=Removal of Blood from the Right Ventricle of the Heart. Direct Method.=—Insert the long thin twelve or fourteen inch trocar two inches above and two inches to the left of the navel and pierce the abdominal wall, pass the trocar keeping the point close to the abdominal wall, in the general direction of the right shoulder as far as the lower border of the third intercostal space, without fear of breaking any circulation. The right ventricle will thus be reached from which blood can be aspirated as in the previous method. Here again a general knowledge of the anatomy as far as the location of all the organs in the upper abdominal and thoracic cavity is necessary to perform a successful operation. This is removal of blood by aspiration. =Removal of Blood from the Right Auricle of the Heart. Indirect Method.=—Make the incision for the femoral artery and vein. Raise the artery and inject about a pint of fluid in order to cause a pressure on the venous system. Open the vein and insert the flexible rubber drainage tube, known on the market as the Red Seal drainage tube or the Worsham drainage tube. Push this tube up through the femoral, external iliac, the ascending vena cava, through the eustachian valve, and into the right auricle of the heart. In order to determine when the tube is inside the right auricle, the operator should have laid the tube on the external surface of the body from the point of entrance to the point where the right auricle normally should be, allowing for the bend of the vein in its course. Mark the tube, then when it has been pushed into the vein to that point the operator is reasonably sure that the end is in the right auricle. In order to make the tube slip easily it should be greased with a liquid solution of vaseline. After the tube has reached the right auricle the blood may be allowed to drain, or it may be aspirated. Either femoral may be used, but the left femoral is preferable owing to the fact that, the angle at the bifurcation of the ascending vena cava is more obtuse. If the operator desires to remove blood from the heart, we believe that the indirect method is the better way. By the use of the direct method to draw blood from the right auricle by means of the trocar there is always danger of rupturing the circulation. The aorta may be accidently pierced. When the trocar is inserted from below to reach the right ventricle the stomach may be punctured and the liver and diaphragm will have to be pierced which, too, may mean an injured circulation. If any accidental damage has been done, it can not be remedied. The direct method is a blind procedure and is always uncertain. On the other hand if the flexible rubber drainage tube is inserted into the vein it must follow the channel of that vein. It is more certain than the trocar method and there is no danger of rupturing the circulation.