the uterus was found displaced into the left lumbar region and the hard swelling mentioned above was demonstrated to be a fibroid growing from the fundus. The bladder was high placed. On the right side the tumour was situated between the layers of the broad ligament and descended down at the side and behind the uterus to within an inch of the vaginal orifice. The ovary was placed on the top, and the round ligament coursed over the front of the tumour. Aspiration got about a pint of slightly bloodstained fluid which coagulated on standing into a yellow and red jelly. The left broad ligament and left ovary were tied off, and the uterus and fibroid attached to it removed. The right uterine and ovarian vessels were next secured, after which the right broad ligament was opened and the tumour shelled out. The vaginal roof was then opened, gauze was stuffed into the cavity left by the removal of the tumour, and brought through with the vagina. A considerable portion of surplus broad ligament was then cut away, and the anterior layer united to the posterior by catgut stitches. Catgut was used throughout the operation. The patient recovered without an anxious symptom.

Naked-Eye Appearance of Tumour.-The tumour presents the shape of a flattened sphere. It measures 6 in. by 6 in. from side to side and from top to bottom. It is 2 inches in depth. The anterior surface is rough, and distributed over it are several fibrous trabeculæ. Its posterior surface is smooth and glistening, being covered by an unbroken capsule. Its consistence is firm and doughy. On section the cut surface has the appearance of a fibromyoma. Under the capsule, chiefly at its upper and lower borders, softening and hæmorrhage have taken place. The round ligament is much increased in size and appears to be changed into fibromyomatous tissue. The tube and ovary appear healthy. The uterus had a fibromyomatous tumour, measuring nine inches in circumference growing from the fundus.

Microscopic Examination of Broad Ligament Tumour, by Dr Shennan. "It presents the characters of a fibromyoma. In some parts the tissue becomes looser, resembling myxomatous tissue, and the majority of the cells here are either rounded, oval, or spindle-shaped, separated by spaces containing fluid

and delicate fibrillæ. The blood vessels are embryonic, and there are minute hæmorrhages into the tissues."

(b) UTERUS removed by vaginal hysterectomy for cancer of the body.

Mrs S., æt. 53, nonipara, married for twenty-seven years, came under Dr Brewis's care complaining of constant bleeding. In February 1899, after complete cessation of menstruation for three years, the patient noticed a little blood come from the vagina. This gradually increased in quantity. Three months before admission very severe pain was complained of in the lower abdomen. After the pain disappeared profuse bleeding took place, and lasted for three days. As the bleeding continued she consulted Dr Joseph Bell, who advised her to see Dr Brewis. Bimanual examination revealed no sign of malignant disease; the cervical mucous membrane was perfectly healthy, but as the body was enlarged, curettage was performed, and the scrapings were reported by Dr Gulland to exhibit the characters of early primary cancer of the uterus. Dr Brewis therefore removed the uterus along with the uterine appendages. The vagina was narrow and senile, and to gain room the perineum was incised. The patient recovered easily. The uterus measured 3 inches in length, and on section the anterior wall was found to be inch in thickness. The endometrium was thickened and reddened, and in the region of the left tubal opening the disease was found to extend for about of an inch into the muscle. The cervical mucosa appeared perfectly healthy, the arbor vitæ being well seen..

(c) MYOMA OF THE OVARY. The ovaries removed in the above case were both senile, but growing from the right was a hard round tumour about the size of a hazel-nut, which, on microscopic examination, was found to be a myoma.

(d) UTERUS WITH APPENDAGES removed by abdominal section for ovarian abscess and pyosalpinx. Dr Brewis showed the above specimens to illustrate the mischief which a miscarriage may bring about. The patient was 29 years of age, and her illness dated from a miscarriage three years ago, since which time she had been in constant pain. On examination a large rounded fixed swelling was found in the right side of the pelvis, displacing the uterus to the left. On 6th

October the abdomen was opened, when the swelling on the right side was discovered to be the ovary enlarged to the size of a foetal head, with the tube much swollen and reddened lying over it. The uterus lay to the left and front, and was distinctly enlarged. The left ovary and tube were enlarged and matted together, forming a rounded mass of considerable size. All the organs were fixed by strong adhesions. The right ovary was first liberated from its bed, and in doing so it ruptured, and about a pint of pus poured out. The ovarian and uterine vessels on that side having been secured, and bladder pushed down, the cervix was divided, followed by ligature of the left ovarian and uterine vessels, and removal of tube and ovary on the left side. The pelvis was then thoroughly irrigated through an opening made in the vaginal roof, after which the pelvis was packed with gauze, the free end of which was drawn down into the vagina. The cervical stump was then covered over with peritoneum and the abdomen closed. The patient's recovery was uninterrupted.

Naked-Eye Appearance of Parts Removed. The right tube is much enlarged, irregularly convoluted, firin in consistence and deeply injected. The fimbriae cannot be recognised. The orifice is patent, and in section the walls are thickened and the interior contains a granular purulent material. The right ovary is greatly enlarged and irregular in shape, is firm and fibrous in consistence, and when opened presents one large cavity with rough walls from which pus escaped at the operation. The broad ligament is thickened and fibrous. The left ovary and tube are incorporated, forming a pear-shaped mass. The tube is spread out over the upper aspect of the ovary, and is adherent to it; the ovary is as large as a hen's egg and contains a large hæmatoma.

(e) LARGE FIBROID TUMOUR of the uterus removed by subperitoneal hysterectomy. Dr Brewis showed the above specimen to demonstrate the ease with which a fibroid tumour tightly wedged in the pelvis could be removed by enucleation. The tumour was a rapidly growing one, and was removed on account of urgent pressure symptoms.