Case of Hernia Umlnlicalis. 301 



pursued without benefit, and the svniptoms increased till 

 the morning of the 2d ot" July, when 1 was requested, to 

 see her. 



The (-peration was immediately recommended, and ac- 

 ceded to on her part. Indeed, I considered tlial toj much 

 deiny had alreadv taken place. 



Ttie integument* over the hernia were very thin, and in 

 close contact with the peritoneal sac, which was also very 

 ihni, and every where m contact wuh and adheririg firmly 

 to the omentum. The omentum was partly torn through, 

 and partly dissected from the peritoneal sac, and a consider- 

 able portion of it was teinoved t)efore the convolution of 

 intestine was brought into view. The omentum was much 

 inflamed, and in [daces approaching to a dark green colour; 

 The convoluiion of intestine was very dark, nearly in a 

 state of gangrene. The stricture was very deep and firm; but 

 when dilated there was not any impediment to the return 

 of the bo^\el: nearlv the whole of the omentum contained 

 in the sac was removed. The extent of the inflammation 

 on the omentum and intestine, the latter appearing almost 

 in a state of gangrene, induced me to observe to the gen- 

 tlemen who had been attending the case, that I was fearful 

 that too much time had been lost, and that it was ot the 

 utmost importance to the safety of the patient, that the 

 operation for hernia should be always performed early. 



July 3d She had a natural stool, was free fmm fever, 

 and continued to recover without anv unfavjurable sym- 

 ptoms. The wound was completely healed in a month, and 

 she was as well as usual, and continued so till her labour 

 came on at the usual time. The hernia then protruded and 

 became strangulated: she had sickness, hiccough, vo- 

 miting, and constipation. She contiimed in this state for 

 two days, when she was safely delivered. The htrnia was 

 still irreducible, and the vomiting and. constipation con- 

 tinued till the next day, when the tumour lessened and the 

 symptoms were relieved. At times she has had violent pauis 

 in the part, and the tunx^ur has become tense and irreduci- 

 ble tor a short period ; bui these sym|itonis have generally 

 subsided wittiout any surgical as>istaiK:e. She could never 

 be prevailed upon to wear a jfroper truss, though strongly 

 recommended so to do. 



April 20, !8.2, 4 1*. M. I was requested by her husband 

 to visit her on account of her old complaini,'of which she 

 was now very ill. Frr)n) bis representation ot the case I 

 took my iiiMruments, and Mr, Burn to assist at the opera- 

 tion should it be found necessary, in order that no time 

 U 3 should 



