and vascular uterine fibroids another factor has to be reckoned with, namely, the enormous veins in the pampiniform plexus, interspersed with lymphatics which in some cases are as thick as the index-finger; it is not an uncommon thing to meet with lymphatics in this situation a centimetre in diameter and filled with straw-coloured lymph. [Illustration: FIG. 10. A FIBROID GROWING NEAR THE RIGHT UTERINE CORNU. It separates the ovarian ligament, Fallopian tube, and round ligament of the uterus from each other. Full size.] The surgeon now secures the vessels. The ovarian pedicles are transfixed and ligatured with silk as in ovariotomy: the round ligament is usually included in the ovarian pedicle. It occasionally happens that a fibroid situated near the uterine cornu will grow in such a manner that it widely separates the ovarian ligament, the Fallopian tube, and the round ligament from each other as shown in Fig. 10. In such a condition it is impossible to save the ovary without risk, and also inadvisable to attempt the inclusion of the round ligament in the pedicle containing the ovarian vessels. In these circumstances the round ligament is easily secured by a mattress suture, which should include both layers of the corresponding broad ligament. [Illustration: FIG. 11. THE MATTRESS SUTURE. A diagram to show the method of applying it.] When the surgeon decides to leave an ovary and the corresponding Fallopian tube, these structures are carefully examined to determine if they are healthy and free from any suspicious fluid. _When the endometrium is septic or cancerous both ovaries and tubes should be removed._ When the surgeon decides to leave an ovary and its corresponding Fallopian tube, he should take care in securing the ligatures to include the ligament of the ovary: it is very liable to slip out of the encircling loop of silk. It is often convenient to include the round ligament of the uterus in the pedicle, but it is not a disadvantage when it is tied separately. [Illustration: FIG. 12. THE STUMP AFTER SUBTOTAL HYSTERECTOMY. To show the method of applying the continuous suture.]