Palmer Dudley relates that on one occasion, in curetting a recently gravid uterus, he tore the posterior wall without being aware of it, and withdrew eight inches of intestine, thinking it to be secundines; he recognized the error, and pushed the intestine back through the opening in the uterine wall. The patient recovered, and subsequently had two successful pregnancies. These cases show how impossible it is to recommend any hard and fast lines of treatment. Much depends on the circumstances of the case, the character of the injury, and above all on the experience and resourcefulness of the practitioner. Ruptures or tears of the uterus in the process of instrumental dilatation or curettage are by no means rare, and they have a high mortality. Jakob of Munich collected 141 instances of such injuries, and of these twenty-three died chiefly from septic peritonitis. Among these injuries seventy-three were inflicted with the curette, nineteen with the sound, fourteen with forceps (_Ausräumungszangen_), and six were due to flushing catheters. =Obstetric injuries.= The uterus is liable, during labour, to be torn, as a result of its own expulsive efforts, especially when the transit of the fœtus is hindered or obstructed by narrowness of the pelvic outlet, tumours, or undue size of the child. This form of injury is called _spontaneous rupture_, to distinguish it from the rupture due to midwifery implements. The uterus is frequently torn in the obstetric manœuvre known as ‘turning’. The literature relating to this accident is abundant, and the reports issued from lying-in institutions deal with extensive figures, but unfortunately the reporters are not in harmony on the principles of treatment. There are three methods of dealing with rupture of the uterus:-- 1. Treating the patient conservatively, which means at most lightly packing the part with antiseptic gauze. 2. Performing cœliotomy and stitching up the rent in the uterus. 3. Hysterectomy, preferably by the abdominal route, as this enables the peritoneal cavity to be cleared of clot. The only point in which there is any semblance of agreement among obstetricians is this: in cases of complete rupture, in which the fœtus and membranes are extruded from the uterus into the belly, cœliotomy is clearly indicated. Admirable reports have been published by Walla, Klien, Ivanoff, and Munro Kerr. Klien’s is a critical and very valuable study, based upon 347 cases of rupture of the uterus published in the preceding twenty years. Of these cases 149 were operated upon, with a mortality of 44 per cent.; 198 were not operated upon, 96 recovered and 102 died--a mortality of 52 per cent. Among the unoperated cases some were not treated in any way, and in these the mortality was 73 per cent., whilst in those treated by drainage, plugging and irrigation, the mortality was only 37.5 per cent.