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542 easily performed and is not so risky or trouble-some as colotomy. A small oblique opening is made through the abdominal wall at the spot usually selected for appendicectomy. The opening should be large enough to admit two fingers, and the appendix is hooked out; this is easy if no adhesions are present. The appendix is drawn through the wound until its base is in contact with the parietal peritoneum, and it is then fixed in this position by a stitch of fine silk or catgut passing through the meso-appendix and the adjacent cut edge of the peritoneum. The appendix is opened immediately or in a few days' time. The cæcum and colon may now be washed out with normal saline, with or without boric acid or other bland antiseptic, or with an astringent solution, through the appendix as frequently as desired. For this purpose a No. 8 rubber catheter with a copper stilette is employed, and a rectal tube with an outflow tube. The patient should lie on his back; should the cæcum get distended and the fluid fail to pass freely, turning him slightly to the left will restore the flow.

Post-dysenteric constipation.— After the subsidence of a dysentery, constipation and balling of the stools is by no means an uncommon event. This complication is best prevented, or met, by enemata of warm water to which a little salt— a teaspoonful to the pint— has been added, or, if the bowel is very irritable, of linseed tea or of thin rice-water. An occasional dose of castor oil, half to one teaspoonful, once or twice a week or of tener, and kept up so long as the motions are not quite healthy, is an excellent routine practice; its action may be supplemented by a glycerin suppository. A course of Carlsbad waters or Carlsbad salts often gives excellent results.

Food and clothing.— In chronic dysentery much attention should be given to clothing and food. The former should be very warm. Dysenteries ought never to feel cold. Cold bathing is very dangerous for them; so are alcoholic drinks of all sorts. Food should be simple in the extreme. Beef, mutton