The Operative Treatment 0/ Hernia in 
Children, with a Report of One Hun- 
dred and Thirty-three Cases. 
BY 
WILLIAM B. COLEY, M.D., 
ASSISTANT SURGEON TO- THE HOSPITAL FOR RUPTURED AND CRIPPLED; ATTENDING 
SURGEON TO THE NEW YORK CANCER HOSPITAL. 
FROM 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
May, 1895. Extracted from The American Journal of the Medical Sciences, May, 1895. 
ME OPERATIVE TREATMENT OF HERNIA IN CHILDREN, 
WITH A REPORT OF ONE HUNDRED AND THIRTY- 
THREE CASES. 
By William B. Coley, M.D.,1 
ASSISTANT SURGEON TO THE HOSPITAL FOR RUPTURED AN?) CRIPPLED ; ATTENDING SURGEON TO 
THE NEW YORK CANCER HOSPITAL. 
I began operating upon hernia in children in December, 1891, just 
three years ago. Since that time I have performed the operation for 
radical cure in 133 cases under fourteen years of age. An analysis 
of these cases, the methods employed, and the results obtained, may 
be of help in determining the question as to the justifiability and value 
of operative procedures. 
We all know in a general way that, until the more recent methods of 
Macewen, Championniere, Bassini, and Halsted, the results were fail- 
ures in so large a proportion of cases that all operations came to be 
looked upon with distrust by the profession at large. That distrust has 
by no means disappeared, even yet, and if we can show that it rests 
rather upon tradition than upon facts as they exist at present, it is our 
duty to do all in our power to dispel it. 
Before taking up the subject of the operative treatment of hernia in 
children it is necessary to refer briefly to the results of mechanical 
treatment. Some surgeons high in authority have made the statement 
that all cases of hernia in children can be cured by trusses. Such 
statements as this, though undoubtedly made in good faith, show that 
their authors have not carefully followed up any very large number of 
cases. Our knowledge of the value and limitations of the mechanical 
treatment of hernia has been greatly increased by the recent publica- 
tion of Macready’s Treatise on Ruptures. It is by far the ablest and 
most scientific work on hernia yet published, and its conclusions are 
based on the records of the London Truss Society, the largest hernia 
clinic in the world. 
As to the question of cure from mechanical treatment in children, 
Macready says,“We can only speak of probabilities; it may be said that 
many boys are cured, but then the prospect is more favorable for girls ; 
that the younger the patient the more probable the cure; those with 
femoral hernia there is little chance of being able to dispense with a truss, 
and that after thirty years of age cure is not to be expected in either 
1 Read before the College of Physicians of Philadelphia, December 15, 1894. 2 
COLEY: OPERATIVE TREATMENT OF HERNIA. 
sex or in either kind of hernia.” The London Truss Society records 
show 33 per cent, of children ruptured go beyond the age of eleven 
years uncured, and the real number Macready considers much larger. 
The records of the Hospital for Ruptured and Crippled bear out 
these statements. Having established this point, that certain cases in 
children do need other than mechanical treatment, it remains to deter- 
mine whether or not these cases can be cured by operation, without 
subjecting them to any considerable risk. 
In an earlier paper on the “ Operative Treatment of Hernia in 
Children” (Medical Record, July 1, 1893) I stated as my belief “that 
operations for the cure of hernia should stand or fall according as they 
fulfilled two conditions of all operations (except emergency) : first a 
mortality either nil or not greater than that associated with the con- 
dition prior to operation ; second, a reasonable hope of success either 
as regards cure or relief.” The older and less perfect methods failed 
to fulfil both of these conditions, but the same cannot be said of the 
methods that we employ to-day. 
In no department of surgery is there need of wider experience and 
sounder judgment than in the management of hernia. The indications 
and contra-indications for operation should be thoroughly understood 
and carefully considered in ever}' case. The indications for operation 
in children, as they appear to me, have already been outlined (loc. cit.') as 
follows: 
1. Cases of adherent omentum (rare in children). 
2. Cases complicated with reducible hydrocele. 
3. Cases irreducible or strangulated. 
4. Cases unable to obtain the care requisite to successful mechanical 
treatment. 
5. Cases where mechanical treatment has been faithfully tried for a 
number of years without benefit. 
The large majority of the cases that I have operated upon have 
belonged to the last two classes, although the other three have all been 
represented by a considerable number of cases. 
Methods Employed. Of the total 133 cases, 5 were femoral, 4 
umbilical and ventral, and the remaining 124 inguinal. (10 females 
and 114 males.) 
Methods of Operation and-Technique. 1. Ligation of the sac 
and suture of the canal, without transplanting the cord, were the method 
employed in ten cases. The immediate and final results were as follows : 
(а) Catgut. In two cases the buried sutures were of simple non- 
chromicised catgut: of these, one relapsed in four months, although a 
truss was worn after operation; the second case is well three years 
after operation. 
(б) Silk. In one case silk was used for the buried sutures. This COLEY : OPERATIVE TREATMENT OF HERNIA. 
3 
case healed primarily, but soon after leaving the hospital two small 
sinuses appeared in the cicatrix and refused to heal until the silk suture 
had been extruded. Relapse occurred in three months in spite of the 
constant support of a truss. 
(c) Chromicised catgut. This was used for buried sutures in four cases: 
of these, two are perfectly sound two years and nine months after opera- 
tion ; a third, two years and ten months; and a fourth, two years and 
eleven months. 
(d) Kangaroo-tendon was employed in three cases: of these, one is 
well, without recurrence, two years and five months after operation ; a 
second, eight months; and the third was not traced. 
