Report of 324 cases which, with but one exception, were traced beyond two years. Two hundred and seventy eases remained cured, while 54. or 16.7 per cent., were found to have relapses. There were 28S eases of inguinal hernia ; of these 48, or 16.7 per cent.. relapsed. Of 22 eases of femoral hernia. 6 relapsed, or 27.3 per cent. Fourteen cases of um bilical hernia showed no relapses, hut are all presented as cures. Another series of eases were operated upon between 1390 and the middle of 1394. Analysis of these showed that the per centage of final cures bears a direct pro portion to the age of the patient. The younger the patient, the better the re sult. The cares over 40 years of age show six times as many relapses as those under 10.
Two hundred and thirty-five cases were operated on by the method of Fer raro slightly modified: free dissection of the hernial sac and high ligation beyond the neck. The anterior pillars are then sutured with silk without transplanta tion of the cord; 53 only operated upon by Bassini's method, substituting the purse-string suture for the interrupted sutures employed by Bassini and using silk. Conclusion that the suture of the anterior pillars is by far preferable to Bassini's method. Results also con firmed the opinion held by most sur geons at present, that primary union is of great importance in securing good and permanent results. Roux (Rev. 1.16d. de la Suisse, vol. xvii, July, '97).
Cure of hernia cannot he considered radical until a period of two years has elapsed since operation, and even after three, four, or five years there may be recurrence.
Of the three varieties of abdominal hernia commonly encountered the um bilical is most readily cured. The crural is the one in which failure is most fre quent. The likelihood of cure is propor tionate to the youth of the patient. Taillens (Revue M6d. de la Suisse Ho mande, July 20, '97).
[Barker (Brit. Med. Jour., Sept. 10, '93) reports 200 consecutive operations for the radical cure of hernia; of these 50 were reported in 1390. But 3 deaths in 200 cases, 1 of which was due to ether poisoning. In both of the other fatal cases the hernia was a large, irreducible sigmoid hernia.
In 21 out of 200 cases, sutures came away either while the patient was in the hospital or later at home. (This affords further evidence in support of the opin ion frequently expressed by Dr. Bull and
me, that non-absorbable sutures not in frequently cause troublesome sinuses.) Own method employed in 79 cases; in 57 Bassini's; in 7 Kocher's; in 2 Mac ewen's. Bassini's operation, when care fully carried out, regarded as the best operation yet devised. • Statistics of Kocher's operations (Deutsche Zeit. f. Chin, B. 4S, H. 5, 6, S. 533, '93) for radical cure of hernia. Since 1393 he has operated upon 163 patients, with 197 herniae. Of these, 14S were inguinal, 17 femoral, 13 umbilical, ventral, and epigastric. The youngest was 1 year, and the oldest 71 years. Of inguinal, 26 were under 1 year; 7S, 1 to 10 years; 33 over 10 years. WILLIAM B. COLEY.] In the radical cure of hernia no oper ation has yielded such brilliant results as Bassini's. During the past eight years 639 hernia; have been personally operated upon, with but 1 death. Bassini's tech nique is departed from in the substitu tion of chromicized kangaroo-tendon for silk in the buried sutures, and a suture is introduced just above the cord, it being passed through the same struct ures below the cord, with a desire to prevent any farther separation of the tissues above the new internal ring, and keeping the cord restricted to narrower limits. The use of absorbable sutures is the most important modifica tion of modern methods. The operation should be performed upon children over four years of age on whom a truss has been given a fair trial without marked improvement, in cases complicated by fluid in the hernial sac, and in all cases of femoral hernia. The results of the operation for femoral hernia are often more successful than for inguinal. W. B. Coley (Med. News, Sept. 2, '99).
Dangers and Complications Associated with the Radical Operation.
The chief dangers to be guarded against are pneumonia and wound-infec tion. Prior to 1890 in the larger propor tion of fatal cases death was due to wound-infection; but at present, with the gradual perfection of technique, I con sider pneumonia from the anaesthetic the greater source of danger. The mortality has been gradually reduced from about 6 per cent., in cases prior to 1890, to less than 1 per cent. in eases operated upon during the last decade. Dr. Bull and I have collected 8000 cases operated upon since 1890, showing a mortality of less than 1 per cent.