7s Srvgical Gates in the C'lfij Dispensary. 



the fomentations wcix continued, and an enema of nicotiana 

 was adaiinisl'jrL'd. 



Dec. 8. Mr. Skinner requested me to accompanv liim in 

 hiii visit to tb.is paii-jnt. No evacuation l)v stool had been 

 procured, nor had any sleep been obtained during the night, 

 and every thiiig was rejected by the stomach as soon as 

 taken; but the j^ulse was softer than on the preceding day, 

 Tvas regular, and did not exceed eighty beats in a minute : 

 the enema of nicotiana was repeated, the fomentations were 

 continued, and the following pills were ordered : 



R. Caloni. o;r. xii. opii. gr. vi. F. pil. vi. quarum sumati. 



scciuidL quaque bora. 

 Dec. 9. The poor si^flcrer was evidcntlv worse in every 

 respect : feculent matter was now vomited in large quanti- 

 ties, and the hieciip had distressed the paiient extremely 

 through the night. The operation was no sooner proposed 

 than acceded to ; and it was agreed ihat it should be per- 

 formed at nine P. M. ; and was done in the presence of Mr. 

 Skinner, Mr. Ililliard, and Mr. Eurgis. She underwent the 

 operation with great fortitude and resignation, which was 

 prolonged consic/cral'/i/ by the va'',i adhey'imis of the omentrim 

 to every part of the snc ; and it was not till a reparation had 

 been made in the substance of the omentum that the fold 

 of the intestine contained in the sac cnnld be exposed to 

 view ; when it was found of a dark colour, but not gan- 

 grenous ; and was readily returned on dilatmg the stricture 

 at the mouth of the sac. This part of the operation was 

 attended with more difficulty than usually occurs, in part 

 from the mouth of the sac being extreme! v deep seated, and 

 in part from the very extensive adhesions of the omentum 

 Vo the peritoneum aronnd that part of the intestine where 

 the stricture wa > formed : the firm adhesion of the omentum 

 to every part of the internal surface of the sac prevented its 

 being returned into the abdomen, and rendered the removal 

 of a large portion absolutely necessary ; which was accom- 

 plished by tearing its substance (in preference to using the 

 scalpel), in order that haemorrhage might not ensue : the 

 integuments, being divided by a longitudinal incision only, 



were 



