. Hernie abdominale : son diagnostic et son traitement. Opération pour la guérison de la hernie lombaire conj^entielle (Z.Ji/rf).—lambeau composé de fascialata et de la partie aponeurotique du fessier maximus et médius. Points placés pour suturer le thislamp à la structure lombaire, au muscle oblique externe et au latissimus dorsi muscleand pour dessiner les parties supérieures du latissimus dorsi et l'oblique externe ensemble. Hernie obturatrice.—la hernie obturatrice se présente sous forme d'enflure anobscure, assise profonde sur la cuisse, sous le Scarpastriangle. Il est rarement reconnu jusqu'à ce que la strangulation soit hasée ou après la mort

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. Abdominal hernia : its diagnosis and treatment. Operation for the cure of conj^ential lumbar hernia (Z.Ji/rf).—Flap composed of fascialata and aponeurotic part of gluteus maximus and medius. Stitches placed for suturing thisflap to the lumbar-fascia, to the external oblique muscle and to the latissimus dorsi muscleand for drawing the upper parts of the latissimus dorsi and external oblique together. Obturator Hernia.—Obturator hernia presents as anobscure, deep-seated swelling upon the thigh, below Scarpastriangle. It is rarely recognized until strangulation hasoccurred or until after death has taken place. Berger, in 404 ABDOMINAL HERNL. examining 10, 000 cases of hernia at the Paris Central Bureau, found one case of obturator Iiernia. It leaves the pelvisthrough the obturator canal with the nere and vessels of thesame naiue. It most commonly occurs in women whohave passed the middle age of life, and it may he double.The contents of the sac are most frequently intestine, but Fk;. 2 2 3.. Stitches lied, leaving a triangular defect above the Hap. {Dowd.) the liladder and uterine appendages have also been foundin it. Franz Schopf (IJiciicr Kliiiischc Uoclicnsdirift. Feb-ruary 19, 1903) reported, including his own case. 5 cases ofprotrusion of the tube and ovary in obturator hernia. In onethe uterus was included. The same writer states that duringtwenty years in a Vienna hospital in 393 cases of strangulatedhernia 3 were for obturator hernia. RARE FORMS OF HERNIA. 405 Diagnosis is seldom made until strangulation occurs orafter an autopsy is made. The tumor is more easily felt thanseen. Macready thinks it is very liable to be overlooked onaccount of faulty methods of examination. He says. It ismost easily approached from the inner side of the thigh. Thethigh must be flexed, rotated outwards, and carried inwards torelax the adductor muscle, and the finger placed against thedescending ramus of pubes behind the adductor longus. Thefinger may also explore the inner op

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