t drainage. A large proportion of these cases do
extremely well with incision and drainage, and in the subsequent healing
of the cavity the wreckage of the appendix either undergoes
disintegration or is rendered harmless for further anxiety.

In some cases, however, the damaged appendix remains as a smouldering
ember, ready at any moment to cause further conflagration. This is made
manifest by lingering pains, and by tenderness and warnings after the
abscess has healed, and the patient will be well advised to have what is
left of the appendix removed by operation at a time of quiescence. The
operation, however, may turn out to be a very difficult one. Sometimes
the wound by which the abscess has been evacuated, by nature or by art,
refuses to heal completely, a little discharge of a faecal odour
continuing to escape. The small wound leads into a faecal fistula, and
a bent probe passed along it would probably find its way into the bowel.
The wound is likely to close of itself in due course; but if after many
weeks of disappointment it still continues to discharge, the surgeon may
advise an operation for its obliteration.

It occasionally happens that after operation the scar of the wound in
the abdominal wall yields under the pressure from within, and a bulging
of the intestines beneath the skin occurs. This is called a _ventral
hernia_, and if the patient cannot be made comfortable by wearing a
truss with a large flat pad, an operation may be deemed advisable.

If, in a case of appendicitis, for one reason or another operation is to
be delayed, what treatment should be resorted to? The patient should be
put to bed with his knees resting over a pillow, and a large fomentation
under oil silk should be laid over the lower part of the abdomen. No
food should be given beyond an occasional sip of hot water. Purgatives
should not be administered, as this would be to set in movement an
inflamed piece of bowel. If the case is not acute, a large enema of soap
and water with turpentine may be given, or, possibly, a dose of castor
oil by the mouth. As a rule, however, it is unwise to set the bowels in
vigorous action until the diseased appendix has been removed. No opium
should be given.

Acute intestinal obstruction, cancer of the intestine, inflammation of
the ovary, typhoid fever and renal and gallstone colic, are affections
which are apt to be mistaken for appendicitis. The first of these
resembles it most closely, and diagn