454 Fatal Case of Hernia. 
She appeared in every respect much relieved, and expressed 
herself confident of getting well without the operation; a’ 
gentle perspiration was diffused over the body, the pulse 
was stronger and less frequent than on our first visit at se- 
ven P. M. (i.e. two hours ago), the tongue was moist, and 
not much furred. . 
18th, six A. M. She had slept for some hours during the 
night, expressed herself greatly relieved, had taken some 
toast and ‘water, had not had any return of the pain, sick- 
ness, hiccough, or vomiting, was in a gentle perspiration, 
the tongue moist, pulse about 80 beats in a minute and 
moderately full: she had had the common clyster given 
during the night, but this returned without any stool; the 
hernia was soft; but the integuments retained that livid ap- 
pearance which made an unfavourable impression on my 
mind as to the result of the case. . 
T visited her again at one A.m. The symptoms were 
the same as this morning at six o’clock, excepting that 
there was more anxiety in the countenance, and that she 
seemed to be in a restless state rather than in pain: the ope- 
ration was recommended again, and assented to on her part. 
At one p.m. the operation was’ performed in the pre- 
sence of Dr. Hancock and three other gentlemen. On 
opening the hernial sac, which was very distinct, some fe- 
-culent matter escaped; the omentum, which formed the 
bulk of the tumour, was not much inflamed : on separating 
the omentum, a very small convolution of one of the sma!| 
intestines was exposed, closely embraced by the stricture: 
the intestine was in a complete state of gangrene, and had 
given way, though the opening was not visible: the stricture 
was dilated in the direction of the linea alba downwards : 
the intestine readily receded ; but the opening into it, through 
which the feces and air passed, remained opposite the 
wound ; great part of the omentum was removed, and its 
adhesions left at the mouth of the sac, with a view of its 
assisting in supporting and retaining the intestine to that 
part; one ligature only was required on a very small artery 
of the omentum. She appeared as well after the operation 
as is usual, and hoped that there was not then any danger. 
In about an hour she became very restless, and died be- 
tween two and three hours after the operation. é 
_ It appears to me, that the effects which took place im- 
mediately on taking the pills were produced by the malady 
terminating at that time in gangrene, rather than from the 
medicine. Is it not highly probable, therefore, that the 
gangrene and even the death of the patient were greatly ac- 
a celerated 
