In a case of this kind in which I performed total hysterectomy for cancer of the neck of the uterus the extensive peritoneal connexions were somewhat troublesome, and when the uterus was removed it seemed as if the floor of the pelvis had been stripped of its serous covering. The bifid nature of the uterus had been anticipated before the operation, as an imperfect vertical septum was known to exist on the posterior vaginal wall. The patient made an excellent recovery. Experience teaches that bicornate uteri cause more difficulties in diagnosis than in technique, but the presence of the vesico-rectal ligament would probably bar the removal of the uterus by the vaginal route. The existence also of a median longitudinal septum, partial or complete, in the vagina would be another difficulty. =Mortality.= In order to give some idea of the great improvement which has taken place in the operation of abdominal hysterectomy for fibroids in London the following figures will be found of great interest. In the year 1896 the results of abdominal hysterectomy for fibroids in the hospitals of London may be inferred from the following table:-- St. Bartholomew’s 7 with 3 deaths St. Thomas’s 5 " 2 " St. George’s 1 " 0 " Middlesex 6 " 1 " University College 3 " 0 " Samaritan 17 " 4 " Soho (for women) 1 " 0 " Chelsea Hospital for Women 9 " 1 " __ __ 49 " 11 " In these hospitals and the New Hospital for Women the returns in 1906 are as follow:-- St. Bartholomew’s 26 with 4 deaths St. Thomas’s 40 " 2 " St. George’s 8 " 0 " Middlesex 50 " 0 " University College 21 " 1 " Samaritan 37 " 2 " Soho (for women) 60 " 1 " Chelsea (for women) 80 " 1 " New (for women) 26 " 0 " ___ __ 348 " 11 " The returns during 1906 and 1907 from my service at the Chelsea Hospital for Women and the Middlesex Hospital, as verified by the Registrars, were 101 abdominal hysterectomies for fibroids; all the patients recovered. Of these 101 operations, 7 were total and the remainder subtotal hysterectomy. [Illustration: FIG. 15. VILLOUS DISEASE OF THE UTERUS. The uterus is shown in sagittal section. The cavity is dilated and occupied by a villous tumour growing from its posterior wall. Successfully removed from a multipara aged 83. Full size.]