98 of the bowels occurred after the 23rd. He was seen by Mr. Russell, who considered that he had probably a volvulus or some form of acute obstruction, though he was suspicious of ,general peritonitis from the first. He asked me to see him on the night of the 28th, when I found the abdomen distended, tympanitic, and intensely painful and tender. There was constant vomiting, not fsecal, no signs of intussusception, and no special signs pointing to typhlitis. We considered diffuse peritonitis

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... ain and probably secondary to a volvulus or some appendix trouble. We 6ried large enemata gently administered and arranged for a laparotomy next day. His condition was then very threatening-vomiting was constant, the pulse was rapid and failing, and his general state was very bad. I decided to open in the middle line in the absence of any defined typhlitic symptoms and in order to be able to explore the peritoneum thoroughly. The peritoneal cavity was distended with intensely foetid sero-pus. There were no adhesions En the upper part, but the right iliac fossa was almost shut off by loose recent adhesions. Finding no band or apparent intussusception and the boy's condition being very bad we decided not to explore the csecum further but passed a drain down to it, flushed out the peritoneum with !hot water, and closed the wound with fishing-gut sutures for the peritoneum and silk twist for the abdominal parietes. He rallied in a few hours and by next day the bowels acted naturally, his pulse fell to 80, and the vomiting ceased. The ' , discharge from the general peritoneal cavity rapidly decreased, but intensely fcetid, necrotic-smelling pus coming :still from the casoal region, on May 18th I made an incision of 32 it. parallel to Poupart's ligament, having its middle -over McBurney's spot, and cut down into a double abscess -cavity, at the bottom of which I found the appendix firmly bound down, curled up, shrivelled, and lying in contact with it a stercolith exactly resembling a cherry-stone. The median drain was removed and a fresh one inserted into the second wound. The median wound healed rapidly. The patient made a tedious but uneventful recovery, but the meal abscess cavity was slow in filling and a residual sinus remained for many months. In July he threatened a relapse of perityphlitic suppuration, the sinus being still open. As his circumstances were very poor we removed him to St. Bartholomew's Hospital, where Mr. Marsh kindly admitted him. Mr. Marsh opened up the sinus, and finding it superficial decided very judiciously not to explore further but to pack the sinus, which accordingly healed slowly by Sept. 2nd. The patient is now fat and well. remarks by Mr. MAUDE.-These operations were performed in a poor cottage in the country, where we had to bring even the sterilised water necessary. The patient had o professional nursing the whole time, though a trained and bighly skilled nurse was in charge at each operation. The case reflects great credit on Mr. Russell, who conducted the dressings and assumed charge during this long period from