MARTIN C. The Ingleby Lectures. On the Dangers and Treatment of Myoma of the Uterus. _Lancet_, 1908, ii. 1682. OLSHAUSEN, R. In Veits’ _Handbuch der Gynäkologie_, Wiesbaden, 1907, Bd. ii, p. 607. ROUTH, A. Fibroid of One-horned Uterus. _Trans. Obstet. Soc._, 1888, xxix. 2 and 57, with a good drawing. CHAPTER VI ON THE RELATIVE VALUE OF TOTAL AND SUBTOTAL HYSTERECTOMY The great success which followed the use of the short ligature in ovariotomy induced several surgeons to apply the same principle to the cervical pedicle when removing the uterus for fibroids. The result was dismal failure. Matters improved somewhat after Koeberlé introduced the serre-nœud, and this continued the safest method until 1892. In the meantime antisepsis had begun to take effect in pelvic surgery, and attempts were made by Bardenheuer (1881), Polk, and other surgeons to avoid the dangerous difficulties connected with the treatment of the stump by removing the cervix as well as the uterus (total hysterectomy), and they attained an encouraging measure of success. Nevertheless, other surgeons (Goffe, Milton, Heywood Smith, and Stimson) felt that the enucleation of the cervix was not always necessary, and sought to find a way of avoiding it. The credit of solving this difficulty fell to Baer of Philadelphia (1892), for he showed that it is dangerous to constrict the neck of the uterus with ligatures, it is only necessary to secure the arteries. Baer’s method of supravaginal hysterectomy, or, as it is now commonly termed, the subtotal operation, soon supplanted the total method of Bardenheuer. The publication of Baer’s paper had great consequences; it came at a time when the attention of gynæcologists was centred on improvements in hysterectomy. The method was promptly tested and adopted in London. The effects of this improvement in technique in a few years revolutionized the surgical treatment of uterine fibroids, as the statistical results set forth on p. 44 amply prove. The great advantage of Baer’s method is its simplicity and safety; but there is a disposition on the part of a few surgeons to prefer the total operation, mainly on the ground that the cervical stump left after subtotal hysterectomy is liable to become attacked by cancer. As far as I can ascertain, Dr. M. Mann, of Buffalo, was the first to draw attention to the occurrence of cancer in the neck of the uterus after the body of the organ had been removed. He stated in 1893 that he ‘removed an ovarian tumour and the body of the uterus, by accident, along with it; the cervix was left’. The patient recovered. ‘Six months afterwards cancer developed in the cervix, from which she died.’ When cases of cancer supposed to arise in the stump left after subtotal hysterectomy come to be critically analysed, they fall into four groups:--