The operation is not applicable to the intra-ligamentous fibroid of pelvic growth, producing urgent pressure-symptoms that demand certain and immediate relief. In the case of profuse exhausting hemorrhage, when the anemia is so great that immediate and certain arrest of bleeding is required, salpingo-oöphorectomy should not be practised. If the woman has reached the menopause, and, notwithstanding the cessation of menstruation, the tumor continues to grow, salpingo-oöphorectomy will do no good. In some cases the tubes and ovaries cannot be removed. They often occupy a position behind or under the tumor, so that they cannot be removed without first taking the tumor away. The tube and ovary may be so distorted that only partial excision is possible, and this will result in no benefit; or the tube and ovary may be spread out upon the face of the tumor, incorporated with its capsule, so that removal is impossible, and any attempt at removal may result in rupture or penetration of large venous sinuses--a most dangerous accident. The operator should therefore never undertake the operation of salpingo-oöphorectomy for uterine fibroid unless he is prepared to perform hysterectomy if this operation is found necessary. _Hysterectomy_ is deservedly the favorite operation for uterine fibroids at the present day. The danger of the operation is small, being but little, if any, greater than that attending salpingo-oöphorectomy for fibroids, if we compare only those cases in which either operation may be performed. The operation is applicable to every kind of fibroid tumor. The relief of symptoms is immediate and certain. The reflex symptoms, such as backache and headache, which are directly due to the pathological condition of the uterus, often disappear immediately and permanently. This cannot be said of salpingo-oöphorectomy, after which operation these symptoms often continue for an indefinite period. The treatment of uterine fibroids has followed in development the growth of abdominal and pelvic surgery. In the days when celiotomy was a dangerous operation the palliative treatment was advisable. When salpingo-oöphorectomy could be safely performed this treatment was practised; and now that hysterectomy is equally safe, it has become the operation of election. The details of the operation of hysterectomy for uterine fibroids will be considered in a subsequent chapter. _Myomectomy (Abdominal)._--In some cases of uterine fibroid it is possible to remove the tumor without taking away the uterus. This operation, when performed through an abdominal incision, is called abdominal myomectomy. From a surgical standpoint it is the ideal plan of treatment, as the woman is cured of the disease without suffering mutilation. Myomectomy is especially adapted to the treatment of single fibroid tumors which may be excised or shelled out of the body of the uterus. It is indicated in the case of young women who are anxious for children.