omentum the size of a small orange. This was again reduced, but because it did not go back and free the ring it was again drawn out and ligated through normal omentum. On endeavoring to push the ligated stump back, the finger encountered a closed sac beneath the muscles, with a small immovable knuckle of intestine at its deepest part, about 3 inches (IS mm.) above the ring. Traction on the sac would not bring this constriction with the imprisoned intestine up to the internal ring without danger

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... of tearing the obstructed intestine. A gridiron incision was made above, the peritoneum opened, and the constricting neck severed from within. It was a Richter's hernia of the ileum. After application of hot salt solution for a few moments, the intestine showed vitality and was returned to the abdomen. Repair was made by Bassini's method, and the patient's recovery was unevent¬ ful. The present clinical study of pericarditis with effusion was suggested by an experimental study completed two years ago, and published about a year later. The points with which our experimental study chiefly concerned itself were: (a) the point at which the exudate accumulates earliest, and the effect of such accumulation on the adjacent organs, particularly the liver;