While spontaneous rupture of the cesarean scar is not as rare as ordinarily supposed, occurring, as it does, in about 3 per cent, of all cases,1 yet it is rare enough to occasion interest. For this reason, it may be worth while to report the following cases: Case 1.\p=m-\Mrs.H. A., aged 33, was admitted to my service at the Seton Hospital, Oct. 18, 1917. She gave a history of having had three pregnancies covering a period of ten years. Her first child was taken away by craniotomy, several

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... ts of high forceps having failed. The second was born alive with much difficulty and has since been mentally defective. The third child was delivered by cesarean section transperitoneally, June 4, 1916. In referring to the operative history of this case, I found that the incision was made into the placental site. This is of especial interest, since Spalding,2 in a recent study of four cases, gave this as a possible cause of the weakening of the resulting scar. The patient appeared to be in good health. She was 4 feet and 10 inches in height, and had been pregnant eight months, with neither signs nor history of tuberculosis or syphilis. Vaginal examination showed a contracted pelvis, especially in the anteroposterior diameter. The scar on the abdomen was scarcely noticeable and had apparently healed by first intention. Fearing a possible rupture of the cesarean scar, I decided to perform the second cesarean operation, the following morning, and preparation was made accordingly. Through¬ out the night the patient seemed restless and vomited twice. At 8 o'clock the following morning, she experienced a severe pain in the abdomen and went into a state of collapse. She was immediately given a quarter grain of morphin and was taken to the operating room. The abdomen was opened under local anesthesia and the child was found lying among the intestines with the mem¬ branes intact. The abdomen was filled with blood, and the uterus was laid wide open by a longitudinal tear correspond¬ ing to the previous cesarean scar, and, although contracted into the pelvis, it was bleeding profusely. Under mild ether inhalations, a rapid supravaginal hysterectomy was per¬ formed and the patient returned to bed. The postoperative course was very stormy, and although the patient apparently rallied from the shock, she never became rational. She died on the third day following the operation from general peritonitis. Case 2.-I was called in consultation to the home of Mrs. . ., aged 28, Oct. 25, ,1916. The physician in attendance told me that she had been in labor about six hours and that the os had been fully dilated when she had suddenly experi¬ enced a terrific pain in her abdomen and had gone into a state of collapse. Six years previously, she had had one living child delivered by a transperitoneal cesarean section, because of a contracted pelvis. When I first saw her, one-half hour after the apparent rup¬ ture, she had a subnormal temperature and a pulse so weak and rapid that it could not be counted. The child could be distinctly palpated and outlined lying in the abdominal cavity, and vaginal examination revealed the uterus con¬ tracted into the pelvis. The patient was immediately sent to the hospital, but was dead before she reached it. On her arrival, the abdomen was opened with hopes of resuscitating the child, but the effort was futile. The child was lying among the intestines with the membranes ruptured. The placenta was found in the 1. Rongy, A. pelvis extruding from the ruptured uterus. The abdomen was filled with blood. COMMENT The first of these cases is exceptionally interesting because of the early rupture and its occurrence at the end of the eighth month. The second case is inter¬ esting because of the long period, six years, since the patient's previous cesarean section. In each of these cases, the incisions in the abdomen were unusually large for the cesarean operation, and although the tears in the uterus may have extended beyond the previous scar, they were unusually long, extending well over the posterior surface of the fundus. In these two cases it was impressed on me that a comparatively small incision into the uterus in a cesarean operation is of advantage, and also that when a second cesarean operation is considered advisable in a patient having a cesarean scar, the operation should be performed not later than the end of the eighth month. For at this time, the life of the child will not be jeopardized, and the possibility of rupture up to this time is comparatively small. The purpose of this research was to determine whether or not neutral solution of chlorinated soda (Dakin's solution) could be used with safety in the peritoneal cavity. The series of experiments was begun with the sole idea of deciding this point for our own benefit, as we believed that other investigators more closely associated with the work would soon publish similar experiments. Since this has not been done, we thought it might be of value briefly to give our results.1 All of the experiments were performed on dogs. In some cases the animals were etherized and the effect of the injection of the solution on the blood pressure was noted. In other experiments, the symptoms produced by the injection on the normal animal were studied. The solution was made fresh for each day's experiments except in those cases in which it was desired to observe the effect of an old preparation, and the hypochlorite concentrate varied between 0.45 and 0.50 per cent, and was neutral. The usual effect of an intraperitoneal injection of a fresh preparation of Dakin's solution into an ether¬ ized dog is an immediate and marked drop in blood pressure, which progresses until it becomes quite low. This result is, of course, more marked when large amounts (300 c.c.) of the solution are employed, but also occurs at times with relatively small quantities. Usually, however, when small amounts (10 c.c.) are used, the blood pressure is at first slightly increased From the Mayo Clinic. On account of lack of space the details of animal experiments are omitted. They appear in the author's reprints of the article. 1. It should be emphasized that no conclusions are drawn either in regard to the use of Dakin's solution or the employment of the Carrell-Dakin method of wound treatment.