In order to give some idea of the risks of unilateral and bilateral oöphorectomy, I gathered the following facts from the Hospital Reports, prepared by the Registrar. During the years 1903-7 (both years inclusive) the staff performed the operation of oöphorectomy for diseased uterine appendages on 287 women. Of these four died. During the thirteen years I have filled the post of surgeon to this hospital I have performed on an average twenty oöphorectomies yearly for the diseased conditions set forth in the above table. I lost one patient during the whole of this period, and that was in 1902. The chief risks of oöphorectomy for inflammatory conditions are undetected injury to bowel, especially the rectum, and septic peritonitis when the streptococcus is present in the tubes in acute cases. =Operation for primary cancer of the Fallopian tube.= This disease is rarely diagnosed before operation. The treatment adopted in the cases first reported was oöphorectomy, but in the majority of patients the disease quickly returned and destroyed them in a few months. It subsequently became the practice to remove the uterus as well as the tubes and ovaries, but a quick recurrence in these circumstances is the rule. The really favouring factor in the case is the condition of the cœlomic ostium of the tube. When this remains open, the cancerous cells escape freely and implant themselves on the pelvic peritoneum and adjacent organs. In very rare instances the cœlomic ostium is occluded: in this happy circumstance a fairly long freedom from recurrence may be hoped for. The relation between the condition of the cœlomic ostium of the Fallopian tube and the recurrence of cancer is illustrated by the following cases:-- A woman, fifty-seven years of age, had a large submucous fibroid in the uterus. At the operation the cœlomic ostium was not only patent, but the carcinoma protruded through it and nodules of growth could be seen on the wall of the rectum at the point where the tube rested on the bowel. The patient recovered from the operation and enjoyed good health for eleven months, then signs of recurrence became manifest and she died a few weeks later. [Illustration: FIG. 5. PRIMARY CANCER OF THE FALLOPIAN TUBE. An ovarian cyst associated with primary cancer of the corresponding tube. The cœlomic ostium is open and the cancerous material has leaked out on to the cyst wall. Half size.] [Illustration: FIG. 6. A SECTION OF PRIMARY CANCER OF THE FALLOPIAN TUBE. This is the cyst wall and cancerous tube represented in the preceding drawing: it shows the cancerous infiltration of the cyst wall. Half size.] A woman, forty-nine years of age, had a large fibroid in her uterus and a Fallopian tube stuffed with cancer, but the cœlomic ostium was completely occluded. The uterus, ovaries, and tubes were removed. The patient subsequently remarried and was in good health three years later.