Surgical Cases hi the Fmshury Dispensary. 357 



pain at the navel and region of the stomach extremely di- 

 stressing ; the hernia was small, scarcely prrjjccting beyond 

 the external abdominal ring, and appeared to recede on pres- 

 sure completely within the ring. 



An infusion of nicotiana (gi, to a pint of water) was in- 

 jected and retained without producing the least apparent ef- 

 fect; two grains of calomel and one grain of opium were 

 given in form of pill every hour, but these were rejected as 

 soon as swallowed. 



At six o'clocl: in the afternoon the tobacco injection was 

 repeated and retained, bui apparently produced no efiect ; 

 the operation being proposed, was acceded to, and per- 

 for'-iKd at 10 o'ck^'k at night. 



The tenduu)us fibres of the external oblique muscle were 

 s-.-.).irated longitadin:uly from the externa! abdominal ritig 

 to.vards tne sujt^ri ;r part of the ilimn, when the hernial sac 

 appeared of a dark blue colour and vtry tense, and co;^.ta;ned 

 vom>- serous fi.nd, and one fold of the intes'inum ilium, 

 W'ich was of a very dark colour, nearly approaching to gan- 

 grene : the stricture on the intestine being at the internal 

 ri vi, renJer;^d it of more difficult access, but it was dilated 

 obliquely up vards and outwards ; that is, in the direction of a 

 line drawn from the symphysis pubes to the superior part of 

 the ilium : at \V?.\. part there were strong adhesions be^veen 

 the intestine and mOuth of the sac ; which being separated, 

 the intestine was returned : but the patient did not experience 

 that change of sensation which frequently occurs on the 

 bowel being returned ; the edges of the wound were brought 

 into contact by two sutures, supported by straps of adhe- 

 sive plaster ; a gentle laxative iTicdicine was given nccasion- 

 allv during the ni^ht, but conid not be retained on the sto- 

 mach, as the sickness and tiiceup continued with unabated 

 violence. 



On the 5th, at 7 o'clrck in the lyiorning, the countenance 

 was much improved, the pulse 9'^, ihe pain nmch dimi- 

 nished ; but the hiccup, sickness, and vomiting, continued 

 the same as before the operation; an enema composed ot 



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Z 3 . jtctcd 



