remove the tumor at a long distance from the seat of the malignancy that I was content with enucleation. Vaginal hysterectomy would have been difficult on account of a long-standing pelvic inflammatory infiltration with dense adhesions. The patient, a year after the operation, remains, I believe, free from recurrence. The cauterization of the cavity in the cervical canal with chloride of zinc unquestionably contributed to the good result.

FIG. 1.-Adeno-fibromatous polyp. Enormous elongation of cervix Depth of the uterine cavity, six and one-half inches.

(4) An Intrauterine Polyp developing long after the Menopause and simulating Malignant Disease; Complete Inversion of the Vagina and Enormous Elongation of the Supravaginal Portion of the Cervix; Combined Abdominal and Vaginal Hysterectomy; Suspension of the Vagina to the Abdominal Wall.-In this patient I was completely deceived as to the nature of the trouble. The woman was 64 years of age. She had had the menopause fourteen years before. Two years before I first examined her she had begun

to bleed, and the bleeding had increased steadily in amount. For the last three months she had experienced abdominal pain. She did not yet show cachexia, nor was there a foul discharge. On an exploration of the uterus with a curette and a curettement forceps I failed absolutely to discover the polyp shown in the illustrations (Figs. 1 and 2), which lay so closely adapted to the uterine wall as to allow the instruments

to slip over it without difficulty. I submitted the scrapings of the endometrium to Dr. H. L. Williams, who informed me that, while there was no distinct evidence of malignant trouble, the appearance of the endometrium under the microscope was certainly suspicious. The whole uterus was accordingly removed, and, to my surprise, nothing was discovered in it but a simple mucous polyp, as shown in the illustration (Fig. 3). The woman, however, made a good recovery, and the prolapse of the vagina has been satisfactorily cured by suspending the vaginal

vault to the abdominal wall. A mistake in diagnosis in such a case seems almost inevitable. The exploration of the uterus was difficult on account of the great length of the cervical canal. The whole uterus, from external os to fundus, measured internally six and a half inches. In spite of this fact, however, the cavity, as I thought, had been thoroughly explored and the possibility of a polyp was excluded. This case, as well as two

more to be mentioned under the next heading, show the importance of careful examinations in the diagnosis of all cases in which intrauterine tumors may be possible, and the liability to error in spite of every precaution.

(5) Uterine Polyps, Myomatous and Mucous, giving rise to Profuse and Continuous Bleeding; Difficulties in their Diagnosis.-Two cases from a number of this kind have been selected to show the difficulties in the diagnosis of what