Fated Case of Inguinal Hernia. 231 



much furred ; the pulse irregular, frequent, and intermit- 

 ted. There was also great thirst and fever. 



The countenance became livid ; the eye had that peculiar 

 stare which often precedes death from strangulated hernia; 

 the extremhies became cold; the skin generally cold and 

 clammy, in a partial state of cold perspiration. 



These symptoms ended in death in 13 days from the first 

 attack; nor does it appear (although the symptoms of 

 strangulated hernia continued from the beginning of the 

 •disease) that any attention was ever directed to the hernia, 

 beyond that of pressing the protruded viscera within the ex- 

 ternal abdominal ring on the first day of the disease. 



The medicines were cathartics, opiates, saline draughts, 

 and glysters. Fomentations to the abdomen and the warm 

 bath were also used. 



These particulars were related to me by two of the pro- 

 fessional gentlemen who attended him, as I did not visii#the 

 patient during life, but only attended to examine the parts 

 after death, when the following appearances were noted. 



The whole of the thoracic viscera were, healthy. The 

 gall bladder was distended with bile, and contained several 

 small biliary calculi. 



The liver, spleen, pancreas, and omentum were healthy; 

 the stomach, duodenum, jejunum, and ilium were much 

 distended with flatus. The jejunum and ilium inflamed: 

 .the inflammation increased as the intestines were turned 

 downwards to the left abdominal ring, through which a con- 

 volution of the ilium had protruded about twelve inches 

 before its termination in the ccecum. The protrusion 

 formed a tumour about as large as a middle-sized apple, 

 and situated on the anterior part of the spermatic process, 

 between the peritoneum and abdominal muscles, so as not 

 to form any tumour visible on the external part of the body; 

 but there cannot be a doubt but it might have been disco- 

 vered during the life of the patient by pressure. 



The stricture was produced by the peritoneum only. 



There were not any adhesions between the hernial sac 

 and intestine, nor had the sac suffered from chronic inflam- 

 mation. The portion of intestine contained in the sac was 

 highly inflamed, but not in a state of gangrene. The in- 

 testines below the stricture were empty and much con- 

 tracted ; the inflammation extended along the intestine 

 only about four inches below the part where the stricture 

 was situated. 



The rest of the abdominal viscera were perfectly healthy. 



The appearances, on dissectiou, of this case show, that 



P4 if 



