=Sterilization after Cæsarean section.= When Cæsarean section is performed the uterus is preserved, and after convalescence the woman is in a position to reconceive. There are conditions in which she is most anxious to produce more children even with the risk of having them extracted by this operation. On the other hand, some women, knowing the risks, ask that steps may be taken to prevent a recurrence of what they consider a catastrophe. This appears a simple matter, but it is not so in reality, for in many instances in which the operator had been under the impression that he had effected this by ligature of both Fallopian tubes in continuity, he has been surprised when the woman has again come under his notice well advanced in pregnancy. This has happened even when each tube has been ligatured in two places and a segment of the tube exsected between the ligatures. Bilateral oöphorectomy has been recommended, but on the whole, when the patient and her husband wish that further risks should be avoided, the wisest plan is to perform subtotal hysterectomy instead of Cæsarean section; moreover it is a difficult matter to completely remove healthy ovaries, and _it needs only a small portion to maintain menstruation_ (Fig. 21). The whole of this matter is one that is really a question of ethics, and the extreme views are represented by Wallace and Sinclair in the papers to which reference has already been made. The difficulty of effectively sterilizing women by simply relying on bilateral oöphorectomy is shown by the well-established cases in which patients have successfully conceived after bilateral ovariotomy and oöphorectomy. The youngest patient on whom Cæsarean section has been carried out with success to the mother and child was thirteen years of age. The operation was performed by Gache in Buenos Ayres on account of smallness of the pelvis. Women have recovered after a self-inflicted Cæsarean section. REFERENCES DORAN, A. Pregnancy after Removal of both Ovaries for Cystic Tumour. _Journal of Obstetrics and Gynæcology of the British Empire_, 1902, 11, i. GACHE, S. Opération césarienne sur une fille de 13 ans: Guérison. _Annales de Gynécologie_, 1904, p. 601. HARRIS, R. P. Six self-inflicted Cæsarean Operations with recovery in five cases. _Am. Journ. of the Medical Sciences_, 1888, xcv. 150. SINCLAIR, SIR WILLIAM. Cæsarean Section successfully performed for the Fourth Time on the same Woman, with remarks on the production of Utero-parietal Adhesions. _Journal of Obstetrics and Gynæcology of the British Empire_, 1907, xii. 335. WALLACE, ARTHUR J. On Repeated Cæsarean Section. Ibid., 1902, ii. 555. CÆSAREAN SECTION IMMEDIATELY AFTER THE DEATH OF THE MOTHER