The great difficulty in dealing with this condition is the selection of suitable cases. Experience teaches that acute cases are unsuitable. The best results have been attained in the chronic forms of the disease where the thrombosis was limited. There is great uncertainty in a given case as to the extent of the thrombosis and the number of veins implicated. As has already been mentioned, there are two routes for gaining access to the thrombosed vessels--the extraperitoneal and the intraperitoneal. I prefer the intraperitoneal route (cœliotomy), for it enables the surgeon to deal with the vessels, iliac or ovarian, of both sides, as well as allowing a thorough examination of the pelvic organs, and it permits the drainage of any collection of serum or pus found in the pelvis. From a study of the reported cases it is clear that the best results are obtained by cœliotomy. The ligature of thrombosed ovarian veins in chronic puerperal pyæmia promises good results for the future, but it needs further experience to teach us the kind of case in which it is likely to be successful. REFERENCES BUMM, E. Zur operativen Behandlung der puerperalen Pyämie. _Berliner Klin. Wochensch._, 1905, xlii. 829. CUFF, A. A Contribution to the Operative Treatment of Puerperal Pyæmia. _Journ. of Obstet. and Gyn. of the British Empire_, 1906, ix. 517. FERGUSON, J. HAIG. Abdominal Hysterectomy for Acute Puerperal Metritis and Acute Salpingitis. _Obstet. Transactions_, Edin., 1906, xxxi. 123. FRIEDEMANN, G. Die Unterbindung der Beckenvenen bei der pyämischen Form des Kindbettfiebers. _Münchener Med. Wochensch._, 1906, liii. 1813. LENDON, A. A. Puerperal Infection, Thrombosis: Ligature of the Right Ovarian Vein. _Australian Medical Journal_, 1907, xxvi. 120. MICHELS, E. The Surgical Treatment of Puerperal Pyæmia. _Lancet_, 1903, i. 1025. STEVENS, T. G. The Bacteriological Examination of a Thrombosed Ovarian Vein (following Hysterectomy). _Trans. Path. Soc._, li. 50. TRENDELENBURG, F. Ueber die chirurgische Behandlung der puerperalen Pyämie. _Münchener Med. Wochensch._, 1902, xlix. 513. CHAPTER X OPERATIONS FOR INJURIES OF THE UTERUS Injuries of the uterus fall into six groups:-- 1. Gynæcological injuries. 2. Obstetric injuries. 3. Injuries to the pregnant uterus. 4. Injuries to the pregnant uterus in the course of abdominal operations. 5. Bullet-wounds of the pregnant uterus. 6. Stab-wounds of the pregnant uterus. =Gynæcological injuries.= The simplest and certainly the commonest accident is perforation of the uterus with a sound, dilator, or forceps in the operation of curetting. Many cases are known in which the uterus has been perforated by clean instruments of this class and the patients have suffered no inconvenience.