In one remarkable case where a small uterus had been securely fixed by its fundus to the abdominal wall by means of ten thick sutures (the operation had been performed in a cottage hospital in Yorkshire), the patient complained of persistent pain, and was sent to me on this account. I found the sigmoid flexure of the colon caught in one of the sutures, which accounted for some of the woman’s trouble, but the uterus was so firmly fixed to the abdominal wall and had been so dragged upon that it had become a rounded sausage-like organ. Its removal was followed by immediate relief. Among rare accidents which have followed this simple operation is tetanus when catgut and wallaby tendon has been used for the retaining sutures (see p. 107). REFERENCES KELLY, H. A. Hysterorrhaphy. _American Journal of Obstetrics_, 1887, xx. 33. OLSHAUSEN. Ceber ventrale Operationen bei Prolapsus und Retroversio Uteri. _Centralblatt für Gynäkologie_, 1886, x. 698. CHAPTER IX OPERATIONS UPON THE UTERUS DURING PREGNANCY, PARTURIENCY, AND PUERPERY Pregnancy is apt to be complicated with tumours growing in the walls of the uterus, _e.g._ fibroids, cancer of the neck of the uterus, or cysts and tumours of one or both ovaries; morbid conditions of the Fallopian tubes, _e.g._ pyosalpinx, tubal pregnancy; tumours and cysts in the broad ligament; displaced viscera occupying the pelvis, _e.g._ the spleen or the kidney; tumours arising in the pelvic bones, _e.g._ osteoma, enchondroma, or sarcoma; and echinococcus cysts and colonies growing in the omentum, but occupying the pelvis, or arising in the pelvic tissues. This is a formidable list, and any one of them may so complicate the pregnancy that it may be necessary to remove the tumour, and in some instances to perform Cæsarean section, or even hysterectomy. CÆSAREAN SECTION This signifies the removal of a fœtus and placenta from the uterus through an incision involving the abdominal and uterine walls. This operation is required when the outlet of the pelvis is too narrow to permit the transit of a viable child, as in rickets and osteomalacia; when the vagina is malformed; when the pelvic outlet is narrowed by tumours growing from the pelvic wall. Occasionally the passage of a fœtus is barred by tumours growing from the uterus, especially a large cervix fibroid, or a fibroid growing from the lower segment of the uterine wall. An ovarian cyst, especially a dermoid incarcerated by the uterus, may render this operation necessary. The rarest causes are cancer of the neck of the uterus and cancer of the rectum. This operation is advocated by some obstetricians in certain cases of eclampsia and placenta prævia.