When there is dangerous bleeding Klien advises immediate operation. Lacerations of the vagina make the prognosis unfavourable, and especially injury of the bladder. During the last ten years hysterectomy has been so much improved and the technique so simplified, that the operative treatment of complete rupture of the gravid uterus will be more frequently undertaken in the future than it has in the past, and with every prospect of reducing the heavy bill of mortality at present associated with this grave accident. Donaldson (1908) reports a remarkable case in which the uterus ruptured during forceps delivery; 12-1/2 feet of small intestine, detached from the mesentery, were extruded with the fœtus. Cœliotomy was performed, the detached intestine cut away, and the proximal end of the bowel anastomosed into the cæcum. A long rent in the posterior wall of the uterus was closed with sutures. The patient survived the accident ten days, and died from sepsis; ‘the entire uterus seemed to be a sloughing mass.’ Donaldson states that, had he removed the uterus at the time he operated on the intestine, the patient would probably have survived. =Injuries to the pregnant uterus.= Some of the most remarkable injuries inflicted on the gravid uterus are the consequences of attempts to induce what is technically called criminal abortion, especially when the abortion is self-induced. Kehr has recorded an example of a desperate effort of this kind:--A widow, twenty-nine years of age, when in the fifth month of an illicit pregnancy, fired a revolver bullet into the uterus through the anterior abdominal wall. Cœliotomy was performed, and the wound in the uterus closed by suture. The woman aborted on the fourteenth day, but recovered. A gravid uterus in the later months of pregnancy is a big organ, and, like the abdominal viscera generally, may be severely damaged by blows, kicks from horses or brutal men, butts from animals, such as a calf or a goat, falls upon the belly, or a fall downstairs, or the woman may be run over. The treatment to be adopted in these conditions varies widely with the circumstances. As a general rule it may be stated that the most satisfactory mode of treatment is cœliotomy; this permits a thorough examination of the organ, and facilitates removal of effused blood. In the late stages of pregnancy accidents of this kind entail Cæsarean section. Among the most curious injuries of this group are those known as horn-rips: these are cases in which the pregnant uterus is torn open by the horn of a bull. An interesting collection of cases illustrating this accident has been made by Robert P. Harris. Even after very severe injuries, in some of which the intestines protruded, women have recovered, and several children survived this terrible mode of delivery.