There are, however, valid objections to the general application of local anesthesia and the cases for its use should be selected with care. It does not produce relaxation nor does it give the surgeon perfect control over his patient. These are considerations which must be taken into account, especially in operating on patients of highly nervous temperaments. Though the patient may be convinced that he will suffer no pain, the mental attitude toward the local anesthesia, together with fear, may operate so strongly as to constitute a shock to the nervous system so great that a general anesthetic should be used and the local method abandoned, even were it apparently indicated. Again, the injection of anesthetic drugs in cicatrical and inflamed tissues is quite difficult of accomplishment and because of the peculiarity of these tissues, diffusion throughout a given area is imperfect, hence insensibility is not complete. The extravagant claims of enthusiastic advocates of this method of anesthesia have retarded its progress. Thus, in the hands of the competent operator it was given but a perfunctory trial to be discarded as impossible. At the present time, however, local anesthesia bids fair to become the method of choice, other things being equal, for many major operations not yet thus performed. Recent investigations alone these lines have developed methods of its application whereby it is possible to render insensible large areas of the integument, and regional anesthesia is performed by anesthetizing nerves proximal to the seat of operation, thus rendering amputations feasible. A single element which has entered as a factor in retarding the progress of local anesthesia in general surgery, is that of regarding the operation as one fitted to the method rather than to the patient under consideration. It is obvious that this is a fallacy and the main issue in deciding between general and local anesthesia is: what will the patient best tolerate? In coming to a decision in the matter one should make a general survey and weigh first the general health of the patient; whether he be in perfect systemic condition or undermined by disease, whether the shock will be greater from one method than the other, and whether the part of the body to be operated on is one which will lend itself better to one method than to the other. These elements are being and will continue to be considered as preliminary to operative procedure and in consequence, general anesthesia will cease to be given in a routine way. +GENERAL PRINCIPLES AND ESSENTIALS+ The first essential to the successful production of local anesthesia is a proper equipment and one that is in good working order. Not only is it necessary to employ the best drug to this end but also to use a syringe having perfect mechanical construction and one not injured by boiling; as also needles of the length, lumen and shape suitable for the surface to be injected.