UMBILICAL HERNIA.--Local anæsthesia is sometimes of great value in dealing with umbilical hernia, especially if it is strangulated, in stout patients who are bad subjects for a general anæsthetic. The injection is best made around the circumference of the hernia. Several intradermal injections are made at points around the swelling, and through these the long needle can be introduced and the deeper tissues infiltrated. If the muscles are fairly well defined and can be felt, they may be infiltrated at the commencement, but it may be advisable in fat subjects to inject only the subcutaneous tissues to begin with, and to delay the injection of the muscles and extra-peritoneal fat until the sac has been opened and a protecting finger can be introduced to guard the intestines. Omental adhesions can be divided without causing pain. If the intestines are extensively adherent to the sac it is better to infiltrate the points of adhesion, as extensive manipulation may cause cramp-like pains. After the circumferential injection has been made in these cases, it is best to wait for ten or fifteen minutes before making the incision in order to allow the anæsthetic solution to diffuse. SUPRAPUBIC CYSTOTOMY.--In operations for drainage of the bladder local anæsthesia is highly successful. The skin and subcutaneous tissues are infiltrated in the line of the incision. The needle is then carried between or through the recti muscles and several drams injected into the layer of fat in front of the bladder. It is unnecessary to inject the wall of the bladder itself. HÆMORRHOIDS.--In patients in whom there is some contra-indication to the use of a general anæsthetic the removal of hæmorrhoids can be carried out quite safely and painlessly under local anæsthesia. A circumferential injection is first carried out round the muco-cutaneous junction. It is best to start the infiltration about an inch out from the anus as the skin immediately around the anal orifice is extremely sensitive. The infiltration is made subcutaneously, and each re-insertion of the needle is made just short of where the previous injection stopped. When the circumferential injection has been completed, a finger is passed into the rectum, and the long needle introduced through the anæsthetised area, injecting as it advances, to a depth of about 2½ inches, keeping just outside the sphincters. Four such injections are made, one on each side of the bowel, one in front and one behind, from 5 to 10 c.c. being injected in each position. Anæsthesia results almost immediately and the anal canal can be readily dilated.