CHEST AND ABDOMEN. 217 teum and is then loosened, with its sheath, from the rectus muscle. A dap of muscle is thus obtained which is turned up over the external ring and fixed by sutures. The author has made trial of the opera¬ tion only upon the cadaver.-Cenbl.f. Chirg., 1890, No. 45. In the 140 years since the discovery and first description of hernia obturatoria by Arnaud de Rousil, there has been a steady increase in the number of recognized and success fully operated cases of such

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... tion. Still Kronlein finds that the diagnostic points are often fancifully stated. From 1870 to 1884 he did not meet a case, but in the next five years he saw 4. Of these only 2 were operated, as the other 2 were already moribund. As an indication of the relative frequency of this form, he stated that during the same five years he did a total of 138 operations for hernia. The two operated cases have been previously described by Munzinger and Brunner. They each resulted fatally, one in a lew hours from collapse, the other from perforation. The symptoms are those of ileus, together with pain in the thigh, radiating from Poupart's ligament to the knee, excessive painfulness from pressure over the corresponding regio pectinea, and still more behind the adductors in the direction of the oval foramen, in one case some swelling of the leg and slight prominence of the regio pec¬ tinea, pain on motion in the hip. But he gives full details of a fifth observation, in which all these symptoms (on the left side) were present in a boy of 12 years, and yet the cause was an intra-peritoneal pelvic exudation instead of an ob¬ turator hernia. In reality, however, no case of such hernia has ever been observed in childhood, this form being particularly the hernia of old age. The double operation was performed three days after the acute onset of the trouble. On opening below Poupart's ligament to the obturator canal the only change found was a distension of the ob¬ turator vein. Then on performing laparotomy (opening along the ex-