It can be seen that the function and vitality of the ovaries are in no way affected by the tubes.  The ovarian function goes on, whether the tubes perform their function of conveyance or not, and if this function can be destroyed, life-long sterility is assured.  There is no abdominal operation more simple, rapid and safe, than simple ligature of the Fallopian tubes.  It may be performed by way of the natural passage, or by the abdominal route, the choice depending on various circumstances.  If the former route be taken, there may be nothing to indicate, in some cases not even to a medical man, that such an operation has been performed.

The Fallopian tubes have been ligatured by Kossman, Ruhl and Neuman for the sterilization of women with pelvic deformities; but all testify to the danger of subsequent abnormal or ectopic pregnancy, and several instances are given.  Mr. Bland Sutton relates a case in an article on Conservative Hysterectomy in the British Medical Journal.

After numerous experiments on healthy tubes, I have found that simple ligature with even a moderate amount of force in tying will cut the tube through in almost any part of its length.  The mucous lining is so thrown into folds that its thickness in relation to the peritoneal layer 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.