inflammation over the right ilium as there was over the left. The fluid in the sinus has increased gradually since the evacuation of it with the aspirator. The inflammation that has now existed for two or three days over these parts of the sinus, led me to conclude that the blood which was left and that which had accumulated, had undergone decomposition and was now pus. I used an exploring needle and found this to be the case. I then introduced a trocar and canula, and drew off fifty ounces of pus, slightly tinged with blood. I re-adjusted the compresses and bandage over the sinus, hoping that a part of it at least would become obliterated before it became necessary to open it more freely.

Feb. 15th, 5 p.m.,—pulse 112, temp. 102.5. The inflammation over that part of the sinus to the right of the spine is still about the same as yesterday; also that over the left ilium. The fluid has increased during the last twenty-four hours so that there is now nearly as much as was drawn off through the canula yesterday. I concluded that further delay to a free opening was useless; consequently with the patient lying on his right side, and near the edge of the bed, I made an opening one inch long in the lower portion of the abscess,—for I now considered it one,—near the spot where the needle of the aspirator and the trocar had been previously introduced.

After the discharge of about a pint of bloody pus, the stream was checked by a clot of blood coming into the opening. I enlarged the opening, making it about two inches long, when a clot the size of a hen’s egg came through, followed by about a pint more of bloody pus. After syringing the cavity with a five per cent. solution of carbolic acid in distilled water, and introducing a tent about four inches long, I applied compresses and bandages. Ordered the quinia continued, and whisky and beef tea.

Feb. 16th, 9 a.m.,—pulse 100, but feeble; temp. 97.8. Removed dressings which were saturated with pus and blood. The latter had excited the anxiety of the Superintendent during the night, and he applied an additional bandage. There was perhaps five or six ounces of thick, flaky, yellow pus discharged. No hemorrhage; syringed the cavity with a five per cent. solution as before, and introduced a clean tent.

On examining the inflamed spot over the left ilium, I detected fluctuation over the anterior part of the crest of the ilium, near the gangrenous spot, and extending down over the abdomen. However, it seemed to be superficial, at least, not deeper than the connective tissue between the external and internal oblique muscles, and not more than one inch by two in size. This I opened, and squeezed out about half a ounce of pus. Introduced a tent and applied oakum over both tents, for the purpose of absorbing the pus, and applied a compress over the main sinus or pouch, and a bandage over the whole lower part of the body.

Feb. 17th, 9 a.m.,—pulse 96, temp. 99. Ordered a laxative of carbonate of magnesia. Both openings discharging very freely. The gangrenous spot over the left ilium is separating from the surrounding tissues. Removed considerable dead flesh from this spot, leaving an opening or pouch one inch in diameter, leading down to the pubis, just beneath the oblique muscles.

Feb. 19th, 9 a.m.,—pulse 106, temp. 99.5. Both sinuses discharging very freely. Made an opening in the lower part of the pouch to the left of the pubis for better drainage, as the patient usually lies on the right side. Laxative has operated. After washing out both sinuses with a five per cent. solution of carbolic acid, I inject the smaller sinus with liquid vasaline.

Feb. 20th, 9 a.m.,—pulse 112, temp. 103.5. There is a great amount of pus being discharged from the large sinus on the back,