sented. The operation was performed two months later in substantially the same manner as in the previous case. The large pouch of the labia was treated antiseptically with a bichloride solution, with the expectation that no suppuration would occur. Owing to its size, tumefaction and ine¬ lastic structure suppuration followed and came near destroying the hopes in the case. The in¬ flammation did not extend to the line of deep incision, but was limited to the pouch of the labia, which being

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... freely, cleansed and washed with sol. carbolic acid, inflammation subsided and all dangerous symptoms subsided, so that patient before I left home was up, parts perfectly healed, and discharged from the hospital apparently well. It is too early at present to speak assuredly of the absolute success of the operation, though all ap¬ pearances at present justify the fullest hopes. I used in this last operation the clamp used for the treatment of haemorrhoids and found it a most appropriate instrument. By reason of the handle it enabled the assistant to hold the part in the most convenient way for suturing, and the thumb screw enables the surgeon to regulate the pressure to be applied so cautiously as not to endanger the integrity of the parts. Feeling that the profession has a new duty to perform to this class of unfortunates, these cases in this connection may not be amiss. Dr. Marcy, in closing the discussion, said that the large number present at this late hour (nearly midnight) shows the interest which American surgeons have in the subject under de¬ bate. He would detain the members but a few moments, although many points of both interest and profit had been alluded to only briefly. He would ask a critical examination of the specimens of the peritoneal sac which he had been to the trouble of bringing, since they showed important pathological changes which appeared recently to have been, in a large measure, overlooked. They are of the first importance to understand if we are to utilize the sac by any method of surgical procedure. Cloquet, in his masterly work, em¬ phasized the great changes which the sac in old hernise usually presented. Dr. Manley evidently entirely misunderstood the use Dr. Marcy made of the words open wound. This was in contra¬ distinction to subcutaneous methods of treatment, as by the yet too generally accepted plan of Dr. Wood of subcutaneous closure by the wire suture, or the methods of cure by injection. He was quite familiar with Dr. McBurney's operation, and had only recently carefully reviewed his method, showing what he thought were primal faults. Elsewhere, in all parts of the body, th· aim of modern surgeons was to secure primary union, and it would indeed be strange if a hernial wound should prove an exception. Why not adopt this plan in the closure of all laparotomies, if so greatly to be preferred. Dr. McBurney's method has found advocates chiefly because the hernial wounds, as ordinarily dressed, are very liable to become infected. Dr. Warren has re¬ ferred to the large size of the animal suture, as compared with silk, which is necessary to be used. This, in a measure, is true if catgut is used, but does not apply to tendon. On the con¬ trary, the tendon suture, the size of silk, is very much stronger, as may be tested by the samples here shown. Dr. Pancoast has just made an elo¬ quent plea for the use of his iron-dyed silk. However he, with most others, admits that it generally must be removed. At the best, silk is encapsuled, while the aseptic animal suture is replaced by bonds of living connective tissue cells. Upon this fact, long since demonstrated, is based, in a large measure, the method here advocated, and it is not too much to believe that the profession will early accept the great gain re¬ sulting from the use of the aseptic animal suture in the coaptation of all aseptic operative wounds. Blind surgery is bad surgery. As advocated, each step of the operation is directed by seeing the exact condition of the parts. The reformed peritoneum is carried within the firm tissues of the abdominal wall. The inguinal canal is re¬ formed. The refreshed pillars of the ring are closed in even continuous suture. The coaptated skin is covered by a layer of germ-proof iodoform collodion. The wound, if aseptic, remains so, and Dr. Warren may rest undisturbed by dreams or visions of discontent, while the patient in se¬ curity goes on to rapid convalescence. The literature of the surgical treatment of affections in the ileo-caecal region has been in¬ creasing very rapidly during the last few years. A great deal has been said and written concerning the propriety of surgical interference in cases of perforative appendicitis, typhlitis, paratyphlitis and perityphlitis. Post-mortem examination and clin¬ ical experience have demonstrated that with few exceptions localized and diffuse peritonitis as well as suppurative inflammation of the connective tis¬ sue originating in the ileo-caecal region, are caused by an antecedent affection of the appendix vermiforniis, which has resulted in perforation or gangrene of that structure. While it cannot be said that unanimity of opinion exists among surgeons in reference to the exact indications for