fewest ruptures after cesarean delivery. Olshausen had one in 120 cases, Leopold none in 232 cases, Schauta none in 177 cases, Küstner none in 100 cases. Olshausen, in a series of 29 cases, operated on two patients twice and upon three patients three times. As early as 1875, Nancrede of Philadelphia had operated the sixth time on the same woman. In such cases the uterus is commonly so broadly attached by adhesions to the belly-wall that it is opened without getting into the peritoneal cavity. In 150 cases of repeated section collected by Polak in 1909 the mortality was only 5 per cent. [110] _Jour. Amer. Med. Assoc._, December 1, 1917. A woman may not be sterilized by having the uterus removed, by fallectomy, or otherwise, solely to obviate danger or morbidity from subsequent pregnancies and cesarean deliveries. Such a sterilization would be a grave mutilation without a present excusing danger, and it would render the primary end of marriage always impossible. Such sterilization of a woman is in contravention to the decretal of Gregory[111] as given in the chapter on Vasectomy. It is also against the bull _Effraenatam_ of Sixtus V., who extended all penalties prescribed for abortionists to those who give women drugs which cause sterility, and to those who purposely prevent the development of the fetus or in any manner abet the deed; and the penalties are to be applied to the women themselves who willingly use these means. These penalties are enumerated in the chapter on Abortion. The Congregation of the Holy Office, May 22, 1895, answered negatively the following question: "Si sia lecita la practica sia attiva sia passiva di un procedimento il quale si propone intenzionalmente come fine espresso la sterilizatione della donne?"[112] [111] _Corpus Juris_, lib. v, tit. xii, c. 5. [112] Is any active or passive procedure licit which is undertaken with the express end of sterilizing a woman? The reason for these laws is that any act which deprives one of the power to generate, and which prevents conception and makes the semen fail of its end, is against the chief intrinsic end of marriage and any benefit that arises therefrom, which is the good of offspring. The act is also against the intrinsic end of the semen, which is to generate; and since the semen cannot possibly effect its end, the conjugal act degenerates into an equivalent of onanism. This act of sterilization, done not to save the whole body from immediate danger, is intrinsically evil, and therefore unjustifiable.