All of these ten cases healed primarily. Of the nine cases traced, 
seven are well without recurrence at present, and of these, six have gone 
nearly three years. The two relapses were due, one to the use of catgut, 
and the other to silk, the objections to which will be dealt with later. 
2. Bassini’s method, with the substitution of kangaroo-tendon for 
silk in the buried sutures, was employed in one hundred and fourteen 
cases. The tendon-sutures were actually employed in but one hundred 
and twelve cases, silk having been used in one case and chromicised 
catgut in one. The silk sutures were used in my first Bassini operation 
done in children. The wound suppurated very badly, the sutures 
sloughed out, and relapse followed, as a natural result, three months later. 
The case in which chromicised catgut was used was a recent case, and 
the catgut was used because I had no tendon at hand. Primary union 
occurred, but three weeks after the operation two small sinuses appeared, 
and I do not expect them to close until the sutures are either thrown off 
or absorbed. 
Having now eliminated these twelve cases in which there was more 
or less variation in technique, we have left one hundred and twelve 
cases not only operated upon by a single method, but in which the same 
technique was observed in every detail. It is only by an analysis of 
cases operated upon under similar conditions that conclusions of value 
can be drawn. 
Although Bassini’s elaborate paper, describing in detail his operation 
and reporting two hundred and sixty-two cases, was published four years 
ago (Archiv f. klin. Chir., 1890), there have been so few accurate 
descriptions of the operation in English that the technique is not gen- 
erally understood, and I may be pardoned for briefly outlining its essen- 
tial features: 
1. The external incision begins at a point nearly or quite on a level 
with the anterior superior spine, continues obliquely downward parallel 
with and about one-half an inch internal to Poupart’s ligament, and 
ends at the centre of the external ring. 
2. The incision is rapidly carried down until the aponeurosis of the 4 
COLEY: OPERATIVE TREATMENT OF HERNIA. 
external oblique is freely exposed for a distance of two and one-half to 
three inches; a director is then passed through the external ring just 
beneath the aponeurosis, and the aponeurosis is divided well above, e. g., 
one-half to one inch above the internal ring. 
3. The cut edges of the aponeurosis are held up with forceps and 
dissected free from the underlying muscles as far as the edge of the 
rectus internally and externally until the shelving portion of Poupart’s 
ligament has been clearly exposed. 
4. The sac and cord are then isolated en masse, and this is best accom- 
plished with the fingers and blunt-pointed curved scissors. If the peri- 
toneal layer of the sac is first reached, the dissection is easy, rapid, and 
bloodless. 
5. The cord and vessels of cord are now separated from the sac, and 
this, too, is best done with the fingers. The separation is carried high 
up within the internal ring, and the sac is ligated or sutured at the 
place where it merges into the general peritoneal cavity. 
6. The cord is held up and the edges of the aponeurosis rolled back, 
while from three to five buried sutures are introduced beneath the cord. 
These are best introduced from within outward, and should include the 
internal oblique and transversalis muscles, the trausversalis fascia (and 
sometimes the edge of the rectus) on the inner side, and the deep shelv- 
ing portion of Poupart’s ligament on the outer side. The lowermost 
suture should embrace the conjoined tendon. 
7. The cord is now replaced and the cut aponeurosis is closed over it 
by means of a continuous suture extending as near the pubis as possi- 
ble without causing undue constriction of the cord. 
8. Closing the skin-wound with interrupted sutures without drainage 
completes the operation. 
Although this may sound like a somewhat complicated operation, and 
in fact it has been objected to for this reason by many surgeons, in actual 
practice it is simple and can be quickly performed. I have done the 
entire operation in fifteen minutes, aud in one day I performed five oper- 
ations upon four subjects in two hours and ten minutes. 
I have endeavored to follow the technique laid down by Bassini as 
carefully as possible with the single, and, as I believe, important modifi- 
cation of substituting kangaroo-tendon for silk in the buried sutures. 
The character of the suture-material I believe to be one of the most 
important factors in the success of any operation for the radical cure of 
hernia, and I do not think sufficient credit has been accorded Dr. H. O. 
Marcy for having demonstrated the great value of kangaroo-tendon in 
such operations. The tendon has been employed for many years at St. 
George’s Hospital, London, and almost exclusively in ligating large 
vessels.1 Its non-irritating properties and the time required for absorp- 
1 Brit. Med. Journ., November 15,1890, p. 1110. COLEY: OPEKAT1VE TREATMENT OF HERNIA. 
5 
tion—two to three months—have been experimentally demonstrated by 
Ballauce and Edmunds, and I believe that an analysis of the cases pre- 
sented to-night alone would be sufficient to establish its superiority to 
other suture-material for hernia operations. During the past three and 
a half years I have used kangaroo-tendon for all buried sutures in one 
hundred and eighty hernia operations; of these, one hundred and 
seventy-four healed by primary union, and the only relapse that has 
occurred was in a case of large congenital hernia of the umbilical cord 
in a child aged three years. 
Silk, silkworm-gut, and silver wire have been in turn much lauded 
by noted surgeons as ideal suture-material for hernia operations. Their 
profound belief in asepsis as the embodiment of all the requisites of 
surgery has led them to think that the human body will rebel against 
nothing but germs: no matter how aseptic silk or silver wire may be, 
they are foreign bodies, and when placed near the surface of the body, 
particularly in a locality subjected to such constant motion as the in- 
guinal canal, there is an effort on the part of Nature to rid herself of 
them. I am not dilating upon theoretical objections. I have seen 
sluggish discharging sinuses at the site of the incision many months 
after the operation for inguinal hernia where silk had been used, and in 
one case the patient remained practically an invalid nearly a year on 
account of this condition. Such instances are not rare, and, what is 
more, the ones I have observed occurred in the hands of men whose 
aseptic technique is as nearly perfect as any with which I am familiar. 
