if the temperature habitually rises above this limit. On receiving a patient the diurnal variation of his temperature is tested, and if it exceeds one hundred he is placed in the recumbent position and kept there until it is brought under control.

Objections are often and freely raised against such a procedure because it is not in conformity with the prevailing doctrines which teach that patients of this kind should take an abundance of exercise in the fresh air out-of-doors. Confinement to bed, however, gives him neither, and hence it is a hard precept for him to accept. But a direct appeal to the reasoning faculty will convince most of these patients that exercise and fresh air are, after all, not so necessary to secure restoration. You can assure them on physiological ground that normally heat is developed by or during muscular contraction; and that a larger amount of heat is dissipated during muscular contraction in phthisis because the heat-regulating centers are already disturbed; hence, by exercising, they elevate and aggravate the fever, and defeat the very end and purpose which the physician has in view.-Practitioner's Monthly.

It

DIAGNOSIS AND TREATMENT OF GASTRIC DISEASE. Dr. H. C. Tweedy, Physician to Stevens' Hospital, Dublin, contributes some observations on recent aids to the diagnosis and treatment of diseases of the stomach. The splashing sound, or "clapotement," a method of examination lauded by Riegel, often gives better results than percussion. This sound may be elicited by pressing repeatedly with the tips of the fingers in the epigastric region. Its lower limit rarely extends below the level of the umbilicus, unless the stomach be dilated, or else displaced downward. may be heard in healthy persons more or less plainly if they have taken a large quantity of fluid, or if the abdominal walls are relaxed, andnot overloaded with fat. By this method we are able to ascertain the size and position of the stomach. Splashing may under some circumstances originate in the transverse colon; but then the splashing is found along a straight line, or along a curve which is slightly convex above, thus distinguishing it from that originating in the stomach, the latter forming at convex line below. If these differences are not distinctly marked, we may inflate the stomach by means of a tube. After insufflation of air the splashing sound in the stomach ceases, while that in the colon persists; but as soon as the air is allowed to escape from the stomach, the splashing sound reappears. This artificial distension of the stomach by gas or air has been much employed as an aid to diagnosis, with the object of enabling us to map out the contour of the organ and especially its greater curvature. Dr. Tweedy also directs attention to the use of electricity in the treatment of diseases of the stomach, especially by using the electrode recently introduced by Dr. Max Einhorn, of New York. The most marked results have been obtained, both in cases of dilatation and also in chronic gastric catarrh. The Dublin Journal of Medical Science.

TYPHOID FEVER IN CHILDREN.-A. Moussous (Arch. Clin. de Bordeaux) states that in a series of fifty consecutive cases of typhoid fever in children under the age of 15 years he had only three deaths. He fully accepts the opinion that the disease is less serious in childhood than in adult life; there is less prostration, less hebetude, and seldom much diarrhoea or pneumonia. At the same time the fever presents the

same characters as in the adult, and is often high104° and even more, the pulse rate is often also increased to 140, but this rapidity has not the serious significance which it would have in the adult, nor are complications so often observed. The disease, however, is more severe in infants under 2 years than in children above that age; this fact is called in evidence to support the view that one of the reasons of the comparative mildness of the disease in children is the activity of their digestive secretions which tend to inhibit the growth of the pethogenic organism. Another reason he finds in the greater functional activity of the liver and kidneys leading to a more perfect elimination of the poisonous bodies produced within the organism during the fever. On this head Moussous presents some new observations. Bouchard and others have shown that the toxicity of the urine in increased by typhoid fever, and that this toxicity persists for a varying period after defervescence, for as much as four or five weeks when the disease is treated by the expectant method, for still longer if antipyrin is used. With the cold bath method the toxicity of the urine is very high during the fever, but ceases quickly when defervescence has taken place (Roque and Weill); naphthol diminishes the production of the poisonous substances both during the fever and during convalescence. Moussous finds the toxicity of the urine in children suffering from typhid fever is sometimes increased during the pyrexial-period, sometimes at its close, but that in either case it becomes normal after a few days of freedom from fever. The elimination of the poisonous substances, therefore, in children who are treated by the expectant method very nearly resembles their elimination in adults treated by baths. Moussous does not recommend resort to baths in in the case of children, and notes one case in which serious syncope followed cold sponging. He advises the administration of laxatives every other day, a copious milk diet and small doses of quinine.-Brit. Med. Jour.

