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highly inflamed, and adherent to each otherby an effusion of lymph. Several folds ofsmall intestines filled the pelvis, and weremore inflamed and adherent than thoseabove. The lowest convolutions were firmlyadherent to the cut surfaces made in the

operation and to each other, so as completely to close the aperture from within ;only a small quantity of serum was effused.The bladder was natural. The perito-toneum, lining the pelvis, had, in general, agreenish and somewhat dull appearance,which, by some present, was thought to beof a gangrenous character, but its texturewas perfectly firm and unyielding. Theovaria were retained in their usual positionby the remainder of the round and broadligaments. The fimbriated extremity of theleft fallopian tube was found closed, anddistended with serum, nearly to the size ofa hen’s egg, and gradually narrowing alongan inch of the tube to a point, where it wasagain closed. The ovaria were, as is usualin persons who have borne children, flat-tened and corrugated, as if covered withcicatrices. The duplicatures of peritoneum,forming the broad ligaments, were moreseparated below than above, where theyinclose the ovaria, and were thus kept inunion. A very careful examination wasmade to discover, if possible, the sources ofhaemorrhage. The arteries were probablyretracted, as none could be found divided,but the mouths of several considerableveins were seen distinctly on the right side,where the layers of the broad ligamentwere separated, and traced to the plexus atthe side of the pelvis..The branches of theinternal iliac on this side, and the sperma-tic arteries, were examined, but no irre-gularity as to size or distribution was dis-covered.The following are a few observations I

beg to offer on the above operation, andits consequences :-

1st. I think it due to myself and the iprofession to state, that it was not done

precipitately. I had been in attendance,more or less, for sixteen months ; thewoman was in great and almost constantpain, rendered unable to follow any occu-pation, and was extremely anxious to havesome method of relief attempted; the dis-ease was advancing, the operation and itsdangers were fairly explained, and she per-sisted in wishing its performance. Thesecircumstances appear to me absolutely re-quisite to warrant the performance of soformidable an operation. Dr. Blundell ap-pears to have taken the same view of hiscase.

2dly. The operation performed on thisoccasion, I conceive, admits of more safetyand expedition than that performed by Dr.Blundell. There was no difficulty, nor much

pain, in bringing down the cervix uteriwithin sight, when two important parts ofthe operation were performed, without anydanger of wounding either the rectum orthe bladder.

The fundus uteri was drawn down

through the upper opening, which, as itwas thus brought in the direction of.theround ligament, appears preferable to bring-ing it through the inferior or lower one.

Whether it would be better, in a future

operation, to divide the broad ligamentsin sitti, without bringing down the fundus,which certainly commits a degree of vio-lence to the parts, I leave for experienceto decide ; I found it more difficult than Ihad anticipated, from the great depth I hadto reach, and, after making one or two at-

tempts, and wishing to shorten the opera-tion as much as possible, I desisted.

3rdly. The hæmorrhage, at least as far asa careful examination of arteries uninjectedmay be depended upon, arose, not from thedivision of any vessel that ought not tohave been divided, but chiefly from thosecommon to the uterus. One or two rather

large veins, coming off from the plexus atthe side of the pelvis, were found divided ;and when it is remembered that these veinshave no valves, it is not unlikely a veryconsiderable haemorrhage may have pro-ceeded from this source alone.The operation lasted twenty-five minutes,

and would have been much shorter, if sometime had not been lost in endeavouring tosecure the bleeding vessel.

EXTIRPATION OF THE UTERUS.

By MR. LIZARS.

To the Editor of THE LANCET.

SiR,—Since my last communication onamputation, which you was kind enoughto insert in your valuable Journal, 1 havethe satisfaction to inform you, that I wit-nessed, this day, Mr. Lizars extirpate thewhole of the uterus, after the scientificmanner pursued by that profound physician,Dr. Blundell, and I have every reason toexpect the patient will recover.

I have prevailed on Mr. Lizars, who ismuch occupied with his different avoca-

tions, to send you a detailed account of thismost interesting operation.

I remain, your much obliged,SCOTITS SECUNDUS.

Edinburgh, Oct. 2, 1828.