scar developed. A year after that an operation for the cure of the hernia was done, which was unsuccessful, inasmuch as in six months the hernia returned as bad as before. This woman felt after the first trial that a cure was impossible and began a truss and abdominal band existence. In 1896 matters grew worse, and until 1903 she had been a constant sufferer and from 1900 she had never had a day free from pain, many times requiring large doses of morphine to be comfortable. In January, 1903, she was a woman five feet two inches in height, weighed one hundred and ninety pounds, with a fat, pendulous abdomen. The hernia was very large, containing intestine and omentum, and was not reducible. On January 16, 1903, she was operated upon and a silver filigree pad four by six inches was stitched snugly to the muscles and fascia, around an opening two inches and a half wide and four inches in its longest dimension. In this case we could not utilize the omentum by fastening it to the margin of the hernial ring, because at this and at previous operations it had been very largely removed. The skin was sutured over the pad by interrupted silk-worm gut. In ten days the wound had healed entirely, she was allowed out of bed in three weeks and went home in four.

CASE 2.-Mrs. B., age forty-three, occupation housewife, had had a hernia for a long time, could not remember when it began, but for the last six years it had given constantly increasing discomfort and pain until the 1st of March, 1903, life had become unbearable and the patient sought and accepted anything that offered any chance of relief. This case was first seen the 12th of March, 1903. She was then a woman five feet in height and weighed about two hundred pounds, with a large deposit of adipose over the abdomen. The hernia was a little to the left of the umbilicus and contained mostly omentum and was not reducible. Her operation was done March 20, 1903. The hernial opening was two by two and a half inches, the largest diameter in the direction of the long axis of the body. In this case the omentum was stitched to the margins of the openings with a continuous silk suture and a silver filigree wire pad three inches by four inches stitched to the muscles and fascia with a continuous silver wire

suture.

The skin was closed by interrupted silk-worm gut with the usual dressings. This patient was out of bed in three weeks and was allowed home in four.

In each case were indications for this operation, namely, each of long standing, with atrophy and thinning of the muscles and fascia, large hernial openings, and, in Case 1, previous attempts at repair.

These cases have been seen recently and are well. Case 1, eighteen months after operation, is, with the assistance of a green Polish girl, caring for a large family. Case 2, fifteen months after operation, is doing the housework for herself and husband with comfort, which she had been unable to do for several years before. A close examination of each case shows a firm, solid abdominal wall without suggestion of diastasis. These women claim to experience no discomfort or consciousness of a foreign body in the abdominal wall and are both enjoying life thoroughly. The question naturally arises, will they ever experience any trouble, and if so, why, after more than a year of freedom? The operation is not difficult, and, with strict asepsis, should be successful.

I venture to suggest this operation as a remedial agent worthy of trial in that class of cases where tissues already existing in the patient cannot be utilized to cure the defect.

ARTICLE XLV.

MALPOSITIONS OF THE UTERUS, THEIR CAUSES AND TREATMENT.

BY DANIEL J. BROWN, M.D.

OF SPRINGFIELD.

READ JUNE 7, 1904.