Surgery.

She

SPASMODIC TORTICOLLIS TREATED BY AVULSION OF THE CENTRAL END OF THE SPINAL ACCESSORY NERVE.— A lady aged twenty-eight was brought to me in August, 1885, by the late Dr. Troutbeck, for very troublesome spasm of the left sterno-mastoid muscle. first experienced trouble in the neck eight years before, soon after the death of a near relative; the jerking of the head had persisted ever since, gradually getting worse. The patient was a tall, thin girl, and delicate locking. There was no history of fits; she had had facial neuralgia, but not severe migraine. The spasm appeared to be entirely limited to the left sterno-mastoid muscle, and was so severe and constant as entirely to preclude the patient from mixing in society, and at night it was some time before she could get to sleep. Dr. Angel Money applied the constant current to the muscle on nine occasions, but with no benefit; indeed, the spasms appeared to be increased in severity. So on Sept. 10th, 1885, with Mr. Hudson's assistance, I exposed the spinal accessory nerve by means of an incision along the anterior border of the upper part of the sternoid-mastoid muscle, intending to stretch it and excise a considerable portion. In stretching it from the central end I felt the nerve gradually give way, and I pulled out a

long, slender nerve from the jugular foramen and excised four inches and a half of it. No special symptoms were noticed from the tearing of the nerve roots. The wound healed without complication, and the patient returned home on Sept. 23d. She called on me on Sept. 8th, 1886. She was then in much better general health, her head was held erect, and was quite steady. She could turn it freely to the left and about half the distance to the right, and she was gaining power in it. The left sterno-mastoid muscle had completely atrophied, and the cervical portion of the left trapezius muscle was markedly smaller than the right. The patient was able to mix again in society, and was very pleased with the result of the operation. A year later (October, 1887) Dr. Troutbeck saw her, and reported to me that she was "quite well, except for occasional fatigue felt in the neck; no jerks."

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The satisfactory result of this operation was, in my opinion, chiefly due to the fact that the spasm was limited to the one muscle-the sterno-mastoid. have on two subsequent occasions intentionally removed the central end of the spinal accessory nerve in the same way for spastic torticollis. The operation is quite a simple one, the delicate roots of the nerve rupture and a long tapering filament is drawn out from the spinal canal. These two cases were treated

last year and it is too early to pronounce with certainty upon the result of the operation in them.— Lancet.

MAGGOTS IN THE NASAL CAVITY SIMULATING MENINGITIS. Dr. Allingham (Med. Neuigkeiten No. 17, 1892) had a woman under his care who was suffering from meningitis, apparently. She had terrific headache and a high fever. As her breath was fetid he injected some peroxide of hydrogen into her nose, after which two maggots were ejected. The injections were continued, and one hundred full grown maggots were discharged from her nasal cavity, together with a quantity of pus. The following days calomel was insufflated, and two hundred more were obtained. The fever and headache immediately disappeared, and only a little gastric catarrh remained. The patient had suffered from ozena, which must have attracted flies. Indeed, she remembered that four days before the meningitic symptoms set in she was awakened by a fly crawling into her nose. It took several minutes to dislodge it, but this was sufficient time for it to deposit its eggs. -Lancet Clinic.

"GONORRHOEAL CYSTITIS."-Du Mesnil (Virchow's Archiv, vol. cxxvi, 1891, Part III) denies that there is such a thing as specific gonorrhoeal cystitis. When gonococci are found in the urine, they have, in all probability, entered with urethral pus, and are not new products developed from the true specific inflammation of the vesical mucous membrane itself. In women pus from the urethra or vagina might easily get into the bladder in this manner. Du Mesnil maintains, on the strength of fresh researches, that gonococci cannot alter the composition of the urine, and that cystitis with ammoniacal urine is not produced by these germs. Indeed, the urine renders the gonococci harmless or kills them entirely.-Brit. Med. Jour.

