52 Treatment of the Strangulated Herma. 



derably weakened, having eat little, and vomitted fre- 

 quently, with hiccough ; pulse 90, small and hard. 



Dr. M'Lane also attended, at the request of Dr. 

 Worral, and it was determined to try copious bleeding. 

 About 24 ounces were taken away, without producing 

 that relaxation we expected, or any benefit in facilitating 

 the reduction. Injections of tobacco smoke by a proper 

 instrument, and the decoction, were repeatedly given, 

 without other effect than distressing sickness and vomit- 

 ing. He was put into the warm bath, and repeated 

 attempts made to return the sac, without effect. The 

 scrotal tumour was now extremely sore, and could not 

 be touched without giving much pain. 



On the 10th, he was considerably worse in every res- 

 pect, with restlessness, almost constant hiccough, and 

 vomiting. Having tried every remedy which either of 

 us could suggest, his pulse getting feeble, and his situa- 

 tion alarming, it was agreed that nothing could afford a 

 chance for recovery but an operation,' which was per- 

 formed between four and five o'clock. 



Dr. M'Lane was requested to take the knife, who he- 

 sitated some time, under the apprehension that the patient 

 could not survive. Considering death as certain without, 

 and a chance of life by, the operation, we urged him to 

 proceed. He began the incision just below the ring, 

 and carried it down the tumour, about four inches, after- 

 wards gradually divided the integuments by repeated 

 strokes of the scalpel, till he laid the peritoneal sac quite 

 bare ; then, introducing the forefinger of the left hand, as 



