mucosa downward

A wall of iodeform gauze was built about the upper margins of the pelvis and drainage secured by inserting to the bottom of the cavity a large rubber drainage-tube and strips of iodeform gauze.

An incision was then made in the appendiceal region, a loop of the distended intestine stitched to the parietal peritoneum about the opening, and the bowel itself then opened. A rubber drainage-tube, 1 cm. in diameter, was sewed into the opening in the bowel wall. Through this tube, the distal end of which was conveniently inserted into a bcttle, there passed off large quantities of gas and liquid feces. The tympanites naturally became less, the intestinal coats regained their tene, and seven days later a tree evacuation of the bowels followed the administration of a dose of castor oil.

Drainage from the abscess has now ceased and the median incision is closed. The fecal fistula still remains but is closing, a process which will soon be complete as the lumen of the intestinal canal is free beyond.

This patient has been sick already four weeks. Let me urge that if general practitioners would let consultants see their patients the first day, instead of the third, not only would general peritonitis be rare but patients would save much valuable time.

This patient was reported well and at work two months later. Case XV. Suppurative Appendicitis. Large Abscess. (Operation, Nov. 20; demonstration in clinic, Dec. 7, 1905).

A. A., aet. 12. Attack began two weeks ago with "stomach-ache." Pain and tenderness became localized a few hours later over McBurney's point. Expectant treatment was applied, but patient grew steadily worse. A large appendiceal abscess had developed when I saw him and he was brought to the Hospital Nov. 20th. The abscess extended from the liver to the pelvic brim and, when it was opened, about two quarts of thin pus were evacuated.

All drainage was dispensed with on Dec. 2nd, and today he is ready to leave the Hospital.

Report of Aug. 9th: scar is firm and hard.

"He looks well and says he is feeling perfectly well. The No symptoms of hernia or other trouble."

(To be Continued)