SOURCES OF SYPHILITIC INFECTION.—“Dr. Rassler, in his essay for the M. D. of the University of Kiel, makes a valuable contribution to the literature of syphilitic disease. The Archiv für Dermatologie und

Syphilis states that Dr. Rassler undertook the labor of analyzing six hundred and thirty cases of syphilis treated in the medical clinic with the object of ascertaining the number arising from extra-genital infection. He found thirty-four such cases, comprising twenty-three of the lips, one of the tongue, two of the mucous membrane of the mouth, and three of the mamma. In three instances the primary sore occurred on the genital organs without connection having taken place, and in the remaining two it was impossible to indicate the locality. The result of these investigations shows that five per cent of all cases of syphilis are due to extra genital infection. According to other authorities, the proportion varies between one and ten per cent, except in certain parts of Russia, where the proportion is said to reach as high as eighty or ninety per cent."-Lancet.

CYSTITIS. In an article upon cystitis in the Atlanta Med. and Sur. Jour., March, 1892, Dr. Murphey, of Atlanta, writes:-In the treatment of cystitis, the measure of the first and greatest importance is absolute rest. The rest should be in bed, with hips slightly raised, in order that pressure may be taken off the neck of the bladder. Constitutional treatment consists in regulating the character of the urine, so that it shall be unirritating to the diseased bladder.

To render the urine less irritating give alkaline diureties, demulcent drinks, etc. Citrate of potash is one of the most valuable alkaline diuretics and is often advantageously combined with buchu, uva ursi, triticum repens.

Opium should be used to allay pain, lessen excitability and relieve spasmodic action. I usually prefer suppositories of opium and belladonna, but if the spasm alone is causing the pain belladonna alone will relieve it, which is preferable. Poultices over the hypogastrium and perineum or hip-baths are useful. The bowels should be kept regular and free in order to secure free action of the portal circulation and prevent straining at stool. Free action of the skin and bowels relieves the taxed kidneys and bladder, giving them less to do. Saline purgatives are better suited for this purpose. Sulphate of magnesia or a glass of a laxative mineral water before breakfast usually acts nicely. Digestion should be watched with care; in fact, I have found cases that could not be relieved until the state of the digestion was improved.

The diet is an important factor that should not be overlooked; irritating articles of food should not be allowed; spirits, alcohol in all forms must not be allowed; coffee and tea should not be allowed. Nothing should be taken that disagrees in the least with digestion.

In a mild case of cystitis, I do not adhere strictly to all of the rules laid down here, but let the patient continue at business if desired, and by proper care and treatment he may be relieved in a short time. For example, the urine is too acid or too alkaline; acts sometimes like a foreign body; it irritates, and the bladder will make efforts to expel it. Deposits of any urinary solids in the viscus are likely to produce an irritable condition. Such cases being of a mild form can readily be relieved if not allowed to stand too long.

In advanced stages of cystitis local treatment can be employed advantageously, by washing out the bladder carefully with medicated injections.-Med. and Surg. Reporter.

EXTIRPATION OF THE LARYNX.-The number of cases in which the operation of removal of the entire larynx has been successfully performed is gradually increasing. The latest of these was recorded by Professor Wolff at the recent session of the Surgical Congress at Berlin, where the patient was exhibited eight months after the operation. The interest of the case is enhanced by the fact that by means of an artificial larynx, invented by Professor Bruns, the patient is able to speak and sing, as illustrated before the congress by his recitation of a monologue from Schiller's "William Tell," and his singing of "Gaudeamus igitur."- Lancet.

BONE IMPLANTATION FOR BONE DEFICIENCIES.-Dr. H. Kunemell, in the Deutsche Medico Wochenschrift (No. 11, 1891), gives a résumé of the subject of bone implantation. He recounts not only his own cases, but also the methods of the two surgeons who have devoted most time to this subject, Senn and Le Dentu. He says: "Two prominent observers have recently made practical tests on the implantation of decalcified bone to fill out defects in the skeleton. The first, LeDentu (Gazette des Hospitaux, No 140, 1881), had been successful in ten cases in curing extensive defects in bone by the implantation of decalcified pieces of the tibia of an ox. He differed from Senn in the fact that he used larger pieces. The author thinks that the effect of the implanted pieces is like an internal splint which serves as a frame work into which the periosteum and the ends of the bones may produce new bone tissue. The implanted pieces are known to have become absorbed or they may become vascularized or may remain as simply foreign bodies.

His first case was one of resection of the tibia and fibula in a tuberculous patient sixteen years of age; he implanted a piece of decalcified bone two and onehalf inches in length, taken from a calf. The result was perfect, and in seven months complete consolidation had occurred.

