The conservative surgery of the uterus and its adnexa in gonococcal pelvic peritonitis was for many years looked upon with disfavor by surgeons. These conservative operations often failed or later required secondary intervention. Preliminary palliative treatment as now used greatly lessened the number of failures. Operations in peritonic conditions are dangerous because they may let loose encysted bacteria and start up a general septic peritonitis, which may be fatal. By delay and palliative treatment the virulence of the bacteria subsides, except where the woman is reinfected by her husband. In any case the blood-count should have been normal for at least a month and a half before any surgical interference is attempted. Olshausen waited nine months to let nature disinfect the pus. The removal of a part of a tube is called salpingotomy; the taking out of the whole tube is salpingectomy; the opening up of a shut tube is salpingostomy. The presence of pus in a tube is absolute indication for removal according to the gynecologists at present. Howard Kelly and others have succeeded at times in such cases with conservative surgery, yet such treatment is now deemed obsolete--the dangers and failures seem to overbalance the little good effected. The end of conservative surgery is to try to restore function without pain, to preserve menstruation and ovulation, to put the organs in a condition to make pregnancy possible, and to preserve the internal secretion of the ovaries. The ovaries, so far as the woman's health is concerned, are the most important of her generative organs. If a woman is at the end of her child-bearing age there is no reason to preserve the tubes when they are affected, and conservation is likely to fail; but the ovaries should always be preserved, wholly or in part, when possible. If one tube is infected from the uterus many gynecologists are inclined to remove both tubes. When a single tube is affected the cause is seldom the gonococcus, but some other bacteria which are not persistent. When both tubes are affected the cause is commonly the gonococcus, and attempts at preservation then fail, as a rule. Norris, who is a reliable authority, holds that "the only cases in which a salpingostomy is justifiable is on old, non-active hydrosalpinges, and in those cases of tubal occlusion or phimosis resulting from extratubal inflammation, such as sometimes result from appendicitis or ectopic pregnancies."[179] When a tube is shut, if it can be opened the opening tends to close again. A few cases of subsequent pregnancy have occurred after salpingostomy, but such a result is exceptional, because the origin is usually the gonococcus, which destroys tissue and is very persistent. [179] _Gonorrhea in Women_, p. 285. Philadelphia, 1913.