not so much from the small one. Patient had a chill last night. After the usual washing out of the sinuses with the carbolic solution, I inject both of them in with liquid vasaline. This I do, a well as the washing out, by means of a No. 10 catheter, attached to the end of a Davidson’s syringe. The sinus on the back extends from the coccyx to the ribs, and from one ilium to the other. The skin and fascia of the external wall being so thin that the catheter can be seen over the entire extent, as I push it from one part to another for the purpose of washing out all parts of the sack. Patient has been complaining of pain and want of sleep; had a chill last night. He still takes beef tea twice a day, and eggs and other food twice a day, making four meals a day; also, continues the quinine and whisky.

Feb. 21st, 9:30 a.m.,—pulse 98, temp. 101. Feels more comfortable. Discharge of pus much less than yesterday. Wash out the sinuses and inject liquid vasaline.

Feb. 23d, 9:30 a.m.,—pulse 98, temp. 101. Complains of being “very sick.” Speaks English but poorly. Considerable discharge of laudable pus, but not so much as before the use of the liquid vasaline. There is one point near the left hand side of the large sinus on the back, where the walls are adherent. I wash them out with a five per cent. solution of carbolic acid in water, and again inject the liquid vasaline. By gentle pressure made over the upper part of the pouch, I force everything out of it at the opening below, bringing the walls of the sack together over the greater part of the surface. Hoping that the adhesion between the walls, which has commenced, will continue, and soon obliterate, at least, all the upper part of the pouch. Put on the usual compresses; this time using oakum instead of folded cloths.

Feb. 24th, 9:30 a.m.,—pulse 108, temp. 101. Did not wash out the upper or left hand part of the pouch on the back, for fear of disturbing adhesions that are taking place. Washed out the lower part and injected vasaline. A small spot, as large as a ten cent piece, has sloughed, making a hole into the pouch over the lower lumbar vertebra. Another spot immediately above this, and about the same size, looks as if it would slough.

Feb. 25th, 9:30 a.m.,—pulse 100, temp. 100.

Feb. 27th, 9:30 a.m.,—pulse 115, temp. 99.2. Adhesion is taking place between the walls of the sinus, on the left of the vertebræ.

Feb. 29th, 9:30, a.m.,—pulse 104, temp. 100. The sacks, or sinuses, have been washed out regularly every day, and dressed with vasaline.

This case presents several features of interest. The first is the very large amount of secondary hemorrhage, and its location, there being sixty-eight ounces removed at one time and fifty at another, and perhaps thirty or forty at another, from just beneath the skin and superficial fascia of the lower part of the back. The second point of interest would be to know from what vessel this hemorrhage took place. The third interesting feature of the case is its progress and treatment.

At the time of the aspiration the patient was in a critical condition; temp. 105.4, pulse 120; the tongue and chill denoting danger of pyemia. This danger was avoided by drawing off the decomposing blood, and giving the patient a new lease of life. This was but temporary, for six days afterward the same danger presented itself again. This was also avoided by opening the sinus freely, by an incision two inches long, which could not have been done sooner for fear of adding to the hemorrhage.

At the end of six days from this last critical period, the temperature again went up to 103.5, and the pulse and condition of the patient indicated great danger of death from exhaustion—the result of the formation of so much pus. This was avoided by preventing the