The author's method of preparation differs somewhat from Dr. Senn's. The periosteum and marrow are removed from the bones of the ox; the piece of bone is then placed in a 16 per cent solution of muriatic acid and allowed to remain eight days, after which the bone is washed in distilled water for twenty-four hours and placed in a bichloride of mer. cury bath for one day and preserved in iodoform ether. The writer enumerates five instances in which he thinks the operation is proper.

First. In resections of the smaller bones in toto, on account of tuberculosis, osteomyelitis or tumors. Second. Resections of long bones in their continuity in cases of compound fractures or similar injuries.

Third. In cases after curetting for either tuberculosis or osteomyelitis.

Fourth. To fill out the defect caused by trephining.

Fifth. In the operative treatment of pseudo-arthrosis. Med. Fortnightly.

OPERATIVE INDICATIONS FOR STONE IN THE BLADDER.-Median Perineal Lithotomy.-Adults; very small stone; irritable and contracted bladder; marked cystitis; moderate sized prostate.

Lateral Perineal Lithotomy.-Children under five years of age, medium-sized stone; adults where there is present a very bad cystitis, contracted and irritable

Under these circum

bladder, medium-sized stone. stances the lateral is preferable to the median operation. Owing to the wound being larger, the bladder can be better drained and the stone more easily extracted.

Suprapubic Lithotomy.-Adults and children very large and hard stone; stone, the nucleus of which is foreign body; marked enlargement of the prostate. Where the latter is present this operation gives the surgeon, after having removed the calculus, the opportunity of doing a partial prostatectomy, which operation enables the patient to live without the use of the catheter, or at least renders the passage of the instrument less difficult.

Litholapaxy.-Absence of Bright's disease; absence of cystitis to any degree; a noncontracted and retentive bladder, one which, if in an adult, will contain and retain six to ten ounces of boracic acid solution, or the equivalent amount of urine, and, if a child, from four to six ounces; a nonirritable urethra. This is determined by passing a steel bougie, the size of the urethra, for two or three days before the operation.

Should the urethra be the seat of a stricture or strictures, there being no other contraindication to crushing, they should be either cut or dilated, depending upon their location; a prostate not too large to embarrass the ready passage of a large lithotrite and the evacuating catheter; a urethra allowing the ready passage of the lithotrite and evacuating tube; a stone neither too large nor too hard.-International Med. Magazine.

STAB-WOUNDS OF THE SPINAL CORD.-Dr. Otto Bode, summing up on this subject (Berl. Klin. Woch.) states that the most conclusive symptom is a sharply defined paralysis below the point of wounding, coming on at the moment the wound is received.

As to treatment, he says the external wound should be enlarged and left open. Above all, free drainage should be encouraged, even to the loss of meningeal fluid, and the blood and secretions of the wound should be kept aseptic. Finally, the wound should be allowed to heal by granulations, or sewn up secondarily.-N. Y. Med. Times.

NERVE GRAFTING.-Mr. Damer Harrisson, after recalling to the Clinical Society, of London the excellent results that followed close apposition of the ends of divided nerves, observed that the only satisfactory method of dealing with nerves, the ends of which were too far apart to admit of their being sutured, was by nerve grafting. He referred in detail to the history of eight cases in which this operation had been performed at home and abroad, and then narrated a case under his own observation. A lad, aged thirteen, was admitted into the Liverpool Northern Hospital eleven weeks after a cut of the front of the right wrist had divided the median nerve and all the flexor tendons except the flexor carpi ulnaris. On admission the fingers were immovably fixed in a flexed position, paralysis of both motion and sensation being complete in the region supplied by the median nerve. Trophic changes were also present, the hand being blue and cold, the skin glossy, and the short muscles of the thumb much atrophied. The flexor tendons were found to be matted together; nearly two inches of the median nerve had been destroyed, leaving a gap between the ends. After dealing with the tendons, the nerve ends were freshened, thus increasing the