Unless there are some advantages to be gained by using a non absorb- 
able suture, 1 see no reason why we should incur the risks of such results 
as I have mentioned. 
In view of the many loose and contradictory statements as to the 
value of operations for the cure of hernia, there is nothing that will 
conduce more to settling this question upon scientific lines than to 
establish some definite period of time beyond which the hernia may be 
reasonably considered cured. Various periods have been given, but all 
of these have been based on impressions of surgeons derived from a 
limited number of cases. The limits more frequently given are three 
years or two years. 
To ascertain whether these limits were in harmony with the facts, I 
have made a careful analysis of 250 cases of relapsed hernia observed 
and carefully recorded at the Hospital for Ruptured and Crippled dur- 
ing the past five years. These cases represent nearly all the operations 
in vogue during this time, and the large majority were operated upon 
by leading surgeons of New York and Brooklyn. One hundred and 
seventy-one operations were for non-strangulated hernia, and seventy- 
nine for strangulated hernia. 
These cases I have analyzed with reference to the time when relapse 6 
COLEY: OPERATIVE TREATMENT OF HERNIA. 
occurred, with the following results: Of the non-strangulated, 120 
cases, or 70 per cent., relapsed one to six months; 27 cases, or 15.8 
per cent., six to twelve months; 84.8 per cent, first year; 14.2 per 
cent, after first year; 5.8 per cent, one to two years; 8.4 per cent, two 
years. 
Strangulated, 79 cases, 64.5 per cent, relapsed one to six months; 20 
per cent., six to twelve months ; 84.8 per cent., first year; 5.4 per cent., 
one to two years; 9.8 per cent., one to two years. 
Some surgeons use ordinary non-chromicised catgut for the buried 
sutures, and even go so far as to state that the sooner the sutures are 
absorbed the better. As I have pointed out in a previous paper, the 
tissues to be united in closing the hernial canal are largely tendinous in 
structure, and the elaborate experiments of Busse1 show that perfect 
tendinous union does not occur under ten weeks, or just about the period 
required for absorption in kangaroo-tendons. No better practical demon- 
stration of the failure of catgut to meet the requirements of a suture in 
hernia operations could be had than the results in 19 cases of hernia in 
children, operated upon at the Hospital for Ruptured and Crippled 
in 1889-90, in which catgut was used. Of these 19 cases operated 
upon by suture of canal in part, and in part suture of external ringv.J4) 
cases relapsed ; 7 of these relapses occurred within three months aftqr 
operation; 5 other cases were not traced, and only 2 were known to Wfe 
sound three years after operation. 
Having described the methods employed, let us analyze the cases now 
in detail. 
Of the 112 cases operated upon by the Bassini method with kangaroo- 
tendon for the buried suture, primary union occurred in 109, or 97 per 
cent. In only one case was the suppuration more than slight and super- 
ficial, and that was only down to the aponeurosis. This case is now 
perfectly sound, one and one-half years after operation. 
The percentage of cases followed by immediate healing of wound 
without suppuration obtained by the leading operators is stated by Sir 
William MacCormac2 as follows: MacCormac, 80 per cent. ; Kocher, 
89 per cent. ; Billroth, 39 per cent. ; Schede, 35 per cent.; Macewen, 
86.7 per cent.; Ball, 81.8 per cent. ; McBurney, 81.6 per cent.; Hal- 
sted, 82 per cent. ; Kuster, 79 per cent. 
Final results. All but two of the cases of Bassini have been traced. 
Of these, 4 have gone without truss and without relapse two and one- 
half to three years ; 10, two to two and one-half years ; 18, one and one- 
half to two years; 17, one to one and one-half years ; 20, six months to 
one year; 45 less than six months; 49 cases have gone more than one 
year. 
Mortality. There has been but one death, caused by double pneumonia, 
1 Deut. Zeit. t. Chir., 1891-92, xxxi. 
- Bradshaw Lecture, 1893. COLEY: OPERATIVE TREATMENT OF HERNIA. 
7 
in a child of live years. It was undoubtedly due to the effect of the 
ether, etc. The child had had measles five weeks before, and took the 
ansesthesia very badly. An autopsy showed double pneumonia, with no 
abdominal complications and no trouble in the wound. Death occurred 
on the fifth day. 
Femoral hernia; five cases. The method employed was high ligation 
of the sac and suture of the crural opening with buried kangagroo- 
tendon. No relapse has occurred, and all the cases have been traced: 
1 is wTell two years and eight months after operation; 1 is well twenty 
months after operation ; 1 is well eighteen months after operation ; the 
other two are recent cases. 
Umbilical and ventral; four cases. These have all been operated upon 
during the past year, and are sound with one exception—a congenital 
hernia of the cord in a girl of three years. A slight recurrence took 
place in this case within three weeks after the operation, due to a severe 
bronchitis. 
The method employed was excision of the umbilicus and sac, suture 
in three layers, with kangaroo-tendon for the buried suture. 
Strangulated hernia. This condition has always been regarded by 
surgeons as too rare to be considered, many of the most noted surgeons 
having never seen a case. 
Tariel, of Paris, has recently contributed a valuable paper on this 
subject, and has collected all of the cases thus far reported in surgical 
literature. He was able to find 128 cases under two years of age, with 
74 recoveries. 
I have operated upon 6 cases: 1 aged eight weeks, 1 aged eight 
months, 1 aged twelve months, 1 aged seven and one-half months, 1 
aged five months, and 1 aged twenty-three months. All except one 
recovered, and that was practically moribund at the time of opera- 
tion. Simple herniotomy was performed without attempting radical cure. 
