catgut. Patient was discharged from hospital December 14. Was last seen about six months after the operation, when the result was very satisfactory.

Case 2.-February 17, 1893. J. L.; aged 28 years; a native of Ireland. This was a case of right oblique inguinal hernia, congenital, very similar to case 1, and had been strangulated for twelve hours. After relieving and replacing the gut, the sac and testicle were dissected out and the canal sutured by the open method of McBurney. It healed very readily and left a good solid cicatrix. Patient was discharged March 24, and has not been heard from since.

Case 3.-May 5, 1893. J. L.; aged 30 years; a native of England. Right oblique inguinal hernia. The sac was dissected out and tied off at the internal ring by a double ligature of catgut, and the canal sutured with silkworm gut retained in position by lead buttons after the open method of McBurney. A firm scar resulted. Patient discharged on June 30.

Case 4.-October 12, 1893. P. W.; aged 29 years; a native of Ireland. Right oblique inguinal hernia. McBurney operation. Nothing unusual in the case. Patient was discharged December 11, 1893, and when last seen, about five months after, still had a firm scar retaining the intes tines readily.

Case 5.-December 2, 1893. J. L.; aged 34 years; a native of Denmark. Right oblique inguinal hernia. Operation by the Halstead method. Used catgut for the deep mattress sutures, and interrupted silkworm gut sutures for the skin. Wound healed nicely. Patient discharged February 1, 1894. Has not been seen since.

Case 6.-August 16, 1894. P. A.; aged 44 years; a native of Denmark. Right oblique inguinal hernia. This was my first operation by the combined method of using the Lembert suture as a mattress suture in the Halstead operation, with the idea of turning the edges of the fascia, tendon, and muscle into the old canal, making a groove externally for the reception of the cord, and forming a new canal beneath the skin. Kangaroo tendons, prepared by Dr. Henry O. Marcy, of Boston, were used for the combined sutures, and interrupted silkworm gut sutures for the skin.

Case 7.-September 10, 1894. Operation on same patient for oblique hernia on left side. In doing this operation my supply of kangaroo tendon ran out, and I had to use chromicised catgut for the lowest combination suture. This proved to be infected, and caused a little suppuration in the lower angle of the wound. The skin was opened and the offending stitch removed, after which it healed nicely. Discharged from the hospital October 14. This case was last seen two months ago. Right side was firm, but the scar on the left side had given way slightly, but not sufficient to necessitate the use of a truss. Case 8.-December 2, 1894. J. J.; aged 45 years; a native of Denmark. Right oblique inguinal hernia, irreducible. In this case there

was a tumor the size of a hen's egg, which could not be reduced, and was found to be a large piece of omentum, which had become adherent to the sac. The canal and ring were closed by the combined mattress suture and the skin by a subcutaneous silkworm gut suture. Discharged from hospital January 8, 1895. Patient was last seen six months ago, and the result was excellent.

Case 9.-January 15, 1895. F. A.; aged 43 years; a native of Austria. Right oblique inguinal hernia. Large scrotal hernia. Was operated on by the combined mattress suture with kangaroo tendon and a silkworm gut suture in the skin. There was nothing unusual in the case and he was discharged on March 6. When seen six months ago the result was excellent.

Case 10.-February 2, 1895. R. F.; aged 28 years; a native of Ireland. Right oblique inguinal hernia. Was operated on by the combined mattress suture. The recovery was uncomplicated. Discharged April 2. He has not been under observation since.

Case 11.-March 4, 1895. C. W.; aged 45 years; a native of Norway. Right oblique inguinal hernia. Was operated on by the combined mattress suture; result excellent. Discharged April 12. Was last seen in September, 1895, when there was no tendency to recurrence.

Case 12.-May 27, 1895. E. T. P.; aged 42 years; a native of England. Ventral hernia 2 inches above umbilicus, which had resulted from heavy lifting several years before. The tumor was the size of a small hickory nut and could not be reduced. It was at times quite painful, especially after hard work or lifting. It was found to be a small knot of omentum which had been forced through the fascia between the recti muscles and had adhered to its sac. It was tied off with catgut and the fascia and muscles stitched together with kangaroo tendon. Was discharged July 25.

Case 13.-July 3, 1895. H. B. P.; aged 24 years; a native of the United States. Right oblique inguinal hernia. Was operated on by the combined mattress suture. Case was uneventful. Discharged

July 29, 1895.

