EXOPHTHALMIC GOITRE may also be operated upon under local anæsthesia after a preliminary hypodermic injection of morphia and scopolamin, though many operators prefer a general anæsthetic on account of the nervous state of the patient. In bad cases a procedure which is often of great value is ligature of the superior thyroid artery on both sides under local anæsthesia. After ligature of the vessels a colloid degeneration takes place in the gland, and the symptoms of hyperthyroidism subside. After a delay of two or three months it may be possible to carry out the radical operation with little or no danger. The incision is two and a half inches in length, and crosses transversely the central part of the thyroid cartilage. The line of the incision is infiltrated with novocain solution in the ordinary way, and both superior thyroid arteries exposed and ligatured. Operations on the Thorax. The greater part of the wall of the thorax is supplied by the intercostal nerves. In front the supraclavicular nerves come down as far as the second intercostal space or sometimes as far as the nipple, and the lateral and medial anterior thoracic nerves supply the pectoral muscles, sending a few twigs to the overlying skin. The long thoracic nerve extends down the side of the chest, supplying the serratus anterior. The intercostal nerves can be blocked in the region of the angles of the ribs and the supraclavicular by carrying a line of infiltration along the clavicle. The anterior thoracic can be blocked by deeper injections. In this way the greater part of the chest wall and the pleura can be anæsthetised. ACUTE EMPYEMA.--This operation should always be performed under local anæsthesia. Exhaustion from septic absorption and from the antecedent pneumonia or other disease, with the dyspnœa from the pressure of the pus on the lung may render a general anæsthetic highly dangerous. The method of producing local anæsthesia is simple and easily carried out. A point is selected on the rib which is to be resected a short distance behind the line of the incision and an intra-dermal injection made with a fine needle. A long needle is then substituted and passed down to the upper border of the rib until it reaches the plane between the external and internal intercostal muscle, the injection being continued lightly as it advances. When the desired point is reached one or two drams of the solution are injected. The needle is then slightly withdrawn and passed to the lower border of the rib to reach the same plane and the same procedure carried out. The infiltration is then carried along the line of the incision or it may be made to pass obliquely upwards to the rib above and obliquely downwards to the rib below so as to catch up the nerves coming from behind into the area of operation. The anæsthesia of soft parts, bone, and pleura is perfect after the above injection. Operations on the Abdomen.