CcEcal hernia. In eight cases the csecum or appendix vermiformis 
formed the contents of the sac. In two cases the appendix alone was 
found, and in both these the tip of the appendix was firmly adherent to 
the bottom of the sac. The adhesions were separated and the appendix 
returned to the abdominal cavity. These two cases, as well as*a con- 
siderable number where the mesenteric attachment of the bowel extends 
low down into the sac, emphasize the importance of opening the sac in 
all cases before ligation or suture. 
Dr. W. L. Rodman, of Louisville, has recently rejyjrted a case where 
a sac which, as far as could be detected by careful examination, appeared 
perfectly empty, on ligation showed a severed appendix in the lower end. 
In two of the strangulated cases the appendix and csecum together 
were found. In one case the color of the appendix was so dark that I 
thought it more prudent to remove it. Recovery followed. COLEY : OPERATIVE TREATMENT OF HERNIA. 
The other case was the child eight weeks old, nearly moribund at time 
of operation. Simple relief of strangulation was all that was warranted, 
and death occurred two days later. In a non-strangulated case of ap- 
pendix hernia, the appendix if adherent can be readily freed and re- 
duced ; and I do not believe it to be the best surgery to attempt removal. 
I cannot but believe it adds something to the danger of the operation ; 
and unless the success of the operation can be shown to be materially 
dependent upon its removal, I do not think it indicated. 
Dressings and after-treatment. In all of the cases the dressings were 
moist iodoform and bichloride gauze, held firmly in place by rubber- 
plaster, over which cotton and a muslin-spica were applied. The scro- 
tum was always left exposed. Fixation was secured by means of a 
plaster-of-Paris spica extending from the edge of the ribs to the ankle. 
This was kept on until the first dressing, or about the eighth day. The 
skin-sutures are entirely of fine catgut, which is usually found to have 
been entirely absorbed by the first dressing. None of the cases, with the 
exception of two or three of the early cases operated upon by suture of 
the canal with catgut, have worn trusses since the operation, and I do 
not believe a truss should be advised. 
Of the 112 cases operated upon by the Bassiui method, with kangaroo- 
tendon for the buried sutures, not a single relapse has occurred and not 
a single case has worn a truss. 
The following table will give the more important points of the cases 
in detail: COLEY: OPERATIVE TREATMENT OF HERNIA. 
9 
No. 
Age Sex. 
Nature of hernia and 
duration. 
Opera- 
tion. 
Operator. 
Primary re- 
sult. 
Final result 
1 
8 
M. 
Right inguinal, congeni- 
Dec. 12, 
Czerny. Catgut-ligature; 
Primary 
Relapse 4 
tal, complicated with 
1891 
no drain. 
union. 
months af- 
hydrocele of cord. 
ter oper’n. 
2 
13 
M. 
Right inguinal, very 
large; 3 years’ dura- 
Dec. 28, 
Bassiui. Silk for buried 
Very profuse 
Relapse in 
1891 
suture ; no drain. 
suppuration 
4 months. 
tiou. 
and slough- 
ing of tis- 
sues. 
3 
6 
M. 
Left inguinal, congeni- 
Jan 25, 
Czerny. Catgut-sutures ; 
Primary 
Sound Dec. 
tal. 
1892 
no drain. 
union. 
1894 
4 
9 
M. 
Right inguinal : 4 years’ 
Jan. 
Czerny. Silk-sutures; 
Prim.union: 
Relapse iu 
duration. 
1892 
no drain. 
sinus form’d 
after leaving 
3 months. 
hospital ; 
sutures 
came out. 
5 
13 
M. 
Left inguinal; 2 years. 
Mar.15, 
Czerny. Chromicised 
Primary 
Perfect ; 
1892 
catgut; uo drain. 
union. 
sound Oct. 
20, 1894 ; 
no truss. 
6 
10 
M. 
Left inguinal, congeni- 
Feb. 15, 
Czerny. Chromicised 
Primary 
Perfect 
tal. 
1892 
catgut; no drain. 
union. 
Oct. 1, 1894 
7 
7 
M. 
Right inguinal. 
Mar .30, 
Bassini. Kangaroo-ten- 
Primary 
Firm Feb. 
1892 
don for buried sutures; 
catgut for skin. 
union. 
1894 
8- 
M 
Double inguinal ; very 
April 8, 
High ligation of sac and 
Primary 
Solid Oct. 
9 
large. 
1892 
closure of canal with 
union, both 
1894 
buried sutures of chro- 
micised catgut ; no 
drain. 
sides. 
10- 
7 
M. 
Right femoral, left in- 
Apr. 28, 
High ligation of sac ; su- 
Primary 
Perfect 
11 
guinal; left 3 years, 
1892 
tore canal with kan- 
union, both 
Oct. 1894 
right 6 months. 
garoo-tendon; purse- 
string suture femoral 
sides 
canal. 
12 
13 
M. 
Right inguinal; 11 years' 
.May 5, 
Bassini. Kangaroo-ten- 
Primary 
Perfect 
duration ; truss 7 yrs. 
1892 
don for buried suture ; 
no drainage. 
union. 
Oct. 1894 
13 
7% M. 
Right inguinal, size of 
June 6, 
Bassini. Kangaroo-ten- 
Primary 
Perfect 
egg; one suture ad- 
herent. 
1894 
don for buried suture ; 
catgut for skin ; no 
union. 
Oct. 1894 
M. 
drain ; omentum li- 
gated. 
14 
Right inguinal, congeni- 
June, 
Bassini. Kangaroo-ten- 
Primary 
Perfect 
tal. 
