63 manipulative methods, the stronger, to my mind, is the o indication for open operation. Conversely, the nearer t the age-limit is approached, the greater the care s necessary before deciding to subject the patient to s the extra risk of an open operation. Since Burghard I emphasised the importance of the ilio-psoas, and s recommended the division of this tendon in papers t published in 1901 and 1903, I have invariably severed t it as a part of the open operation for reduction of congenital

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... slocation. As regards the second operation, I think this is particularly indicated in a case in which previous bloodless reduction has been accomplished, but has been followed by relapse, and which is still young enough to stand a good chance of a cure resulting. The method I have adopted with success has differed from Jackson Clarke's in that the joint is not opened. The periosteum is incised parallel to and about a third of an inch above the acetabular margin, and a flap of this membrane is roughly rugined down till the cotyloid ligament is reached and elevated from the acetabular margin. A few stitches are inserted to keep this flap turned out from the bone, and also to take in the slack in the upper part of the capsule. A more certain result should be obtained by making use of some form of bone graft. These procedures are not, in my opinion, justified at and above the age-limit, nor should either be made use of till the possibility of obtaining a satisfactory result by means of the bloodless method has been carefully excluded.-I am, Sir, yours faithfully, Dec. 23rd, 1919.