Circular letter was sent to over one hundred prominent surgeons. Thirty four surgeons gave an approximate per centage of recurrence in their practice; this percentage varies from 1 to 15 per cent. This last percentage agrees with the figures of Professor Girard, of Berne, who claims that the percentage or recur rence in Europe will amount to 15 per cent. The percentage will average 5.5S per cent., based on 6027 operations by 34 surgeons. From statements con tained in letters received in answer to the circular, it is fair to infer that only one-half of the total number of opera tions were reported. This would bring the percentage up to near 15 per cent. These letters show that infection is less frequent and that there is no recurrence when wire or silk-wo•m gut is used in the Phelps, Halsted, or Abbe method of operation.
The Phelps operation considered an ideal one. It is the only one that in sures a successful and a permanent cure. As stated by Abbe, silver wire or silk worm gut should be employed in prefer ence to absorbable sutures. Suppura tion has nothing to do with causing re currence; the real causes of relapse or recurrence are deficient origin (attach ment) of the internal oblique muscle, pressure of truss (where one has been worn), length of time that hernia has existed, lack of nerve- and blood- supply, and intra-abdominal pressure rupturing the cicatrix. The latter factor can be disregarded if the Phelps method is em ployed, because if the wire mattress is once placed properly there is no possi bility of relapse by a rupture from the intra-abdominal pressure. The doctrine advanced by some writers doubted that varicocele is a causative factor in in guinal hernia. All herniotomies should be regarded as modified laparotomies. B. M. P,icketts (Phila. Med. Jour., Feb. 9, 1901).
of the patient and the size of the hernia, cannot be too strongly condemned.
Roux, of Lausanne, Switzerland (per sonal communication), has operated upon 1398 cases, with 5 deaths.
[Results of 1042 operations for radical cure performed since 1888 by Bull and Coley; 522 by Dr. Bull, including 66 children, and 531 by myself, including 365 children. Of Dr. Bull's cases, 134 were operated prior to 1890 by the Czerny and Socin methods, and show the great superiority of the Bassini method.
Out of the 134 cases operated upon prior to 1890, only 49 healed by primary union; 40 per cent. relapsed within two years after operation, and most of these relapses occurred during the first year after operation.
It should be noted that of the 134 eases only 16 were in children under 14 years of age.
In regard to the suture material, silk was used in 12 cases, and in every ease traced a sinus developed after a longer or shorter interval after operation, re maining open until one or more sutures were finally discharged or removed. The
silk was prepared by boiling in a 5-per cent. carbolic-acid solution just before using it.
The mortality (3 deaths) was con siderably higher than that in the later cases. Death was caused in 1 case by ligature of the omentum too close to its attachment to the bowel; 1 died of Inemorrhage and 1 of peritonitis.
Of the total number of cases,-1053,— 924 were inguinal, 94 femoral, 19 .um bilical, and IS ventral; 100 of the cases were females, 461 were children between 4 and 14 years of age, and 502 over 14 years.
Bassini's method was employed in 618 cases, with 12 relapses. Of these cases 371 were children under 14 years of age, with 3 relapses, or V, of 1 per cent.; 247 adults over 14 years, with 9 relapses, or 3.7 per cent. In the GO cases in which the cord was not transplanted, but in which the other steps of the technique were the same as in Bassini's method, there were 4 relapses. Of Dr. Bull's cases, 170 were operated upon by Bas sini's method, and of Dr. Coley's cases, 448 were operated upon by Bassini's method.
Broca, of Paris, has operated upon 1064 cases by his own method, with 9 deaths; a large proportion of these cases were children. The number of cases traced is not stated. Halsted has oper ated upon eases with 1 death. In 205 operated upon by his own method, there were 12 relapses. Macewen has operated upon 224 by his own method, with 2 deaths. Of this number 107 were traced with 15 relapses and 93 cases well from two to ten years after operation. WILLIAM B. COLEY.] Analysis of 133 cases of hernia oper ated upon for radical cure with no mor tality, and, as far as traced (78 cases), only 6 relapses. One-third of the entire number had been under observation ten years. The writer attempts to recon struct the canal, and uses buried sutures of kangaroo-tendon, to which he at tributes, in great measure, his very ex cellent results. Marcy (Lancet, Aug. 16, '93).
There were 477 operations for radical cure in children under the age of 13 years,-14 for umbilical hernia, 41 for inguinal hernia in girls, and 395 for in guinal hernia in boys. Of all these eases, a single one, a boy, died from sep tic peritonitis. Although strangulation, which is not common in very young children, yields readily to taxis, as a rule, operation should nevertheless be performed, especially when associated with ectopia. Of 250 cases seen after six months, only 3 had had a relapse; 2 of these had again been operated ou and definitely cured. Several of the children had had whooping-cough after the oper ation. Broca (Nouv. Arch. d'Obstet. et de Gynec., Aug., '95).