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discount the idea that just because a hernia is big it is also safe. Strangulation is not seen in small congenital hernias either. I think strangulation depends mostly on the angle at which the long axis of the presenting part meets the plane of the hole. In congenital umbilical hernias it is usually 90 degrees, but in inguinal hernias the angle is more acute; in acquired adult umbilical hernias the hole is made by the stretching of the interdigitating fibres, and the resulting hole is likely not to be always at right angles to the force producing it, and therefore strangulation sometimes occurs. Possibly associated with the high incidence of hernias in Africans generally is a small but probably significant increased incidence of strangulated internal-that is, retropaitoneal-hernias. Two cases of small-bowel obstruction, both due to herniation into the right duodenojejunal fossa, were seen. In the first the diagnosis was easy because of the large ventral hernia; the short dilated afferent loop of jejunum could be felt leading to the tumour and it was dealt with effectively. In the second no umbilical hernia was present. The patient's continued vomiting was suspected to be due to gastritis following the drinking of pombe (native beer, like fermented gruel) and the true nature of his illness was not discovered until a necropsy was performed. Although the presence of large umbilical hernias facilitate palpation of the abdominal viscera, when the latter are felt to be abnormal the presence of the former cannot usually be made the excuse for laparotomy however tempting this may be. Most unsophisticated Africans seem to be proud of this expansile device and wish to keep it.-I am, etc., STuART H. WYDELL. Camperdown District Hospital, Camperdown, Victoria.