2d. Where shall the opening be made? This question is often decided for us by Nature. The puncture, as a rule, should be made where pointing has occurred. If pointing has not occurred, a position from which the abscess can be most easily reached through the vagina or abdominal wall should be selected. The vagina should be given the preference, because the opening would then be at the most dependent portion. The rectum should not be selected as the channel through which to evacuate the pus artificially, although spontaneous discharge into that tube occurs almost as frequently as into the vagina. The patient does not recover as quickly, however, when the abscess opens into the rectum, and more cases of septic poisoning occur from decomposition of the pus as a result of the entrance of air and fecal matter into the abscess-cavity. Further, it may become necessary to keep the opening patulous and to wash out the cavity of the abscess. This could not be done properly if the opening were in the rectum. I believe it to be the best practice to open from the vagina rather than from the rectum, even at greater risk to intervening structures, because it may greatly facilitate the after-management of the case. If the tumor should be located high up in the iliac fossa or in the hypogastrium, the point of election for opening must be somewhere on the abdominal surface in the region of the abscess. 3d. How shall the operation be done? The opening of a pelvic abscess should never be regarded as a simple operation. As much care and deliberation should be taken in the selection of the proper method of evacuation of the pus, and in the operation itself, as was previously given to the diagnosis of its presence. Always begin with the administration of an anæsthetic. This not only protects the patient from unnecessary mental agitation and physical pain, but it better enables the {225} physician to confirm his previous opinion of the case, as well as to be more deliberate in the election of the point of puncture. With the patient in the dorsal position, if it be determined that the pus is contained in a single cavity, and there be no evidence of its decomposition, shown by the absence of symptoms of systemic poisoning, it should be liberated by aspiration. By this means a smaller puncture will be required and the entrance of atmospheric air prevented. If, happily, the operation has been performed early, before the formation of the so-called pyogenic membrane, or at least before sinuous tracts have resulted from burrowing, the abscess-cavity may then collapse and disappear. But should the patient not improve after the pus has been removed, or should the cavity again fill up, it is probable either that there is another pus-cavity, which had not been reached by the trocar, or that there has been developed on the internal surface of the sac an unhealthy fungous, granular condition. Under these circumstances a free incision should be made into the cavity of