=Operative Means of Treating Retrodisplacement of the Uterus.=--A great many kinds of operation have been introduced for curing retrodisplacement of the uterus. The fundus has been attached to the anterior abdominal wall by passing a needle and a suture into the uterus and thrusting it through the uterine wall and the anterior abdominal wall; the uterine cornua have been sutured to the anterior parietes; the round ligaments have been shortened by folding each upon itself, and fixed in this position by suture; the round ligaments have been drawn back through openings made in the broad ligaments and attached by suture to each other and to the posterior surface of the uterus; the utero-sacral ligaments have been shortened; the uterus has been held forward by sutures applied through the anterior vaginal fornix. The two operations that have deservedly met with the greatest favor are ventro-suspension of the uterus, in which the abdomen is opened and the fundus is sutured directly to the anterior abdominal wall, and Alexander’s operation, in which the uterine displacement is corrected by shortening the round ligaments as they emerge from the inguinal rings. The latter operation is designed to be extra-peritoneal. The following is the method of performing Alexander’s operation: The uterus should first be replaced as already described, and held in position by a gauze or cotton pack. A two-inch incision is made from the pubic spine in the direction of the inguinal canal. The external inguinal ring is opened without wounding the pillars. The thin layer of fascia over the ring is divided, the fat is separated, and the round ligament is sought with a blunt hook. If the ligament is not found here, the canal may be opened to the internal ring. When one ligament has been found, it is secured with forceps and the wound is protected while the other ligament is secured in a similar way. The ligaments are then gently drawn out until they become tense. If the inguinal canal has been opened, it should be repaired by a catgut suture. The ligament should be sutured to the pillars of the ring by two or three sutures. The excess of the ligament, sometimes amounting to two or three inches, should be cut off. The incision should then be closed. The field of this operation is very limited. It is not applicable when there are adhesions nor when there is disease of the tubes or ovaries requiring operative treatment. Many of the cases of retroversion of the uterus that require operative treatment are complicated by salpingitis and pelvic adhesions, though these extra-uterine conditions are very often not recognized by bimanual examination before the abdomen is opened. The operation that at present seems to possess most advantages for the cure of those cases of retroversion of the uterus that cannot be cured by the pessary is the operation of ventro-suspension of the uterus (Fig. 96). It is performed as follows: