In all cases of hysteropexy the uterus is of necessity sutured to the lower angle of the wound, and is therefore in close relation to the bladder. It facilitates the operation to introduce the lowest sutures first and then gradually work up to the fundus. The wound is then closed and dressed as described for cœliotomy. =After-treatment.= This is conducted on the same lines as after ovariotomy. =Risks.= Hysteropexy, when performed by surgeons experienced in pelvic surgery, is such a simple operation that it should have no mortality. At the Chelsea Hospital for Women, from 1904 to 1906, both years inclusive, this operation was performed on 190 patients, all of whom recovered from the operation. Many of these operations were complicated with oöphorectomy, ovariotomy, or myomectomy. A wide study of operation returns show that hysteropexy is not absolutely free from risk, as deaths from sepsis, lung complication, and intestinal obstruction have been reported. The remote consequences of hysteropexy are of interest. When the uterus has been enlarged by previous pregnancy its fundus can be brought without undue strain into contact with the anterior abdominal wall, so that when it is secured by sutures there is little or no strain on them. When hysteropexy is performed on spinsters or barren married women in whom the uterus is small, there is, in many instances, a strain on the sutures. The effect of this strain is twofold. When the uterus is attached to the abdominal wall by an aseptic suture, lymph is exuded from the surfaces of the peritoneum in contact with the retaining sutures. This effused lymph organizes into a tenacious tissue, and the strain of the uterus, when the operation is performed on virgins, or the weight of the organ when it is done for prolapse, will cause the sutures to erode their way out of the uterine wall, but the plastic material effused around the silk threads slowly stretches as the uterus descends into the pelvis, producing a tendon-like structure which may be called the ‘artificial fundal ligament’ (Fig. 20). [Illustration: FIG. 20. THE FUNDUS OF A UTERUS. A long fibrous cord arises from the fundus as a result of hysteropexy performed nearly five years previously for inveterate retroflexion. Full size.] In patients in whom the length of the uterus allows its fundus to come in contact with the abdominal wall without strain, the union may be so secure that the woman may pass through one or more pregnancies successfully without disturbing the union, or even stretching it. This I have proved in twelve instances where some subsequent trouble such as appendicitis, gall-stones, ovariotomy, cancer of the colon, or the like has led to a repeated cœliotomy, and has afforded me an opportunity of examining the condition of the uterus.