The patient, a doctor's wife, 43 years of age, was taken with a severe pain in the abdomen November 17, but as she had been subject to such attacks at intervals for several years, it was not thought serious. Her condition, however, continued to grow worse until on November 27 her husband became alarmed and sent for me to operate upon her, if an operation was thought advisable. Another twenty-four hours elapsed before I saw her. At that time her face was drawn, eyes sunken, temperature 102, pulse 120, tongue dry, brown and heavily furred. She had been vomiting bile; the abdomen was slightly distended, the walls tense and too tender to admit of any but the gentlest manipulation. Pain was referred to the right side, and as it was thought we had to deal with an abscess, it was considered safer to open the abdomen than to try to