Salpingotomy for and the tumors are isolated, readily recognized and threatening life, or the cause of unbearable pains, it is as justifiable to consider their removal by abdominal section, as it is slightly enlarged ovaries. When in laparotomy one or the other tube is found diseased, there is no doubt that its removal is necessary, Mosetig „ Moorhof successfully removed, with a left ovarian tumor, a right ovary 7i inches long and five inches in circumference with a pus-containing tube.
Within recent years, according to fixed diagnostic rules laid down by A. Hegar, Lawson Tait, Schroder, A. Martin, Baumgartner, Gusserow, Kaltenbach, Zeiss, Knowsley Thornton, Sanger and others, salpingotomy is extensively performed.
Modern laparotomy must be more thoroughly developed before, in doubtful cases, salpingotomy should be substituted for tapping from the vagina. The removal of the tubes, on account of numerous adhesions ' with the surrounding structures and the friability of the tissues, is diffi cult, and many times partially or wholly impossible. The operation is usually more dangerous than ovariotomy on account of possible infection of the peritoneum from the contents of the tube. A. Martin calls specitil attention to this danger; in eighteen operations for tumors of the tube he lost five women (four from sepsis).
The method is: Extirpation of the whole sac. When possible use a double ligature between the uterus and the tube, and sever with the Paquelin.
Partial extirpation consists in incision of the sac and sewing its cut edges to the abdominal wound and using drainage through the wound, or sewing in the abdominal cavity and instituting drainage through the vagina (A. Martin).
A. Wiedow has advocated making an incision from the vagina or Poupart's ligament to the tumor, and should it be found adherent on all sides, to incise and drain; but should it be found not adherent the incis ion should be filled with iodoform or sublimated gauze, and incision of the tumor postponed until it becomes thoroughly adherent to the sur roundings, and only then should it be opened and drained. A. Hegar successfully treated a case by making an incision from Poupart's ligament to the tumor which he found free, packed the wound with iodoform, and in a few days made an incision through the vagina, passed a drain through both openings and washed with a sublimate solution 1:2000.