1892 
don for buried suture ; 
catgut for skin ; no 
drain ; omentum li- 
gated. 
union. 
Oct.3, 1894 
15 
8 
M. 
Right inguinal, 1 week ; 
July 9, 
Canal closed with buried 
Primary 
Oct. 3, 1894 
mos 
strangulated, 24 hours. 
1892 
kangaroo-sutures; cord 
union ; one 
perfectly 
not transplanted. 
week in 
sound ; no 
hospital. 
truss worn. 
16 
14 
M. 
Left inguinal, congeni- 
July 20, 
Bassini’s method: lower 
Primary 
Perfect 
tal; size of egg. 
1892 
part of sac sutured 
union ; no 
Dec. 1894 ; 
over testis; kangaroo- 
tendon for buried su- 
truss. 
no truss. 
ture. 
17 
10 
M 
Right inguinal, verv 
July 26, 
Bassini. Kangaroo-ten- 
Primary 
Sound 
large, congenital; com- 
1892 
don for buried suture ; 
union. 
Oct. 1894; 
plicated with hydro- 
cele ; reducible. 
no drain. 
uo truss. 
18 
14 
M. 
Left inguinal; not held 
Aug.23, 
Bassini. Kangaroo-ten- 
Primary 
Sep.29,1894, 
by truss; 1 year’s 
1892 
don for buried suture. 
union ; two 
weeks in 
perfect: 
duration. 
no truss. 
bed. 
19 
12 
M 
Left inguinal, congeni- 
Aug.23, 
Bassini. Kangaroo-ten- 
Primary 
Feb.24,1894, 
tal. 
1892 
don for buried suture. 
union 2% 
sound ; no 
weeks 
truss. 
20 
4 
M 
Right inguinal, caecal, 
Sept.13, 
Canal sutured ; cord not 
Pri marv 
Not traced. 
congenital. 
1892 
transplanted, kan- 
garoo tendon for su- 
ture ; no drain. 
union. 
21 
11 
M. 
Right inguinal; several 
Sept. 9, 
Bassini. Kangaroo-ten- 
Primary 
Oct. 1,1894, 
years ; not held by truss. 
1892 
don; no drain. 
union. 
perfect; 
no truss. 
22 
9^2 
M. 
Right inguinal. 
Oct. 5, 
1892 
Bassini. Kangaroo-ten- 
Primary 
Perfect 
don ; no drain. 
union. 
Oct. 1, 1894 10 
COLEY: OPERATIVE TREATMENT OF HERNIA. 
No. 
Age 
Sex. 
Nature of hernia and 
duration. 
Opera- 
tion. 
Operator. 
Primary re- 
sult. 
Final result. 
23 
14 
M. 
Left inguinal, congeni- 
tal ; relapse after sup- 
posed cure from truss. 
Oct. 29, 
1892 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894; 
no truss. 
24 
12 
M. 
Left inguinal.very large, 
congenital. 
Nov 1, 
1892 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Feb. 1894, 
firm ; no 
truss. 
25 
4 
M 
Right inguinal, congeni- 
tal. 
Nov 4, 
1892 
Bassini. Kangaroo-ten- 
don ; no drain 
Primary 
union. 
Well 
Feb. 1894; 
no truss. 
26 
11 
M. 
Right inguinal. 
Nov.29, 
1892 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Well 
Oct.12,1894 
27 
4 
M. 
Right inguinal; csecal; 
(spine disease). 
Jan. 6, 
1893 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Sound 
Dec. 1894 
28 
4 
M. 
Case No. 27 ; left side. 
Jan 6, 
1894 
BasBini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Sound 
Dec. 1894 
29 
6 
M. 
Left inguinal, compli- 
cated with reducible 
hydrocele. 
Jan, 20, 
1893 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Sept. 1894 
30 
9 
M. 
Left inguinal; 4 years ; 
no improvement with 
truss. 
Jan. 
1893 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Nov.17,1894 
31 
14 
M. 
Left inguinal. 
Feb. 
1893 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dee.15,1894 
32 
7 
M. 
Left inguinal. 
Feb. 
1893 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Fel). 1894 
33 
14 
M. 
Right inguinal, compli- 
cated with undescend- 
ed testis. 
Mar.10, 
1893 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Sept 29,1894 
34 
10 
F. 
Right inguinal. 
Mar. 10, 
1893 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
35 
10 
M. 
Right inguinal; ca;cal; 
appendix adherent to 
Mar.24, 
1893 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
36 
14 
F. 
Right femoral. 
April 4, 
1893 
Purse-string suture, 
kangaroo-tendon. 
Primary 
union. 
Perfect 
Dec.10,1894 
37- 
38 
12 
M. 
Double inguinal; recur- 
rent few months after 
Czerny operation, done 
February, 1890. 
Right inguinal, compli- 
cated with undescend- 
ed testis. 
Apr. 11, 
1893 
Bassini. 
Primary 
union. 
Perfect 
Oct. 6, 1894 
39 
13 
M. 
Feb. 
1893 
Bassini. 
Primary 
union. 
Perfect 
Feb. 1894 
40 
5 
M. 
Right inguinal. 
April 4, 
1893 
Bassini. 
Primary 
union. 
Perfect 
Feb. 27,1894 
41 
7^ 
M. 
Strangulated ; csecal and 
appendix. 
June 1, 
1893 
Appendix removed. 
Primary 
union. 
Perfect; 
died four 
weekB later 
of another 
trouble. 
42 
11 
F. 
Right femoral. 
June 6, 
1893 
Purse-string suture. 
Primary 
union. 
Perfect 
Oct.20, 1894 
43 
9 
M. 