separation to two inches, and a graft 21⁄2 inches in length, taken from the sciatic nerve of a recently killed kitten, was fixed in position by one fine catgut suture at each end passing through the substance of the nerve. The limb was then put in a splint, with the hand flexed and the fingers straight. The wound healed by first intention. Sensibility began to return in the palm at the end of forty-eight hours, and eventually extended to the fingers and the thumb, except to the tips of the fingers. There was also transference of sensation impressions, those from the index finger being referred to the middle finger. At the end of three months the nutrition of the hand showed great improvement. Motion did not return until the end of five months, and appeared first in the short muscles of the thumb. Now the patient could oppose the thumb to the index finger. Another operation of the same kind had still more recently been performed by Mr. Mitchell Banks, of Liverpool, upon the ulnar nerve at the elbow after excision of a neuromatous tumor, four inches being grafted from the sciatic nerve of a dog. Sensation returned within thirty-six hours. Of the ten cases quoted by Mr. Harrisson, three were perfectly successful, six partially successful, and one failed. He attributed the difference in the success attending primary and secondary grafting to the trophic disturbances present when grafting was resorted to as a secondary operation. Restoration of function took place readily enough after long periods of time in respect of sensory nerves, but the degeneration which took place forthwith in the distal portion of motor nerves rendered repair slow and the return of function very gradual.- Med. and Surg. Reporter.

A BOAR BITE.—In the Pacific Medical Journal Dr. A. E. Baldwin reports the following:

M. Cadoza, a Portuguese, aged 29, of fine physique and weighing 183 pounds, was brought to the San Mateo Hospital, February, 8, 1890. He was covered with blood and dirt and roaring with pain after a fight with a vicious boar. The man's condition was almost bloodless, he having been gashed in five places, the right tendo-Achillis was cut clean off, the sheath also with the exception of the deeper fourth and the internal saphenous vein, three inches above its bony attachment. The vastus externus, rectus and sheath of the femoral vessels of the left leg were cut at the upper third of femur, there was a gash over the supinator muscles of the forearm, another into the vastus internus, and the left orbicularis was laid open for an inch.

The wounds were all bleeding freely when patient was admitted, and the cuts were thoroughly washed and syringed out with the mercuric chloride solution, small vessels tied under chloroform as soon as feasible; the divided muscles sewed with heavy silk and the tendo-Achilis treated after shaving the ankle and applying adhesion straps to unite the cut.

The foot and knee were strongly flexed, adhesive plaster applied to keep the muscular origin of the tendon perfectly quiet, and a perfect callous was thrown out which gave the patient a useful limb. The cuts all healed without trouble except in the case of a gash and stab where the muscle was very badly pulped, here the skin sloughed away so much that skin grafting was resorted to with good results.

The difference between this treatment and the old superstitions is evident from the fact that on the second day my patient wished me to stop treatment and allow his countrymen to bind on some of the hair from the boar's back. In forty-one In forty-one days patient left hospital and is now in Contra Costa county in best of health.

A NEW TREATMENT OF ACUTE GONORRHOEA.-Cotes and Slater (Lancet, London,) describes a new treatnient for acute gonorrhoea. The patient is first made to micturate, and thus remove as much discharge from the urethra as possible. The endoscope tube, warmed and oiled, is then passed into the urethra, the patient lying on a couch. As a rule, the passage of the instrument gives rise to but slight pain, but occasionally, in sensitive patients, a ten per cent solution of cocaine, previously injected into the urethra, will be found useful. The urethra is then thoroughly mopped with dry cotton-wool, fixed in a stilet, and examined by the electric light. The exact limit of the inflammation can be clearly seen. It is, as a rule, quite five inches from the meatus; it may be four as early as the third day. The implicated surface is at once to be recognized by its swollen, bright-red appearance as contrasted with the rosy color of the healthy urethra. It is important not to pass the endoscope needlessly far back of the posterior limit of the inflammation, which is usually sharply defined. The diseased membrane should now be carefully mopped again so as to remove every vestige of secretion. A mop of cotton-wool, on a stilet, charged with a solution of nitrate of silver (ten grains to the ounce), should be pushed through the endoscope tube and out the distal end. The tube and the mop are then simultaneously withdrawn. For the two inches of urethra near the meatus a fresh mop is used, so as to completely saturate this part, where the disease commences, and the inflammation is most intense. Patients generally complain of slight pain afterward, which, however, passes away in the course of ten minutes. The patient is recommended to take a hot bath that night and remain in bed the following day. A saline purgative and an alkaline or copaiba mixture are given internally. From four to six times daily the patient should use a simple cleaning injection-say Condy's fluid (one drachm to the pint). The forty cases treated in this manner have been cured in a little over twelve days; a few cases had lasted for some days, and some were associated with chordee.

