Case of Hernia successfully treated by an Operation. 215 
dicted to the use of spirits, and has been at times deranged. 
She has been subject to hernia in the left thigh for many 
"years, but it never attained any considerable size; nor has 
it been much noticed, and no truss was ever applied. 
On Friday last, the 16th instant, she was seized with 
pain over the abdomen; which extended to the lumbar re- 
gion, but was most severe at the umbilicus and in the scro- 
biculus cordis, attended with a sensation of heat. 
On Saturday the 17th the abdomen was more tense—creat 
perspiration, hiccough, sickness and vomiting. On the 
1Sth these symptoms were more violent; and on the 19th 
feculent matter was vomited. Dr. Hancock, who was 
called in, ordered fomentations to the abdomen, and aperient 
medicines. On the 20th the symptoms were still increas- 
ing, and the oleum ricini was ordered. 
On the 21st symptoms increased: calomel and scam- 
mony were administered, but every thing was rejected by 
the stomach. The symptoms at length induced Dr. H. to 
suspect hernia; and on the 22d [ was requested to visit the 
patient, which I did at 1 P. M.* 
It appeared to me that no time ought to be lost in per- 
forming an operation, as the hiccough and vomiting of fe- 
culent matter were very distressing, and the countenance 
indicated great constitutional irritation, although the pulse 
was moderately firm and not very quick. The ‘tumour was 
very small, being scarcely perceptible except when the pa- 
tient was lying on her back. ‘The operation was acceded 
to and performed at 3 P. M. 
The hernia was situated high up, nearer to the ilium than 
to the pubis, and was very firm. On dividing the integu- 
ments, the adipose cellular substance and fascia propria, the 
hernial sac was brought into view ; it was extremely thin ; 
and on dividing it a portion of firm omentum appeared, 
somewhat discoloured: on the inside of this omentum 
there was a fold of one of the small intestines greatly dis- 
coloured and thickened, so deep seated as not to form any . 
part of the tumour seen externally: some fluid was also 
contained in this part of the sac, but not any above where 
the omentum was situated. The stricture was so deep as 
to take the whole length of the bistoury, and it was di- 
lated inwards and downwards towards the pubis. The in- 
testines and omentum were returned; and the wound’ was 
secured by two sutures, straps of adhesive. plaster and lint. 
* The patient never ascribed her illness to any thing like hernia, and 
submitted to an examination of the parts with great reluctance, on the sub- 
ject being acini to her. 
O4 On 
