350 Surgical Cases in the Citij and Fi/islury Dispensaries. 



which took place on Monday August 24th, when she was 

 seized with violent pain and tension of the abdomen suuilar 

 to labour pains. The neighbours gave her the usual carmina- 

 tives ; but the pain increased, the tumour enlarged, vomit- 

 ing, hiccup, and cold sweats came on ; she was worse on 

 the 25th, and was delirious at night. On the 26Lh in the 

 morning an aperient medicine \va'< given, but that was im- 

 mediately rejected on its beiug received into the stomach. 

 At four o'clock in the afternoon- an enema was injected, but 

 that also returned immediately without any feculent matter. 

 On the 27th she was much worse during the whole day, 

 feculent matter being vomited in large quantities. I saw her 

 for the first time at nine o'clock in the evening, when the 

 pulse was scarcely perceptible, the extremities cold, the eyes 

 had a peculiar wild stare, and the body was partially covered 

 with a profuse cold svvcal : she appeared to be nearly in arli- 

 culo mortis. Having explained the extreme danger of the case 

 to the patient and to her husband, she expressed her desire 

 of having the operation immediately performed. The hernia 

 was situated under Poupart's ligament, on the inner side of 

 the large blood-vessels (the usual seat of crural or femoral 

 hernia). An iircision of about three inches in length was 

 made through the integuments along the middle of the tu- 

 mour, bc2;innmg at the mfcrior edge of Poupart's ligament. 

 The fascia was thin, and very little adipose substance inter- 

 vened between the intecruments and hernial sac: which last 

 was also extremely thin, but did not contain any fluid, and 

 adhered to the omentum, which was much discoloured and 

 compressed, the circulation having ceased in every part of it. 

 It was then removed by excision close to the mouth of the 

 sac, the edgefe of the integunicnls were supported in contact, ■* 

 bv two sutures and some straps of adhesive plaster. The 

 patient lay perfectly quiet during the operation, from which 

 she did not express any sensation of pain. Two spoonfuls of 

 an aperient medicine were then given, which remained on the 

 stomach. She was quiet during the night, but did not sleep, 

 eSih. There hadnot been any pain or sickness since the ope- 

 ration, the pulse was somewhat more distinct, but the ex- 

 tremities remained cold. The aperient niedicine was repeated, 



and 