Right inguinal; cmcal. 
June 13, 
1893 
Bassini. 
Primary 
union. 
Perfect 
Sept.28,1894 
44 
11 
M. 
Right inguinal. 
June 18, 
1893 
Bassini. 
Primary 
union. 
Perfect 
Oct.20, 1894 
45 
11 
M. 
Right inguinal. 
July 18, 
1893 
Bassini. 
Very profuse 
suppuration 
to deep 
fascia. 
Perfect 
Nov. 2,1894 
46 
8 
M 
Right inguinal, congeni- 
tal, with undescended 
testis. 
Jan. 18, 
1893 
Bassini. Kangaroo-ten- 
don for testis anchored 
to wire from outside 
scrotum; testis atro- 
phied ; no drain. 
Primary 
union. 
Perfect 
Oct. 1894; 
testis atro- 
phied. 
47 
9 
M. 
Right inguinal; 7 years’ 
duration. 
Aug. 18, 
1893 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union ; 2% 
weeks in 
bed. 
Perfect 
Feb.27,1894 
48 
11 
M. 
Right inguinal, congeni- 
tal ; size of goose-egg. 
Aug. 
1893 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Oct.11,1893; 
not traced. 
49 
8 
F. 
Umbilical, congenital. 
Aug.29, 
1893 
Omphalectomy suture; 3 
large kangaroo-ten- 
dons for buried suture. 
Primary 
union. 
? 
50 
11 
M. 
Right inguinal, congeni- 
tal ; truss 11 years. 
Aug.ll, 
1893 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union, three 
weeks. 
Well Dec. 
1894 
51 
12 
F. 
Right femoral; 7 years’ 
duration ; truss entire 
time. 
Sept.25, 
1893 
High ligation of sac ; 
purse-string suture of 
canal; kang.-tendon. 
Primary 
union, three 
weeks. 
Well Nov. 
1893 GOLEY: OPERATIVE TREATMENT OF HERNIA. 
No. 
Age 
Sex. 
Nature of hernia and 
duration. 
Opera- 
tion. 
Operator. 
Primary re- 
sult. 
Final result. 
52 
5 
M. 
Right inguinal, congeni- 
tal. 
Oct. 10, 
1893 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union, 2% 
weeks. 
Well Nov.l, 
1894 
53 
12 
M. 
Right inguinal ; 6 years’ 
duration. 
Oct. 10, 
1893 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Well Oct. 6, 
1894 
•54- 
55 
5 
M. 
Double inguinal, con- 
genital, large. 
Oct. 17. 
1893 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Well Sept. 
25, 1894 
56 
10 
M. 
Right inguinal; dura- 
tion 3 years. 
Nov.14, 
1893 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Well Sept. 
29, 1894 
57 
7 
M. 
Right inguinal, size of 
goose-egg; since in- 
fancy. 
Nov.14, 
1893 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Well Oct. 1, 
1894 
58 
i'A 
M. 
Right inguinal; caeca!. 
Nov .21, 
1893 
Bassini. 
don. 
Kangaroo-ten- 
Wound heal- 
ed primari- 
ly ; orchitis 
which sup- 
purated se- 
cond week. 
Well April 
26, 1894 
59- 
60 
14 
F. 
Double inguinal. 
Nov.28, 
1893 
Bassini. 
don. 
Kangaroo-ten- 
Very slight 
suppuration 
on suture- 
hole. 
Well Nov. 
3, 1894 
61- 
62 
8^ 
M. 
Double inginal, congeni- 
tal ; size of fist both 
sides. 
Dec. 1, 
19, 1893 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Well March 
6, 1894 
63- 
64 
6 
M. 
Double inguinal, with 
Pott’s disease. 
Left. 
Dec. 22, 
1893 ; 
right. 
Feb. 6, 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Perfect 
Feb. 5,1894 
65 
7K 
M. 
Right inguinal, since 5 
weeks old. 
Dec. 29, 
1893 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Perfect 
Nov.3,1894 
66 
5 
M. 
Left inguinal, with Pott’s 
disease. 
Jan. 9, 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Perfect 
Nov. 1894 
67 
3% 
M. 
Left inguinal, compli- 
cated with Pott’s dis- 
ease. 
Jan. 9, 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Died few 
weeks later 
tubercular 
meningitis. 
68- 
69 
6 
M. 
Double inguinal, with 
Pott’s disease. 
Jan. 30, 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Perfect 
Sept. 1894 
70 
6 
M. 
Right inguinal, congeni- 
tal. 
Jan. 30, 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Perfect 
Oct. 1, 1894 
71 
M. 
Left inguinal; hernia in 
infancy cured with 
truss ; relapsed 2 years 
ago. 
Feb. 13, 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Perfect 
Sept.29,1894 
72 
4 
M. 
Left inguinal, congeni- 
tal; size largo orange. 
Feb. 13, 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Perfect 
Apr. 6, 1894 
--1 -J 
2^ 
M. 
Double inguinal, con- 
genital ; truss since 6 
weeks old ; very large; 
uncomfortable. 
Right 
Feb. 16; 
left, 
Sept. 27, 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Perfect 
Dec. 1,1894 
75 
6 
M 
Right inguinal. 
Feb. 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Died ou 8th 
day; double 
pneumonia 
confirmed 
by autopsy. 
76 
10 
M. 
Left inguinal ; very 
large. 
Mar .30, 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Perfect 
Dec. 1,1894 
77 
9 
M 
Right inguinal, scrotal ; 
since infancy. 
Apr. 10, 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Perfect 
Oct. 6, 1894 
78 
12 
F. 
Double inguinal ; opera- 
tion right side ; con- 
genital. 
