The  operation  is  in  many  respects  an  excellent  one,  the
chief  objection  that  could  be  urged  against  it  being  that
it  is  incomplete.  The  vaginal  portion  of  the  cervix,
which  is  retained  to  give  firmness  to  the  pelvic  roof,  does
not  seem  to  be  required  for  that  purpose,  as  can  be  proved
in  hundreds  of  cases  in  which  vaginal  hysterectomy  for
cancer  has  been  performed;  moreover,  its  nutrition  being
cut  off  by  the  ligation  of  the  uterine  arteries,  it  may  atro-
phy, or  even  come  away  entirely,  as  in  a  number  of  re-
ported cases.  Another  objection  to  this  method  consists
in  the  possibility  that  decomposing  material  may  be  re-
tained in  the  fossa  between  the  peritoneum  and  the  va-
gina, and  give  rise  to  septic  phenomena.1

There  remains  to  be  described  the  method  of  complete
removal  of  the  uterus,  which  is  practically  identical  with
the  method  described  by  Freund  in  1879  for  the  removal
of  the  uterus  for  cancer.  Freund's  operation  was  aban-
doned because  of  its  great  technical  difficulty,  but  with
the  improvements  which  have  been  made  it  would  not
be  surprising  if  it  again  came  into  prominence,  and  even
supplanted  vaginal  hysterectomy,  with  its  difficulties  and
uncertainties,  in  the  treatment  of  cancer.  The  improve-
ment which  has  made  Freund's  operation  not  only  feas-
ible, but  simple  and  rational,  whether  for  cancer  or  my-
oma, is  the  Trendelenburg  position.  By  its  aid  the
structures  which  are  to  be  removed  can  not  only  be  felt
but  seen,  and  thus  can  be  removed  with  greater  safety
and  celerity  than  by  any  other  method.  The  work  of
Eastman,  Gordon,  Polk,  Krug,  Edebohls,  and  others  in
bringing  this  operation  before  the  profession,  and  detail-
ing histories  of  cases  which  have  been  almost  uniformly
successful,  is  well  known.  The  technique  of  the  opera-
tion is  usually  simple,  especially  with  tumors  of  mode-
rate size,  for  which  the  operation  is  especially  adapted.
