course, be repaired. Whatever the operation selected, it should permit of thorough intrapelvic work, and should be one that restores the normal axis of the uterus, at the same time leaving it free to adapt itself to its normal range of motion. The operation I am about to describe meets these requirements.

The recti

"1. A transverse incision is made through the skin, fascia, fat and aponeurosis down to the recti muscles. This incision, in the ordinary subject, should be about 11⁄2 inches above the pubis, and should extend laterally to the outer border of the recti. are separated vertically in the median line and the peritoneum opened in the same direction. The pelvis is investigated, proper attention given to the local pathological conditions, and the uterus raised.

"2. A pair of light compression forceps with teeth in the end (Senn's) is passed through the abdominal opening and grasps one of the round ligaments about the middle of its intraperitoneal portion. By traction on the forceps the uterus is pulled somewhat to the side of the pelvis which is opposite the ligament held, the peritoneum is drawn away from the region of the internal abdominal ring, and the ligament made taut so that it may be the more readily recognized in the extraperitoneal manipulations to follow.

"3. Now just beyond the outer edge of the rectus, at the end of the transverse incision, the point of a pair of artery forceps is thrust through the posterior sheath of the muscles, but does not enter the abdomen. The forceps is opened and withdrawn, so that an aperture large enough to admit the index finger is left. The finger is introduced through this opening in the preperitoneal fat, and feels the round ligament without difficulty, for it is brought into prominence by tension on the forceps which holds its uterine end.

"4. The finger passed through the opening just described, is hooked under the extraperitoneal portion of the ligament from below upward, and draws it up into the wound. The sheath of the ligament is then split open by blunt dissection. The sheath and the peritoneum are stripped back in the direction of the uterus, completely divesting the ligament of its covering. It is then drawn out of the wound, and forceps slipped underneath retains it until the opposite ligament is raised and denuded in the same way. the uterus has been in a state of marked retroversion, the ligaments. will have become so attenuated as to allow their approximation in the median line in front of the recti, which approximation will restore the uterus to its normal position.

If

"5. When it has been determined that the ligaments are long enough to meet in the median line they are each left looped over forceps, while the peritoneum of the median incision and the recti muscles are closed with continuous kangaroo or catgut sutures.

"6. The ligaments are next approximated in front of the recti and tied together.

"7. Now, beginning in one angle of the transverse incision, the cut edges of the aponeurosis are stitched together with a continuous kangaroo suture. When one or two loops of the suture have been passed, the needle, in crossing the interval between the two edges, is made to pass through the ligament. It is well also to pick up a little of the muscle on each side of the ligament in order to provide against dead spaces. This process is continued as each successive loop is passed until the centre of the incision is reached, when the free end of the suture is clamped and left long. Starting in the other angle of the transverse incision (but looping in a contrary direction, so that when the two sutures meet their free ends may be on opposite sides of the wound), a second strand of kangaroo unites the edges of the aponeurosis on that side and picks up the round ligament and adjacent portions of the muscles as before. The kangaroo tendons are tied together, and the ligaments are thus embedded and firmly anchored between the aponeurosis and muscles.

"8. The structures in front of the aponeurosis are closed in the usual manner."

The advantages of the operation may be stated as follows: There is but one incision and through it any pelvic complication may be treated. The operation utilizes the strongest part of the round ligament instead of its distal end. The normal mobility of the uterus is not disturbed, and it is left in the pelvis where it belongs. It causes no vesical irritation or dysuria if the ligaments are not embedded too low down, and no dragging if they are not brought through too high up. The anchorage is superior in permanency to all peritoneal attachments; the uterine portion of the ligament will not stretch away. There are no sutures in fundus to irritate the uterus. The fixation is extraperitoneal; no irritated point invites subsequent adhesions to abdominal viscera. The peritoneal investment of the ligament is not drawn into the abdominal walls, producing funnel-shaped depressions and inviting hernia. It does not interfere with the physiological development of the uterus during pregnancy.

During the last year I have made this operation twenty-three times. In all but three there were intrapelvic or other complications. In ten the appendix vermiformis was removed, either because of a history of definite recurring attacks of appendicitis, or because from its appearance it was deemed wise to remove it. In one case a broad ligament cyst was removed and in several, diseased appendages were taken out. These are mentioned merely to show that there is no difficulty in doing any necessary intrapelvic work through the transverse incision and separation of the recti muscles. In all the cases local office treatment by means of

tampons or pessaries had been resorted to without relief. Most of the cases were in women who are obliged to work, and who preferred to undergo an operation rather than submit to further treatment. The three uncomplicated cases were marked neurasthenics with dysmenorrhea. While the displacement remains corrected, there has yet been no improvement in the dysmenorrhea, and little or none in their general condition. There were no deaths or serious complications following these operations. So far as I have been able to follow the cases the results have been all that could be expected.-CHARLES W. OVIATT, M.D., in the Journal of the American Medical Association.

Society Reports--Notes of Interest.

FIFTH ANNUAL MEETING OF THE CANADIAN SOCIETY FOR THE PREVENTION OF TUBERCULOSIS.

