The instrument used by the author consists of a strong pair of forceps somewhat like those used in lithotomy, with the two distal ends notched with sharp teeth like a volsella. A portion of the tumour is seized between these two blades, and partly cut and partly twisted off. With patience and care the whole tumour may be thus removed. In one case the author was enabled to remove two large growths, each filling a pint measure. This operation is specially suitable in women in whom an abdominal operation is to be avoided. =Operations for interstitial tumours.= Interstitial fibroid tumours, if not above the size of a small fœtal head, should be treated by vaginal hysterectomy (_vide infra_); if large, by hysterectomy by the abdominal route (see p. 36). [Illustration: FIG. 68. SUBMUCOUS FIBRO-MYOMATA, CAPABLE OF TREATMENT BY MORCELLEMENT. (_From drawings made at time of operation._)] =Vaginal hysterectomy.= By vaginal hysterectomy is meant removal of the whole uterus by the vagina, with or without the appendages. The advantages that the vaginal operation possesses over abdominal hysterectomy are, there is less disturbance of peritoneum and intestines, less shock, and no abdominal scar or risk of subsequent hernia. The operation is limited to uteri not exceeding in size the head of a full-time fœtus. =Indications.= (i) Malignant disease of the uterus (fundus or cervix) in an early stage: chorio-epithelioma malignum. (ii) Certain cases of fibro-myoma of the uterus. (iii) Certain cases of inflammatory disease of the uterine appendages complicated by recurrent attacks of local perimetritis. (iv) Other conditions, such as intractable uterine hæmorrhage, usually due to uterine myo-fibrosis, and, as a last resort, severe dysmenorrhœa. It has also been advised for irreducible chronic inversion of the uterus, and for severe procidentia uteri. No case of the former has occurred in the author’s experience in which the operation was found necessary. In the latter condition the operation is not to be recommended, the almost certain result of the procedure being prolapse of the vaginal walls and the intestines (enterocele). =Vaginal hysterectomy for carcinoma.= The only cases suitable for operation are early ones, in which the disease is still confined to the uterus itself, which should be freely mobile in all directions. No signs of infection of the surrounding cellular tissue and vaginal walls should be present. It cannot be too strongly insisted that all cases should be thoroughly examined under anæsthesia to settle this point before operation is decided upon. Rectal examination is most important to estimate the condition of the sacro-uterine ligaments, the cervix being pulled down so as to place them on the stretch.