, indeed everything with which they come in contact; this renders their removal tedious and exacting for the surgeon and dangerous to the patient. Although a suppurating ovarian cyst adheres to surrounding organs, its removal is simpler than in the case of a large pyosalpinx, because the Fallopian tube is intimately enclosed within the folds of the broad ligament, and these connexions serve to bind it firmly in the pelvis. In undertaking the removal of such enlarged tubes the surgeon’s first duty is to expose the parts by a free incision, and then carefully isolate the intestines and upper parts of the abdomen with dabs in order to prevent them from being contaminated with pus. He will quickly recognize in the majority of cases that he has to deal with tubal disease, because the distended uterine section of the tube will lie on the more globular outer portion of the tube and assume the familiar shape of a chemical retort. With the fingers the adherent omentum and bowels are carefully detached, and the adhesions between the distended tube or ovary and the rectum are carefully broken through with the finger, and the parts withdrawn from the pelvis. With great care it is usually possible to carry this out without bursting the tube. This is important as it prevents the universal spread of pus in the pelvis. When the tube bursts in the process of removal it is useful to swab it up with some strips of gauze and thus keep the ‘Gamgee dabs’ clean for the final stages.