angle of the scapula. Pain also sometimes extended into the right lumbar and inguinal regions. Nausea and vomiting at times relieved the pain. When pain was over the gall-bladder she was unable to lie down. Pain usually came on in the night, and it was rare that she was free from it for a week; was once for four weeks without it, but frequently had attacks for many nights in succession. The abdomen bloated after the pain, and felt as if a constriction or a string were about the waist. Food did not distress, except when having the pain; was constipated. Was operated upon last September, when no stone was found, and relief has not been obtained; a second operation was therefore determined upon. A contracted gall-bladder was found, surrounded by dense adhesions which were separated, but no stone could be found either in the gall-bladder or in the common duct. The common duct seemed occluded by cicatricial tissue. An anastomosis was made between the gall-bladder and what was supposed to be the duodenum; the latter could not be surely determined because of the many adhesions. The opening into the gall-bladder remaining from the previous operation was closed. Drainage was established to the site of the anastomosis. The subsequent course was complicated, but recovery was finally satisfactory. The opening into the intestine maintained itself, and bile now passes in that way with sufficient freedom.

In cases of tubal or ovarian disease, where possible, the apparently healthy portion of the ovary has always been left behind; my own experience thus far is convincing that the best results are obtained by conserving some ovarian tissue, even if it is necessary to remove the tube of the same side. I am also much pleased so far as a limited experience will allow of conclusions with the results following ventrosuspension in selected cases, and ventro-fixation in cases of procidentia. Where both tubes and ovaries are removed, if possible to bring the uterus to the abdominal wall, it is now invariably suspended, with only good results so far as I am able to determine. In cases with procidentia, ventro-fixation has thus far proved a cure, and attention is called to the two following cases:

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Mrs. A. M., age forty-eight. Has had seven children, no miscarriages; menses were regular and lasted three days; during the last three or four weeks she has had almost constant flowing. The present trouble began ten years ago with bearing down and backache. The entire uterus was outside of the body, and did not return when lying down. The cervix was enormously hypertrophied. Ventro-fixation was undertaken January 10, and on February 24 plastic operations upon the vagina were performed.

Mrs. S. P., age fifty-eight. Has had seven children, the youngest now nineteen years old; menopause eight years ago; there is much headache and backache, with pelvic pains and constipation; also a coffee-colored discharge; the uterus is entirely outside the body, the fundus lying in a pouch of the rectocele. Ventro-fixation performed January 17, and plastic operations upon the vagina March 10.

In each of these cases the uterus lay entirely outside of the vagina, and had been down so long that there was enormous hypertrophy of the cervix. It could be returned into the pelvis, but could not be retained there. The exposed cervix was eroded because of chafing, and the uterine body was ridiculously small compared with the size of the cervix. Both cases were operated in two sittings. The first operation opened the abdomen above the pubes, and brought the fundus up between the recti muscles, and there securely fixed it, the peritoneum anterior to the uterus being sutured to the peritoneum over the bladder. This carried the cervix. well up into the pelvis, and restored the vagina, which in each case was so capacious that the whole fist could easily be introduced.

After recovery from this operation, plastic operations were undertaken upon the vagina and perineum. In the first case the cervix was so nearly reduced to normal size that it was not further disturbed, but anterior and posterior colporrhaphy and perineorrhaphy were performed. In the second case, at the time of the second operation the size of the cervix was greatly reduced, but by reason of an old laceration, an amputation of the cervix was made, followed by anterior

and posterior colporrhaphy and perineorrhaphy. In each case the result was entirely satisfactory.

One case of umbilical hernia is worthy of record in some details, although the case proved fatal:

Mrs. A. M., age fifty-two. Mother of seven children; menses stopped a year ago; hernia began twenty years ago, but has very rapidly increased during last four or five years until she has become completely incapacitated by it. The accompanying photographs explain her condition better than any words. Operation January 27. The abdomen was opened at the lower portion of the hernia and the sack was found filled with omentum and intestines which were densely adherent to the same, and rendered reduction impossible. These latter were all broken up and a large mass of omentum removed, together with the distended skin. The opening in the abdominal wall proper was closed with buried silver wire sutures, after returning the intestines to the abdominal cavity.

The operation was borne remarkably well, and there was almost no nausea following it. The first night after the operation was favorable, the temperature being 99° and the pulse 100. She urinated satisfactorily at 2 A. M. In the forenoon, however, the breathing became rapidly oppressed, until at II A.M. cyanosis was marked, and she died at 2.20 P.M., with a rapidly developed œdema of the lungs.

A Case of Retention Cyst of the Kidney.

Miss L. G. G., age twenty-three. A year ago first noticed a tumor in the right side, below the border of the ribs ; later this tumor disappeared. Three months ago it reappeared and since then has grown quite rapidly. It showed as a tumor with a rounded, smooth outline in the region of the gall-bladder, slightly movable laterally, distinctly fluctuating; and although there had been no jaundice or colic, it was thought to be a gall-bladder cyst. Upon opening the abdomen, however, it was found to lie behind the peritoneum, and, upon exposure, proved to be a large cyst of the right kidney, which was opened, and evacuated, and drained through a lumbar incision. The first opening into the abdominal cavity was closed. The patient made a satisfactory recovery.