Sanger tells us that gynecology is the surgery of the female genitalia. His definition is neither exact nor complete, but it is clinically useful. As a matter of fact the first thing to be determined in every gynecologic case is the advisability of operation. A necessary subdivision of the question is at once apparent. There is the consideration of immediate operation at the time of examination, the operation in such cases being trivial. There is to be considered the advisability of local and systemic treatment, which is often to a great extent tentative, with the reasonable hope that surgical treatment may ultimately be dispensed with or may become relatively insignificant, at least not especially dangerous, and finally, there is the certainty that operative measures are imperative, perhaps that their immediate adoption is the only known means of relief or of saving life, in which event removal of the patient to