Apr. 20, 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Perfect 
Dec. 1893 
79 
8 % 
M 
Right inguinal; duration 
6 years ; hernia vermi- 
form appendix. 
Apr. 20, 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Perfect 
Dec.15,1894 
80 
6 
M. 
Lett inguinal ; 3 years 
truss treatment. 
Apr. 19, 
1894 
Bassini. 
don. 
Kangaroo-ten- 
Primary 
union. 
Perfect 
Sept. 1894 
81 
14 
M. 
Left inguinal; since in- 
fancy. 
May 8, 
1894 
Bo8sini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
82 
4 
M. 
Right inguinal; csecal ; 
operation for recur- 
rence ; size goose-egg; 
irreducible, adherent. 
Right inguinal; 8 years. 
May 15, 
1894 
Canal sutured with kan- 
garoo-tendons ; gauze- 
drain. 
Primary 
union ex- 
cept at site 
of drain. 
Well Dec. 
11, 1894 
83 
11 
M. 
May 8, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Aur.21.1894 12 
COLEY: OPERATIVE TREATMENT OF HERNIA.. 
No. 
Age 
Sex. 
Nature of hernia and 
duration. 
Opera- 
tion. 
Operator. 
Primary re- 
sult. 
Final result. 
84 
3 
F. 
Hernia of umbilical cord, 
congenital ; size goose- 
egg- 
Nov. 
1893 
Excision of umbilicus 
and sac ; suture fascia; 
kangaroo-tendon; cat- 
gut for skin. 
Primary 
union. 
Slight re- 
lapse few 
weeks after 
operation. 
85 
13 
F. 
Umbilical; since in- 
fancy. 
June 12, 
1894 
Excision of umbilicus ; 
sutures kangaroo-ten- 
don buried. 
Primary 
union. 
Perfect 
Oct.17,1894 
86 
9 
M. 
Left inguinal, congeni- 
tal; undescended testis. 
June 12, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Oct. 5, 1894 
87 
8 
M. 
Kight inguinal; since in- 
fancy ; truss 3 years. 
June 23, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Nov.12,1894 
88 
4 
F. 
Ventral; Bize of English 
walnut, just above 
navel. 
June 19, 
1894 
Suture fascia with kan- 
garoo-tendon. 
Primary 
union. 
Perfect 
Oct. 1894 
89 
734 
M. 
Right inguinal. 
May 18, 
1894 
Bassini. 
Primary 
union. 
Perfect 
July, 1894 
90 
4 
F. 
Right inguinal; 2% yrs. 
July 6, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union. 
Perfect 
Oct. 4, 1894 
91 
7 
M 
Right inguinal, compli- 
cated with reducible 
hydrocele. 
July 9, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union. 
Perfect 
Sept. 1894 
92 
6 
M. 
Right inguinal, since 3 
months old. 
July 10, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union. 
Perfect 
93 
10 
M. 
Left inguinal; 4 years. 
July 10, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union. 
Perfect 
Nov. 3,1894 
94 
7 
M. 
Right inguinal; since 6 
weeks old. 
July 20, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union. 
Perfect 
Aug. 24,1894 
95 
9 
M. 
Right inguinal ; truss 2 
years. 
July 20, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union. 
96 
12 
M 
Right inguinal, congeni- 
tal. 
July 27, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union. 
Perfect 
Oct. 4, 1894 
97 
10 
M. 
Right inguinal. 
Aug. 3, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union. 
Sound 
Dec.15,1894 
98- 
99 
9 
M. 
Double inguinal, with 
double reducible hy- 
drocele. 
Aug. 7, 
1894 
Double Bassini. Kan- 
garoo-tendon; no drain. 
Primary 
union. 
Perfect 
Nov.13,1894 
100 
7 
M. 
Right inguinal; vermi- 
form appendix, adher- 
ent, reducible. 
Aug.14, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Nov.24,1894 
101 
14 
M. 
Left inguinal; since in- 
fancy ; relapsed after 
truss “cure.” 
Aug.14, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Sept.24,1894 
102 
9 
M. 
Right inguinal, congeni- 
tal ; truss 7 years. 
Aug.21, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Slight sup- 
puratiou 
tenth day. 
Perfect 
Oct.11,1894 
103 
4 
M. 
Right inguinal; since 
infancy 
Aug.28, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Oct. 4, 1894 
104 
10 
M. 
Right inguinal; yrs.; 
truss 6 yrs. 
Sept.5, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Oct. 3, 1894 
105 
9 
F. 
Right inguinal ; 6 years. 
Sept.27, 
1894 
Bassini. Kangaroo-ten- 
don; no drain. 
Primary 
union. 
Perfect 
Nov. 1894 
106 
4 
F. 
Right inguinal. 
Oct. 4, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Nov. 1894 
107 
11 
F. 
Right femoral ; 6 years ; 
size of egg. 
Oct. 5, 
1894 
Excision of sac; suture 
canal; kangaroo-ten- 
don ; no drainage. 
Primary 
union. 
Perfect 
Dec. 1894 
108 
5 
M. 
Right inguinal; 3 years. 
Oct. 1, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union. 
Perfect 
Dec. 1894 
109 
6 
M. 
Right inguinal, congeni- 
tal ; truss 4 years. 
Oct. 9, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union. 
Perfect 
Dec. 1894 
110 
6 
M. 
Left inguinal; 3 years. 
Oct. 1, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union 
Perfect 
Dec. 1894 
111 
5K 
M. 
Right inguinal, with 
large reducible hydro- 
cele. 
Oct. 9, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union. 
Perfect 
Dec. 1894 
112 
9 
F. 
Right inguinal. 
