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PURULENT PERICARDITIS -WITH EMPYEMA. [MDTIAO 9 and there was no adventitious sound, and no cough or expectoration. The only area of dullness was the one alluded to. This was triangular in shape, with the apex at the fifth rib in the mid-axillary line, becoming broader towards the costal margin, where itwas continuous with the swelling felt below. There were no vocal fremitus, rdles, or crepitation to be detected over the area. The uterus was repeatedly irrigated, and portions of fetid secundines removed. Quinine and opium were administered internally, and enemata to relieve the boweis.Progress.-June 27th. Condition much improved; there was no sickness, and she was able to take liquid nourishment. Temperature, X020 pulse, 08o; respirations 32. I was called hurriedly on June 30th, and the patient complained of pain in the left side over the dull area, which I found increased. There was pain at the end of inspiration, and a pleuritic rub was audible over the area. Temperature 1040, pulse 124; respirations 36. On July 2nd, Dr. Tudor Thomas, who visited her for me, found symptoms of effusion into the pleura, and her condition very grave. On July 3rd I made an exploratory examination with a long needle of large bore in the seventh space in the mid-axillary line, and from a depth of 2i in. withdrew a syringeful of thick, reddish offensive pus, and an operation was advised as the only means of saving the patient.Operation.-The condition of the patient was extremely grave. The pulse 140, temperature 1030, respirations 40. It was a question whether she would stand the shock of the operation. Dr. Edgar Davies, who gave the anaesthetic, examined the patient and found incidentally a patch of consolidation in the right base. I made a 3j in. incision over the eighth rib and removed about 2 in. of its length, and on opening the pleural cavity a considerable quantity of thin blood-stained serum escaped from the sac. Portions of costal pleura were excised, and in a window about 2 in. square, the lung presented. The needle was again plunged into abscess and a long sinus forceps was with difficulty forced into the abscess cavity, but so dense and tough was the lung substance that I had :to introduce a grooved director and cut it freely with a scalpel before I could introduce the finger. About io oz. of thick reddish and most offensive pus was evacuated. The cavity had a craggy uneven wall and extended to the pericardium, the finger feeling in detail the movements of the heart in its sac. Iodoform'was introduced into the abscess cavity, two large drainage tubes inserted, the wound around the tubes packed with iodoform gauze, a large padding of alembroth wool applied, and the patient put back to bed. Dr. Davies injected strychnine before and during the administration of the anaesthetic. She bore the operation (which did not last 20 minutes) well.Progress.-The case was dressed daily, and a great deal of pus continued to be discharged for ten or twelve days. The temperature continued high, IOIO to 1030, and though she took nourishm...

I venture to illustrate this lecture with accounts of my first and of my latest case of hour-glass contraction treated by operation. I published a detailed description of the first and most remarkable case, with five others,

SURGEON TO GUY'S HOSPITAL, LON'DON.THE object of this paper is to suggest that the need of rest after operations has been greatly exaggerated, witlh the result th-at patients are kept in bed much longer than is really necessary. Traditions and long-established 1habits are generally followed blindly and witlhout question, whereas it is our -bounden duty, in the interests of progress, to submit them to criticism, to continue what is good, to cast-aside what is useless, irksome, and harmful, and to evolve better and mlore lhum-ane methods. For some ten or more years I have been asking myself the following questions:Is it necessary or kind to insist on-so