APPENDICECTOMY is not suitable, as a rule, for local anæsthesia. If the cæcum is fixed or the appendix bound down by adhesions, the traction necessary to bring the appendix to the surface causes considerable pain. In ACUTE OBSTRUCTION, when the procedure of enterostomy has been decided upon owing to the gravity of the patient’s condition, local anæsthesia is often of great value. The abdominal wall is infiltrated in the manner described, and a distended loop of bowel brought to the surface and sutured to the parietal peritoneum. A Paul’s tube can then be introduced. INGUINAL HERNIA. Local anæsthesia is specially suited to cases of strangulated hernia, but it may be employed in the ordinary case. It should be pointed out that spinal anæsthesia gives equally good results and is less troublesome to carry out. The injection is commenced with a fine needle a little beyond the lateral end of the proposed incision. An intradermal wheal is produced at this point, a long needle introduced into the subcutaneous tissue, and about half-an-ounce of anæsthetic solution injected in this position. The needle is then passed downwards and medially, and the subcutaneous fat infiltrated in the line of the incision. The needle is then partly withdrawn and again advanced until it reaches the resistance of the aponeurosis of the external oblique. This is gently pierced and about half-an-ounce of solution injected underneath so as to block the ilio-hypogastric and ilio-inguinal nerves. In most cases this is all that is necessary. As additional precautions the line of incision may be infiltrated intradermally, and an injection may be made around the neck of the sac after it is exposed. FEMORAL HERNIA.--A femoral hernia may be anæsthetised by infiltration along the line of the incision, or by injecting around the circumference of the hernia after the method of Hackenbruch. After the sac has been exposed and defined, it is necessary to inject some novocaine solution around the neck, care being taken to avoid the femoral vein which lies on the lateral side.