The principal points of this treatment are:

cation comes directly in contact with the diseased membrane.

(2) The extent of diseased surface may be seen. (3) The remedy is applied when the urethral walls are stretched, so that all furrows are obliterated.

They think that nitrate of silver is the best of all injecting fluids, from the fact that, in the strength of 1 to 2,000, it kills the organisms and produces very little irritation, and at the same time exerts a healing influence on the inflamed membrane.-Univ. Med. Mag.

THE OBJECTIONS TO THE INSERTION OF RAINAGE TUBES INTO WOUNDS.-In the Maryland Medical Journal for November 14, 1891, Professor William H. Welch summed up the objections to the insertion of drainage tubes into wounds as follows: First, they tend to remove bacteria, which may get into a wound, from the bactericidal influence of the tissues and animal juices. Second, bacteria may travel by continuous growth or in other ways down the sides of a drainage tube and so penetrate into a wound which they otherwise would not enter. He has repeatedly

been able to demonstrate this mode of entrance of the white staphylococcus found so commonly in the epidermus. The danger of leaving any part of a drainage tube exposed to the air is too evident to require mention. Third, the changing of dressing necessitated by the presence of drainage tubes increases in proportion to its frequency the chances of accidental infection. Fourth, the drainage tube keeps asunder tissues which might otherwise immediately unite. Fifth, its presence as a foreign body is an irritant and increases exudation. Sixth, the withdrawal of tubes left any considerable time in wounds breaks up forming granulations and thus both prolongs the process of repair and opens the way for infection. Granulation tissue is an obstacle to the invasion of pathogenic bacteria from the surface, as has been proved by experiment. Seventh, after removal of the tube there is left a tract prone to suppurate and often slow in healing. To these Dr. Halsted adds an eighth: Tissues which have been exposed to the drainage tube are suffering from an insult which more or less impairs their vitality and hence their ability to destroy or inhibit microorganisms. N. Y. Medical Journal.

ligation of the lingual artery is not definitely settled, but the weight of authority is against its necessity.

7. The advantage of leaving one-half the tongue in unilateral disease must be considered undetermined, but the weight of positive experience is in its favor. In splitting the tongue into lateral halves, Baker's method of tearing through the raphe should always be employed.

8. A preliminary tracheotomy adds an unnecessary element of danger in the removal of the tongue in ordinary cases.

9. When the floor of the mouth has become involved or the glands are enlarged, Kocher's operation should be employed, omitting the spray and preliminary tracheotomy.

10. Removal of the glands by a separate incision after the removal of the tongue, must be considered insufficient.

11. Volkmann's method still rests on individual experience. Its just value cannot be determined until it has been subjected to trial by a number of surgeons.

12. Thorough and complete removal should be the aim of all operations, whether for limited or extensive disease.

13. By whatever method the tongue is removed, the patient should be up and out of bed at the earliest possible moment, and should be generously fed.-Journal of the Americ. Med. Association.

THE RADICAL CURE OF INGUINAL HERNIA IN CHILDREN.--Broca (Revue Mensuelle des Maladies des l'Enfance) describes the operative treatment of inguinal hernia in children, with the report of seven cases. This operation is of little importance in very young children.

1. The tissues are thin and delicate.

2.

The parts are small and difficult to reach. 3. A thorough anatomical knowledge is necessary.

Through fear of operations many surgeons have adopted other measures-especially the application of a bandage. This sometimes does result in the cure of these cases, but its application must be continued from two to three years. If the hernia be complicated by ectopion of the testicle, then operation must be resorted to. Operation in very young children--from one to three years--would only be justifiable where a gradually increasing hernia should suddenly become irreducible or strangulated. Strangulation is a rare condition at these ages. Colotomy was formerly done in very young children for strangulation, with considerable success, but Broca believes the operation is rarely if ever necessary. Sometimes strangulated hernias can be reduced by pressure and carefully applied taxis.

Two reasons are given by some authors why operations in earlier years should not be performed: 1. Operations in children up to five years are generally grave.

2. Before five years the continued use of the bandage generally cures.

But if great care be taken during the operation and in the after-treatment of the wound there is but little danger. A congenital hernia, without being a properitoneal hernia, may have a dilatation, retro-peritoneal or pro-peritoneal. These conditions were found in four adults operated upon. He thinks that pressure will cause obliteration of the inguinal canal; but how