Case 14.-July 26, 1895. J. M.; aged 61 years; a native of Ireland. Right oblique inguinal hernia of long standing with very large ring. The combined method was used with kangaroo tendon. Discharged September 12. Has not been seen since leaving the hospital.

Case 15.-August 16, 1895. L. G.; aged 51 years; a native of Germany. Right oblique inguinal hernia of long standing. The combined mattress suture was used with excellent results. Discharged October 9.

Case 16.-September 24, 1895. C. J.; aged 30 years; a native of Norway. Left oblique inguinal hernia. Was operated on by the combined method. Discharged October 29. When seen nine months later there was no tendency of hernia to return.

Case 17.-November 13, 1895. J. S.; aged 52; a native of Finland. 10918-18

Right femoral hernia of several years' standing. The sac was tied off high up by double catgut ligature and cut off close, and the ring closed by stitching the fascia to Poupart's ligament. It healed nicely. Patient was discharged January 11, 1896.

Case 18.-November 19, 1895. J. A.; aged 43 years; a native of Austria. Left oblique inguinal hernia. This case had been operated on two years before in San Francisco, but it had returned. It could not be ascertained what method had been used in the former operation, but the new hernia had formed through the scar. This made it quite difficult to dissect out the sac. The ring was closed by the combined mattress suture with kangaroo tendon. Was discharged from hospital December 15. He was last seen in August, 1896, and there was a very slight recurrence of the hernia through the upper part of the scar, but not sufficient to require the use of a truss.

Case 19.-December 12, 1895. T. B.; aged 29 years; a native of Ireland. Right oblique inguinal hernia. Was operated on by the combined mattress suture method. Discharged February 8, 1896. He has been at hard work firing on steamboats and stevedoring since that time and has not felt the slightest trouble and there is no tendency to recur

rence.

Case 20.-December 18, 1895. H. J.; aged 34 years; a native of Sweden. Right oblique inguinal hernia. This case was operated on by the same method, but unfortunately a severe hemorrhage occurred into the wound, the distention of the clot causing the skin suture to give way. The clot was scooped out and the skin reunited by interrupted sutures of silkworm gut. The recovery was considerably delayed by this accident. Was discharged from hospital February 16, 1896. When seen in October the result was very satisfactory.

Case 21.-December 22, 1895. P. H.; aged 28 years; a native of Ireland. Right oblique inguinal hernia. Congenital, with testicle retained in canal. When the testicle was freed from the sac, it accidentally dropped back into the abdominal cavity, and could not be recovered. The canal and ring were completely closed by combined tendon sutures. Discharged February 11. When seen ten months after the result was excellent, and the testicle had given no trouble, although he had been at hard work for several months.

aged 26 years; a native of Combined kangaroo tendon The patient played football

Case 22.-January 24, 1896. E. F. O.; Germany. Left oblique inguinal hernia. suture used. Was discharged March 12. in a league during the season, and has never felt the slightest pain or disturbance in the wound.

Case 23.-February 6, 1896. T. G.; aged 32 years; a native of Wales. Right oblique inguinal hernia. The combined method was used. Discharged March 31. Has not been seen since.

Case 24.-March 10, 1896. E. C.; aged 36 years; a native of the United States. Right oblique inguinal hernia. Operated on by the

combined mattress suture method. He had an uncomplicated recovery and was discharged May 8.

Case 25.-August 5, 1896. W. A. C.; aged 35 years; a native of Germany. Right oblique inguinal hernia. Operated on by the combined mattress suture method. Recovery uneventful. Discharged from hospital September 19.

Case 26.-October 10, 1896. E. S.; aged 40 years; a native of Ireland. Right oblique inguinal hernia. Technique, the combined mattress suture. A slight suppuration of one stitch delayed the union somewhat. He was discharged December 7.

Case 27.-November 18, 1896. G. M.; aged 18 years; a native of the United States. Right oblique inguinal hernia. Combined sutures of kangaroo tendon. Union by first intention. Discharged from hospital December 9. No tendency to recur.

