er is
considerable. Because of this, the tube when tied alone is brittle, and
a ligature applied to it will very easily cut through, and either allow
of reunion of the severed ends or leave a patent stump. In a recorded
case in which pregnancy occurred after each tube was ligatured in two
places, and then divided with a knife, a patent stump was no doubt left.

In order to obviate this danger the peritoneal layer must be opened, and
the mucous membrane, which is quite brittle and easily removed, must be
torn away for about one quarter of an inch. A simple cat-gut or silk
ligature lightly tied would then be sufficient to insure complete and
permanent occlusion.

Nature often performs this operation herself, with the inevitable and
irrevocable result, lifelong sterility, with no tittle of positive
evidence during life of its occurrence.

Here are a few examples:--A young married woman has a miscarriage; it is
not severe, and she is indiscreet enough to be about at her duties in a
day or two, but within a few days or so she finds she must return to
bed, with feverishness and pelvic pain. Before a month is past she is up
and quite herself again. But she never afterwards conceives. What has
happened? To the most careful and critical examination nothing abnormal
is detected. Her general health, her vitality, her emotional and sexual
life, her youthful vigorous appearance, all are unimpaired. But she is
barren, and why? A little inflammation occurred in the uterus and spread
along the tubes. The sides of the tubes cohered, permanently united by
adhesive inflammation, and complete and permanent occlusion resulted.

The operation of tubo-ligature is an artificial imitation of this
inflamatory process.

Pelvic inflammation, sometimes very slight, following a birth, or the
same process set up by uterine pessaries used for displacements, may
induce adhesive inflammation in the tubes, and simple and permanent
sterility is the incurable result. It is a well known fact that
prostitutes are usually sterile, and this arises from the prevalence of
venereal disease, which produces gonorrhoeal inflammation of the
Fallopian tubes, resulting in complete and permanent occlusion.

This process could be best imitated, if cauterisation of the tubes were
a safe and reliable procedure. An electric cautery passed along the
tubes would result in a simple and speedy occlusion. But in the present
state of our gynecological knowledge this appears