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Pilonidal sinus, phimosis, hydrocele, varicose -veins and anal complaints are familiar in the list ,of conditions which commonly inflict varying degrees of discomfort in the younger age group of the population. Implicit in the undertaking of treatment is the expectation that comfort or cure ,can be achieved by a relatively minor procedure followed by a rapid convalescence and return to work. The most mutually satisfying extent to which this expectation may be realized is conditioned in the majority of cases by the method of surgical technique and management. True, one method may differ from another only in detail, but it is the detail that may in large measure decide the .smoothness of the post-operative course, the quality of the end result, and the time spent in hospital or off work. In these respects the subsequent modifications and details of technique have proved valuable in the treatment of the conditions already mentioned. Some comments have also been made on evaluation of treatment particularly in regard to varicose veins. Pilonidal SinusThe difference between primary and secondary healing in these cases almost implies the difference between three weeks and three months in hospital. 'The essentials for success in primary suture are well recognized in complete excision, meticulous asepsis, and a method of closure which eliminates dead space. The last is of first importance since most failures are initiated by tenting of the superficially healed skin and subcutaneous tissues. The cardinal point is to ensure that the soft parts are not -only in mutual apposition but that they are also in close contact with the aponeurotic covering of the sacrum. Indeed, the principles are the same as in the application of a full thickness skin graft to an awkward contour. The two factors which militate against success are the relatively avascular sacral bed and the forces of tension.which are constantly persuading the sutured soft parts to assume the more relaxed position away from the sacrum. For these reasons a pressure dressing is a sine qua non and must be maintained for at least I4 days. If

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I25 vision of specific remedial physiotherapy for a short period a day in the early stages with the progressive addition during convalescence of physical training, occupational therapy and mvntal exercise so that gradually the whole day is devoted to the process of recovering the physical and mental capacity for a full day's work. For example a patient in the later stages of convalescence from a severe pneumonia might spend the final days in hospital in the following manner. 9-I0 ward duties, I0-I0.30 standing chest class, I0.30-II break, II-I2 lecture, I2-I lunch, I-3 workshops or gardening, 3-4 standing chest class followed by games, 4 tea. In this manner a few days extra are spent in hospital in getting thoroughly fit instead of leaving at the earliest possible moment and spending an indeterminate convalescence at home. It is not necessary to live in hospital for the final stages and, indeed, the greater contentment of being able to live at home is a positive contribution to rehabilitation; but facilities must be available for the patient to spend the whole day at the rehabilitation centre and to have a midday meal and rest.