times incontinence of urine. The urinary analysis disclosed nothing abnormal except a diminished excretion of urea. Vaginal discharges profuse and muco-purulent in character. Heart, lungs, etc., negative. Inspection shows an egg-shaped fibroid tumor, about nine inches long and six inches in diameter, attached by a pedicle on its side to the upper right margin of the os uteri. are five superficial ulcers, three upon the anterior and two There FIG. 3.-Dissection of bladder and rectum from cervix uteri, and amputation of latter at the internal os. upon the posterior surface of the tumor, averaging the size of a silver dollar. The vagina is completely everted, not even a sulcus remaining within the vulva. The bladder and rectum are turned out through the vaginal orifice, forming deep pouches in front of and behind the mass. The cervix is as large as an ordinary sized man's wrist, and elongated sufficiently to permit extrusion of the vagina, while the fundus uteri is near its normal position. The cavity of the uterus is three inches deep, that of the cervix seven inches, making a total of ten inches. The round FIG. 4.-Showing restoration by inverting vagina, rectum, and bladder, and anchoring with mattress sutures in the stump. ligaments are very much hypertrophied, feeling like cords larger than a lead pencil. Other pelvic organs seem free from disease. As hysterectomy is often unsatisfactory in procidentia uteri, I determined to do a supravaginal amputation of the neck and replace the everted vagina, knowing that the supports were equal to the task of sustaining the parts. The operation consisted in the usual circular incision dissecting off the bladder, rectum, and post-uterine peritoneum from the cervix for a distance of six and a half inches and amputation of the cervix at the internal os, ligating the uterine arteries and other large vessels as they were encountered. The parts were very vascular; many of the vaginal branches were as large as small quills; consequently the operation was tedious, frequent ligation being necessary. After removal of the neck of the womb the vagina was stitched to the stump by four mattress sutures introduced an inch back of the free margin of the vagina, then through the walls of the uterus, beneath the cut surface of the stump, emerging from the cervical canal, then passed in the reverse direction and tied on the surface of the vagina. These sutures served the double purpose of closely applying the vagina to the stump, especially in the angles of the wound, and of controlling oozing from the uterus. The margins of the vagina were fastened by superficial sutures to the mucous membrane of the cervical canal, and the remainder of the wound closed in a transverse line, except at the angles where drainage was provided for. The vagina was dressed with gauze to prevent pouching or pocketing between the opposing raw surfaces. Thirty-eight minutes were consumed in performing the operation. She made a very fair recovery, considering her condition. at the time of the operation. The suppurating tumor having been removed, the temperature dropped, but on the seventh day, when the mattress sutures cut into the tissues the temperature reached 103 degrees, but came down immediately upon the removal of the stitches. From that time on her recovery was uninterrupted. The uterus mounted higher in the pelvis, the vaginal orifice contracted |