but it remains for me to respond to the criticisms or objections raised against my mode of operation and of treatment since its first publication. This I shall attempt to do very briefly, as a practical response is at once offered by the greater success of the cases recorded, than that following any other plan yet brought forward. Hypothetical, à priori, objections are not worth discussing; for it is experience alone that can prove the fitness or unfitness, the safety or danger of any operation. It is absurd to descant on the necessary danger of a measure, when experience, sufficiently ample, proves that if such peril be not altogether imaginary, it is so small as not to be taken into account with the benefit to be gained by incurring it. Give importance to such an objection and what operation would be attempted. On Immediate Operation.-Supposed danger of vaginitis is an objection of a cognate character to immediate operation after the accident. It has been said that an immense danger will then attend the suturing of the parts, from the inflammation set up in the vagina, and its tendency to extend to the uterus and neighbouring parts, which after delivery require to be carefully preserved from any such morbid action. But, omitting for the present, reference to the teachings of experience, we may observe, it is a mucous canal that is dealt with, not very delicate, and not prone, like a serous tissue, to so rapid propagation of a morbid process; for within it severe inflammation may be very limited in its extent. Moreover by immediate operation, the otherwise necessary denudation of surface is avoided; only the sutures have to be introduced, and the sphincter divided; the torn edges are thus placed in contact, and only that amount of inflammation necessary to union required; whilst the accurate apposition of surfaces guards against the noxious irritation from secretions. But, supposing the case left, will not the chances of extended inflammation be even greater? will not the inflammation, unavoidable, indeed even necessary to the healing of the lacerated surfaces, be greater, and its duration longer, seeing that the torn parts are exposed to every source of irritation? The reply must surely be in the affirmative. The noxious influence of the lochia on the wound, chiefly in preventing or retarding the healing process, has been urged against immediate operation. The danger therefrom is, however, obviated by the close and accurate apposition of the surfaces when sutured, and when, too, the action of the sphincter fibres in drawing them asunder is annihilated. The ill effects of this discharge are further provided against by the constant attention to cleanliness, and by the use of injections as recommended. A reason for deferring a surgical operation until some time has elapsed after delivery appears, to many practitioners, in the fact of the successful issue of some cases which have been left to themselves. For my part, I cannot admit this as a sufficient argument for delay. The maxim that "delay is dangerous," here holds good in all its force. The chances are greatly against spontaneous cure, even in milder cases; in severe, it is vain to hope for it. Surgical operations would be few indeed, if extraordinary instances of natural cure were allowed generally to contra-indicate resort to them. On the other hand, the operation for ruptured perinæum, and more particularly in recent cases, is not of that formidable character to alarm the patient, or to peril her life; whereas, by it a complete restoration may confidently be anticipated,—a result hardly ever to be reckoned on when the injury is left to repair itself with all the advantages obtainable from general attention to quiet, position, and such like expedients. That this laissez faire doctrine has so extensively prevailed, is readily accounted for, when we consider how very frequently unfavourable have been the results of operative proceedings heretofore devised and put into practice. Too often has the operator not only failed in procuring union of the fissure, but has also rendered the mischief worse by his interference. This sore discouragement will, I believe, no longer attend the surgeon, if the principles of treatment laid down in these pages be followed out; and then what has prevailed so often to deter from immediate operation will have ceased to influence. Lastly, it is to be remembered that resort to operative means may in slighter cases secure an adhesion of the lacera |