Examination of her blood shows: Hemoglobin 62 to 65 per cent; erythrocytes, 3,100,000 per cubic millimeter; leucocytes, 118,

Plate 4-Loop 2 has been cut away and loop I takes its place in the hand of the assistant, with loops 3 and 4 held in his other hand, thereby bringing into apposition that portion of the walls to be included in the second third of the suture. The operator continues the suture to the points of insertion of loops 3 and 4, where again a back-stitch is taken, to fix the suture and prevent a purse-string contraction of the same. The white elevation in the center of illustration, representing mesentery, shows that that portion of the intestinal wall not covered by peritoneum, at the mesenteric border, has been secured in the suture.

case. Together with the above described condition in the pelvis and marked emaciation, a diagnosis of pelvic abscess is made.

Physical exploration of the chest was negative; urinalysis nega

Plate 5-At this point the needle for the first time is made to emerge from the lumen of the bowel, at a point corresponding to where the next stitch would be taken, and appears on the serous coat of one cut end of the intestine. Two-thirds of the circumference of the intestine have been sutured. Suspending loops are now cut and removed.

tive; her pulse ranges from 88 to 100; temperature normal, no history of recent chills nor sweating, bowels constipated, appetite poor, no irritation vesical symptoms.

Plate 6.-There remains now only the last or convex-third of the walls to be closed. What was a complete section of the bowel has been transformed into a transverse incision, extending only one-third of the circumference, at the convex border. Owing to the impossibility of holding the divided edges of the last third in sero-serous apposition, and yet unite this third in the same manner as the previous two thirds, it is necessary to proceed somewhat differently to achieve this same result. The suture itself, being fixed at each end, can now be utilized as suspending threads, the free end in one hand of an assistant and the needle end, where it emerges from the bowel wall in the other, while the operator is free to proceed with the suture. This he does by passing the needle from where it emerges on one cut end to the other cut end, there to be inserted, from without inward, at a point corresponding to that which would be pierced if the walls were in apposition, serous coat to serous coat.

Plate 7.-The needle, after having entered the lumen, is passed out again on the same side, one-eighth inch distant; then over to the opposite cut end, where it is inserted from without in and again emerges from within out, on the same side. This step is repeated alternately on opposing margins until the necessary number of stitches have been inserted. It will be observed that when the needle enters the lumen the last time it makes what might be termed a half-stitch, as it does not return again through the wall, but having reached the point where the suture was commenced, the free end and the needle end will complete the last stitch, when tied, on the mucosa. The needle at this point is then brought out of the lumen alongside of the free-end of the suture. The cross-over stitches are next carefully drawn up, thus bringing into contact the apposing serous surfaces at every point except where the suture ends still protude.

April 18, 1900, the patient was prepared for an operation. An abdominal incision was made, and the large swelling which filled the entire left side of the pelvis, and which was buried in omental and

Plate 8.-The suture ends are held by an assistant, while the operator inserts the eye-end of a threaded needle between any two of the previously inserted stitches, preferably about opposite the point of emergence of the suture ends.

intestinal adhesions was discovered. Because of the complicated condition of the tumor, and the unsatisfactory physical condition of the patient, it was determined to drain the abscess through an incision