The fifth annual meeting of the Canadian Society for the Prevention of Tuberculosis was held in the Railway Committee-room of the House of Commons on the afternoon of the 15th of March. The gathering was largely attended by medical men from various parts of the Dominion. Among those present were: A. Mackenzie Forbes, Montreal; A. J. Richer, Montreal; John Noble, Toronto; T. V. Hutchinson, London; Rev. Manly Benson, Arnprior; E. Herbert Adams, Toronto; F. A. Lawrence, M.P., Truro; Rev. W. H. Stevens, Montreal; N. H. Arthur, Sudbury; R. F. Preston, Carleton Place; James Third. Kingston; J. D. Page, Quebec; Clarence H. Brown, H. Beaumont Small, Dr. Dewar, George Baptie, F. Montizambert, Ensign Wm. Thompson, Capt. Oldford, Ottawa; R. S. Weir, Toronto; Chas. Hodgetts, Toronto; R. Preston Robinson, Rev. Thomas Garett, Ottawa; Prof. J. J. Mackenzie, Toronto; P. D. Bryce, Ottawa; J. D. Lafferty, Calgary, N.-W.T.; Sir James Grant, Prof. James Robertson, J. M. Courtney, John Sweetland, J. A. Gemmill, James Manuel, Ottawa; Charles Sheard, Toronto; E. J. Barrick, Toronto; C. A. Daigh, Montreal; D. C. MacIntosh, Lanark; Chas. H. Higgins, J. G. Rutherford, Veterinary DirectorGeneral; D. Tamblyn, F. W. Grey, Ottawa; George S. Young, Prescott; W. M. English, London; Rev. A. B. Johnston, Aylmer, Que.; A. F. Jeannotte, Montreal; J. W. Lalonde, Montreal; Wm. Gray, Gatineau Point; W. H. Brunel, Geo. G. McCarthy, A. Harvey, E. Bourgue, D. M. Robertson, W. L. Shirreff, James

Seager, Max O. Klotz, George H. Perley, M.P., Ottawa; H. Logan, M.P., Amherst, N.S.; Theo. Cypbrit, Montreal, and many others.

Senator Edwards, president of the association, occupied the chair. He opened the proceeding by congratulating the association on the large attendance at the meeting. This showed the great interest taken in the work. This year it was thought better to have just a business meeting, and next year a large convention, occupying two or three days. He referred to the resolution moved by Mr. Perfey, in the House of Commons, to the effect that the time had arrived for the Government to take up this great question. The resolution had met with warm approval. A similar resolution was offered in the Senate.

SECRETARY'S REPORT.

Rev. Wm. Moore, the secretary, in his annual report, after saying that Earl Grey, shortly after his arrival in Canada, had accepted the place of honorary president, set forth that in accordance with the resolution passed at the last annual meeting, a large deputation from all parts of Canada waited upon the Dominion Government with reference to the establishment of a sanatorium. They were presented by Senator Edwards. The Premier expressed his pleasure at meeting them, and his sympathy with their objects. The sub-committee which was appointed, with Dr. Bryce as convener, with the object of getting County Councils and other public bodies to petition for the establishment of a sanatorium in each province, to be assisted from the Federal treasury, has met with gratifying success. Twenty-four petitions to the Governor-inCouncil have come from British Columbia alone. The matter has been warmly taken up in Manitoba, many places raising money for the establishment of a sanatorium in that province, hoping, of course, for some help from the Dominion Government. The British Columbia Association for the Prevention of Tuberculosis and the association of Colchester, N.S., were admitted to affiliation. During the year the secretary delivered fourteen lectures in Ontario, eleven in Prince Edward Island, nine in Nova Scotia, and two in New Brunswick. An attack of illness prevented him from continuing the course. He also lectured before the Lanark County Public School Teachers' Association, and the Eastern Ontario Dairyman's Association. During the eleven months to March 1st the literature distributed amounted to 785,000 leaves. The resolution offered by Sir James Grant last year in favor of a medical inspection of children in the schools, was sent to the Minister of Education of the different provinces, but no indication has yet been received of any intention to take action.

The report from Colchester, N.S., showed that an association was formed there on January 5th, 1905, and has aroused widespread

interest. Observation seems to show that tuberculosis is much more prevalent in Colchester and vicinity than the average for the whole Dominion. The death rate from tuberculosis in that county is one in five.

THE FINANCES.

The treasurer's report covered the eleven months ending on March 1st. Its receipts showed cash on hand, $1,199.73.; membership fees, $13; life membership fee, A. W. Fleck, $50; Dominion Government grant, $2,000; collected in small sums at various places, $182.85; total receipts, $3,445.58. The expenditures were $2,513.12, leaving a balance on hand of $932.48. The treasurer congratulated the association on this showing. He did not know any association that got so much work done for so small an expenditure.

Mr. F. A. Lawrence, M.P. for Colchester, N.S., said a few words, pointing out that Nova Scotia was the first, and as yet the only province to have a provincial sanatorium. It was modest, but it was a good beginning.

Dr Adams, of Montreal, reported on behalf of the branch in that city. He spoke of the tuberculosis dispensary which has been established there, and which is doing an excellent work. He also praised highly the City Council for its grant of $700, and for the subsequent assistance given by it, as well as its action in appointing one of its health inspectors as the special inspector for the association. During the year several thousand wall cards have been distributed, giving instructions as to the conduct and care of people with tuberculosis and the means of preventing it.

Dr. Barrick said that good progress was being made in raising, by private contribution, the $25,000 which must be secured before the $50,000 voted by the municipality becomes available. He hoped that a municipal sanatorium would be a reality in Toronto before long.

TO CHECK THE DISEASE.

It was moved by Sir James A. Grant, seconded by Mr. George H. Perley:

That whereas the following resolution was agreed to unanimously by the House of Commons, on the 20th February, 1905, viz.:

"That in the opinion of this House the time has arrived when Parliament should take some active steps to lessen the widespread suffering and the great mortality, among the people of Canada, caused by the various forms of tuberculosis;"

It is hereby resolved that this association do now and hereby respectfully petition the Dominion Government to take such action as may be expedient to constitute a Royal Commission, with authority to inquire into and report upon what active steps should