Prof. H. Starck states that among 450 cases of Basedow’s disease observed in the last few years sixty-nine were operated on by prominent surgeons, nearly all of which had been seen by him before the operation. From his observations he concludes: 1. Operation effected a cure (_i. e._, complete physical and mental restoration) in approximately 30 per cent, improvement in 35 to 40 per cent, while in the other cases it proved ineffective or was followed by a change for the worse. 2. The operative mortality was 9 per cent (6 deaths in sixty-nine cases). Kocher had a mortality of only 3.1 per cent; according to others, however, it is 12 per cent. 3. If the surgeon accepts the view that a persistent thymus is responsible for a fatal outcome, although no positive evidence is at hand, he must determine whether this gland be present before resorting to resection of the struma; if it is, ligation of the vessels or resection of the thymus is to be considered. 4. The choice of the anesthetic is of great importance as to the outcome of the operation. The Basedow’s type with predominating nervous, myasthenic and psychic symptoms is best operated on under general anesthesia, the other cases under local anesthesia. 5. Operation is contraindicated in status lymphaticus; if it can not be avoided, a local anesthetic should be employed. 6. In many cases the operation only lays the foundation for successful internal treatment. 7. The most unfavorable time for operation is that of increasing intensity of the disease; the most favorable, the stage of latency, or arrest. 8. The most suitable cases for operation are those in which there is a “goiter heart;” also some cases with classical Basedow’s symptoms. Only slight success is to be expected in the presence of a nervous-myasthenic-psychic symptom complex with but moderate cardiovascular symptoms. 9. The size of the goiter as determined by palpation is no criterion as regards the question of operation. Small, soft goiters are often of greater significance than large, firm ones. 10. The blood picture also is of no importance in considering the operative treatment, since it is not materially influenced by operation.—_The International Journal of Surgery._ ACUTE APPENDICITIS.