Another illustration is found in burns of the second degree. Here large blisters have formed and broken, and much skin is denuded of its cuticle. In such a case the author administers an anesthetic, opens the blebs, removes the detached skin, scrubs the parts with an antiseptic solution, covers the denuded surface with strips of gutta-percha tissue, and leaves the case to nature. When a change is made, it should be of the outer dressings only. And the reasons for this treatment are that in such burns “the serum which is thrown out is germicidal, and is destroying all the bacteria upon the skin very rapidly. This germicidal action will go on so long as the serous exudation is free, but when the coagulation of lymph begins on the surface, this action becomes very much diminished, and the bacteria are then liable to liquefy the lymph and grow very rapidly, as new portions of serum are thrown out. This leads to sepsis and sometimes to the formation of thrombi, with necrosis of the duodenum and perforating ulcer. The patient’s friends complain if the dressings are left long in place, and yet I know of no wounds which do so well when ‘neglected’ as burns.” In the discussion that followed, the author, being asked what he would do with suppurating sinuses, said “he knew of sinuses that had been kept open week after week and month after month, and had proved veritable gold lodes to the surgeons. If the surgeon had been compelled to go away for a time, these sinuses would have healed long before they did. This might seem like a joke, but it was a fact with which he was brought face to face all the time. His rule was to leave sinuses alone, in the belief that the poorly fed granulations lining them would in time cause approximation of the walls, and healing would occur. It was true that exceptions would have to be made for some sinuses, but that did not affect the rule as given.” Such considerations give accentuation to the dictum of Velpeau, that “nature is a good physician but a bad surgeon,” and dignify the _bon mot_ of Holmes, who, seeing the smoothly healed and finely cushioned stump which resulted in time after an amputation, exclaimed: “There’s a divinity that shapes our ends, Rough hew them how we will!” For the surgeon’s far more than the physician’s successes depend upon the _vis medicatrix naturæ_, and he who is best versed in physiological and pathological processes, and administers the surgical art accordingly, will secure the best results. They who neglect their surgical cases from ignorance, carelessness, or a wanton disregard of the great pathological dicta of the day, can find no justification in these teachings, for the truth, as embodied in the author’s closing words, puts all such to shame and confusion: “A good deal of skill is required in order to neglect wounds well. This ‘neglect’ of course implies a proper understanding of the processes with which one is dealing.”