Treatment of the Strangulated Hernia. 35 



appeared imminent. By this dilatory mode of practice, 

 I lost three patients in five, upon whom the operation 

 was performed. Having more experience of the urgency 

 of the disease, I made it my custom, when called to a pa- 

 tient, who had laboured two or three days under the 

 disease, to wait only about two hours, that I might try 

 the effect of bleeding, if this evacuation was not forbid- 

 den by some peculiar circumstances of the case, and the 

 tobacco clyster. In this mode of practice, I lost about 

 two patients in nine, upon whom I operated. This 

 comparison is drawn from cases nearly similar, leaving 

 out of the account those cases, in which a gangrene of 

 the intestine had taken place. I have now, at the time 

 of writing this*, performed the operation thirty-five times, 

 and have often had occasion to lament, that I had per- 

 formed it too late, but never that I had performed it too 

 soon. There are some cases so urgent, that it is not 

 advisable to lose any time in the trial of means to pro- 

 duce a reduction." 



Mr. Hey's Practical Observations on Surgery contain 

 some excellent directions for opening the sac, when that 

 is to be done, which, with a number of cases perspicu- 

 ously detailed, well merit attention. 



The annexed letter from Dr. Worrall will show, that 

 the cure has been complete, and, I hope, will remain so. 



Yours, &c. 



Jas. Lyons. 



* Published in 1803. 



