almost every one will call forth many cases with the perineal support completely destroyed, and yet the uterus and other organs are in their normal position. Then, is it intra-abdominal pressure? Let us look to the other organs in the abdominal cavity. Has not every operator noticed that many times the abdominal cavity, no matter how lax its muscular walls, contains organs all in an absolutely normal position? In these cases there may be absolutely no intra-abdominal pressure, the organs all lying limp when

(Copy from Dudley.)

What supports them?

Deaver in his

the abdomen is opened. incomparable work on anatomy gives as the entire support of the liver, which is the uppermost and heaviest organ in the abdominal cavity, peritoneal folds; and who has not in the cadaver found that the ligaments of the liver will hold many times the weight of this organ, which of itself is several times heavier than all the

generative organs? The spleen is held in place by peritoneum. The stomach and all the intestines are held in place by peritoneum. The kidneys are held in place by simply being behind the peritoneum. Moreover, the best operation which has been given us for the support of the uterus depends entirely upon the attachment of the uterus to the loose peritoneum of the anterior abdominal wall. Adhesion of an abdominal organ covered with peritoneum to another peritoneal surface when firmly organized will tear a hole in another hollow organ before the peritoneal union will separate, as shown by stitching two intestines together. The omentum attached to the abdominal wall becomes very much

thickened and is so firmly adherent to a peritoneal surface that it will hold many times the weight of the lighter organs in the abdominal cavity. I have had occasion to notice this in the "hammock" operation for gastroptosis.

Who has ever known the parietal peritoneum to be found out of contact with the abdominal wall? Is it not a fact that the loose peritoneum of the abdominal wall, even though it may be drawn inches away from the wall and attached to another organ will generally pull the organ to it and retract to its normal attachment? Therefore, considering this fact that peritoneum clings to the abdominal wall under all circumstances, and considering the

fact that all of the organs in the abdominal cavity are held by peritoneum, why should we attempt to make an exception in the case of the uterus, especially when we consider the fact that the uterus has running into its sides larger folds of peritoneum and more advantageously placed from a mechanical standpoint than any other organ in the abdominal cavity?

In considering the anatomy of the peritoneum of the pelvic

Fig. III.-Section through body showing retroflexed uterus
(Copy from Dudley.)

portion of the abdominal cavity, we find that it comes down on the sides of the pelvis from above and is attached firmly in a vertical direction in the long axis of the uterus to the postero-lateral border. It comes in from the sides of the pelvis, covering over the tubes and round ligaments like a blanket, and attaches near the fundus. A portion of that coming from below is attached to

the antero-lateral border of the uterus in a vertical direction, in the same manner as that coming from above is attached to the postero-lateral border. That portion of the peritoneum of the uterus dips far down forming what is called Douglas' cul-de-sac, which lies in loose folds capable of expanding and stretching many times its normal length. Coming up from below anterior to the uterus, the peritoneum is spread loosely over the bladder like a cover and drops in loose folds between the bladder and uterus forming the vesico-uterine fold. The loose folds before and back of the uterus are ample to give room for the expansion of the rising of the uterus during pregnancy. That portion of the peritoneum which is attached to the postero-lateral borde

Fig. IV. Retroflexed uterus shown from abdominal incision.

proceeds from the sides and front of the pelvic cavity downward, forward and inward. That portion attached to the antero-lateral border proceeds from the sides and front of the abdomen upward, forward and inward forming almost a triangle, the apex of which is from one to two inches wide and is attached to the sides of the uterus, while the base of the triangle comes from the sides of the pelvis over a surface of six to ten inches. The roof of the triangle comes from the sides and front of the pelvis to the internal opening of the inguinal canal and proceeds almost directly toward the center and is attached to the fundus of the uterus, forming a tent loosely attached over the round ligament and adnexa of the

uterus. The triangular portion of the peritoneum is commonly known as the broad ligament. That portion of the broad ligament coming from either side of the rectum and attaching into the posterior surface of the uterus is commonly known as the utero-rectal ligament. That portion of the peritoneum proceeding from either side of the bladder to the antero-lateral surface is known as the utero-vesical ligament. That portion of the pelvic

Fig. V.-Side view of the uterus showing attachment of broad ligament. Straight lines indicate points of peritoneum where some

tension is made, curved lines peritoneum in fold.

peritoneum lying between the rectum and uterus, behind and between the uterus and bladder in front, lies in loose folds in contradistinction to all that portion of peritoneum which goes to form the broad ligaments, which is normally found in a more or less tense condition. Thus it will be seen that the uterus is slung in