Case 28.-January 20, 1897. J. A. S.; aged 63 years; a native of the United States. Left oblique inguinal hernia. Scrotal variety of eight years' standing. For seven months prior to the operation he was almost completely disabled from following his trade as a marine engineer. He was a very large, fleshy man, and exceedingly nervous, so that it was difficult to keep him quiet in bed. The stitch above the cord suppurated and gave away, thereby causing a return of the hernia high up on the outer side of the cord. A secondary operation to close this by freshing the muscular edges and inserting new sutures was advised, but he refused to submit. Discharged February 28. The hernia recurred in about two months, and since then has increased in size and is but poorly retained by a truss. It is in fact a very low ventral hernia.

Case 29.―January 25, 1897. C. O.; aged 27 years; a native of Norway. Left oblique inguinal hernia. Combined mattress suture. Was discharged from hospital March 6. When last seen cicatrix was very firm.

Case 30.-February 20, 1897. J. H. S.; aged 46 years; a native of the United States. Left oblique inguinal hernia. Was operated on by the combined mattress suture of kangaroo tendon. Discharged April 1. When last seen, four weeks ago, there was no tendency to return.

Case 31.-March 9, 1897. F. W.; aged 65 years; a native of Germany. Right oblique inguinal hernia of one year's standing. Operated on by the combined method. Primary union was delayed by suppuration. Healed readily when a few pieces of kangaroo suture had come away. Discharged May 8. He has been at work at his trade as sailor ever since, the scar remaining very firm and secure.

Case 32.-April 5, 1897. E. A.; aged 15 years; a native of the United States. Right oblique inguinal hernia of one year's standing. Was operated on by Andrew's lap-joint method, with continuous silkwormgut sutures for the aponeurosis and tendon, the ends being brought out through the skin in order that they might be withdrawn after union had

taken place. Healed by first intention. When an attempt was made to draw out the silkworm-gut sutures they adhered so firmly that it had to be abandoned. They were drawn out as far as possible and clipped off so that the ends retracted under the skin, thus making a buried suture. Discharged April 25. Has not been seen since.

Case 33.-April 11, 1897. C. W.; aged 54 years; a native of Ireland. Left oblique inguinal hernia of eight years' standing. Large, scrotal variety, and was retained by a very crude homemade truss, consisting of a piece of wood about 3 inches in diameter tacked to a band. Was operated on by the Andrew's lap-joint method, with kangaroo tendon. Patient was quite large and fleshy, and union was delayed by a slight suppuration in the adipose tissue. Discharged May 8. He has been working steadily since that time, with no tendency to return.

Case 34.-April 12, 1897. C. B.; aged 54 years; a native of Sweden. Right oblique inguinal hernia of twenty-five years' standing. Was well retained by a truss and did not descend into the scrotum. Operated on by the lap-joint method, using kangaroo tendon for sutures. Union by first intention. Discharged May 2. When seen a few weeks ago showed no tendency to return.

Case 35.-May 17, 1897. J. A. S.; aged 36 years; a native of the United States. Left oblique inguinal hernia of thirteen years' standing. Was caused by a slip of the foot while walking. Operated on by the Andrew's lap-joint method. There was a thick layer of fat over the ring, and union was delayed by a slight suppuration. Was discharged from hospital June 26. No recurrence.

Case 36.-May 21, 1897. C. M.; aged 36; a native of the United States. Right oblique inguinal hernia, which was caused by a heavy lift about six months before. Was operated on by the lap joint method, with chromicised catgut sutures. Primary union followed. He was discharged June 20. There has been no tendency to recurrence of the hernia.

Case 37.-June 28, 1897. J. S.; aged 26 years; a native of Portugal. Right oblique inguinal hernia of eighteen months' standing, caused by lifting a heavy sack of grain. Was operated on by the lap-joint method, with kangaroo tendon sutures. Union was delayed somewhat by suppuration around the skin stitches. Discharged from hospital August

7, and has not been seen since.

Case 38.-June 28, 1897. R. P.; aged 36 years; a native of the United States. Left oblique inguinal hernia. Scrotal variety of eighteen years' standing, which was caused by jumping. Operated on by the lapjoint method, with kangaroo tendon sutures. Union was delayed by a hemorrhage which occurred under the skin, necessitating removal of the superficial stitches in order to scoop out the clot. Was discharged July 30.

Case 39.-July 5, 1897. R. T.; aged 36 years; a native of Norway. Right oblique inguinal hernia of twenty years' standing, which was caused by hard coughing. It descended into the scrotum, and had been