Case of Hernia Umlilkalis. 303 



that she was not able to turn herself or to raise herself in 

 bed wiihoLit assistance. 



The tumour was rather of a livid colour, not very tense, 

 but had that peculiar feel as if it was filled with fasces trom 

 a rupture of the intestine. There was but little pain in the 

 hernial tumour, or on the lower part of the abdomen; but 

 above, and rather inclined to the left side, there was a small 

 part more tense and painful on pressure. 



After stating the extreme danger in which she was, both 

 to herself and to her husband, I named the operation as 

 the only thing to be done, which could give any chance 

 for her life, and left it for them to decide; which they did 

 in the affirmative. 



The incision was made in the direction of the linea alba, 

 through the integuments, which were very thin and adhered 

 in every part to the peritoneal sac. There were about 3 oz. 

 of a stra.v-coloured fluid contained in the sac. The intes- 

 tine was now exposed, being of a dark colour, almost 

 black. The peritoneal coat was abraded or ulcerated on one 

 part, to the extent of the size of a shilling : the stricture 

 was between three and four inches deep, requiring the 

 w hole length of the bistoury : it was dilated a little both 

 above and below, in the direction of the linea alba : there 

 was no adhesion or impediment to the return of the intes- 

 tine, nor vias any force required. When the stricture was 

 dilated, it appeared almost to withdraw itself into the ab- 

 domen. 



The edges of the wound were laid together, and supported 

 by strips of adhesive plaster and a compress of lint ; the 

 >^hole confined by a common roller. 



The following medicine was ordered, and two table 

 spoonfuls directed to be taken every second hour. 

 Be Conf. arom. 5ii. 

 Spt. lavd. comp. 5'fs. 

 Tinct. opii 5i. 

 Aq. menth. pip. ^^ifs- M. 

 On visiting her at nine p. m. four hours after the opera- 

 tion, the sickness and vomiting had entirely subsided. She 

 had taken three cups of tea, which she seemed to like. She 

 was still very cold, the clammy perspirations were not 

 abated, and the skin was almost as much discoloured as it 

 was before the operation : but on the whole she felt her- 

 self relieved. The medicine was directed to be continued. 

 Siie died at four o'clock in the mormng, eleven hours after 

 the operation. 



It has often fallen to my lot to record similar cases to 

 U 4 the 