Oct. 9, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union. 
Perfect 
Dec. 1894 
113 
6% 
M. 
Right inguinal; 4% yrs, 
Oct. 9, 
1894 
Bassini. Kangaroo-ten- 
don. 
Primary 
union. 
Perfect 
Dec. 1894 
ni- 
iis 
11 
M. 
Double inguinal. 
Oct .25, 
1894 
Double Bassini. Kan- 
garoo-tendon right 
side ; chromicised cat- 
gut left. 
Fourth week 
small sinus 
at site of su- 
ture where 
ch.catgut 
used. 
Perfect 
Dec. 1894 
116 
13 
M. 
Right inguinal; 6 years. 
Oct. 26, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
117 
12 
M. 
Right inguinal; since 
infancy. 
Oct. 26, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 COLEY: OPERATIVE TREATMENT OF HERNIA. 
13 
No. 
Age 
Sex. 
Nature of hernia and 
duration. 
Opera- 
tion. 
Operator. 
Primary re- 
sult. 
Final result. 
118 
11 
M. 
Left inguinal; 3 yeurs. 
Oct. 26, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
119- 
120 
10J4 
M. 
Double inguinal; 3 yrs ; 
treated 3 years with 
truss. 
Oct. 20, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
121 
5 
11108 
M. 
Strangulated inguinal 
right; strangulated 48 
hours. 
Oct. 22, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
122 
6 
M. 
Right inguinal. 
Nov. 1, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
123 
4 
M. 
Right inguinal. 
Nov. 8, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union 
Perfect 
Dec. 1894 
121 
13 
M. 
ltight inguinal. 
Nov. 2, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
126 
M 
Double inguinal; opera- 
tion left side ; 7 years’ 
truss treatment. 
Nov 10. 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
120 
7 
M 
Right inguinal. 
Nov.15, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
127- 
128 
9 
M 
Double inguinal; 5 years 
Nov .30, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
129 
7 
M. 
Right inguinal ; size of 
orange ; since infancy. 
Nov.23, 
1894 
Bassini. Kangaroo-ten- 
don : no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
130 
7 
F. 
Right inguinal; yrs. 
Dec. 1, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
131 
23 
moft 
M. 
Strangulated, right in- 
guinal 
Dec. 7, 
1894 
Bassini. Kangaroo-ten 
don; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
132- 
133 
5 H 
M. 
Double inguinal ; dura- 
tion years. 
Dec. 7, 
1894 
Bassini. Kangaroo-ten- 
don ; no drain. 
Primary 
union. 
Perfect 
Dec. 1894 
134 
12 
mos 
M. 
Left inguinal strangu- 
lated. 
Feb. 
1893 
Bassini. Kangaroo-ten 
don ; no drain. 
Primary 
union. 
Perfect 
July. 1894  Jolirijal 
of the MEDICAL SCIENCES. 
MONTHLY, $4.00 PER ANNUM. 
WITH 1895 The American Journal of the Medical Sciences enters upon its seventy- 
sixth year, still the leader of American medical magazines. In its long career it has 
developed to perfection the features of usefulness in its department of literature, and 
presents them in unrivalled attractiveness. It is the medium chosen by the leading minds 
of the profession on both sides of the Atlantic for the presentation of elaborate Original Articles; 
its Reviews are noted for discernment and absolute candor, and its Classified Summaries of 
Progress each month present an epitome of medical advances gleaned by specialists in the 
various departments. According to unquestionable authority, “ It contains many original papers 
of the highest value; nearly all the real criticisms and reviews which we possess, and such 
carefully prepared summaries of the progress of medical science and notices of foreign works that 
from this file alone, were all other publications of the press for the last fifty years destroyed, it 
would be possible to reproduce the great majority of the real contributions of the world to medical 
science during that period.” 
Tl?e Medical N^s. 
WEEKLY, $4.00 PER ANNUM. 
BY KEEPING closely in touch with the needs of the active practitioner, The News has 
achieved a reputation for utility so extensive as to render practicable its reduction in 
price from five to Four Dollars per annum. It is now by far the cheapest as well as 
the best large weekly medical journal published in America. Employing all the recognized 
resources of modern journalism, such as the cable, telegraph, resident correspondents, special 
reporters, etc., The News furnishes in the 28 quarto pages of each issue the latest and best infor- 
mation on subjects of importance and value to practitioners in all branches of medicine. Its 
numerous departments are designed to subdivide and present its material in the most attractive 
and convenient manner. 
In a word The Medical News is a crisp, fresh, weekly newspaper, and as such occupies a 
well-marked sphere of usefulness, distinct and complementary to the ideal monthly magazine, 
The American Journal of the Medical Sciences. 
The Year-Book of Treatment for 1895 
Gives a cjassified summary and review of the real advances in treatment made during 1894 in all 
departments of the science of medicine. Price, $1.50; or in combination with either or both the 
above journals, 75 cents. Ready early in 1895. 
The Medical News Visiting List for 1895 
Published in four styles : Weekly, dated, for 30 patients ; Monthly, undated, for 120 patients per 
month; Perpetual, undated, for 30 patients weekly per year; Perpetual, for 60 patients weekly 
per year. The first three styles contain 32 pages of important data and 160 pages of assorted 
blanks; the 60-patient perpetual consists of 256 pages of blanks. Price, each, $1.25. In com- 
bination with either or both above periodicals, 75 cents. Or, Journal, News, Visiting List 
and Year-Book, $8.50. Thumb-letter index for Visiting List, 25 cents extra. 
LEA BROTHERS & CO., PUBLISHERS, PHILADELPHIA, 706, 708 & 710 SANSOM STREET.