369 



HERNIA. 



78, A cart stallion brought to the external clinique on the 14th 

 June, i8g8. 



A few hours before, when working in a dray, one of the arms of the 

 windlass * had penetrated the left flank. 



A large oedematous swelling was visible in the left flank opposite 

 the stifle. On manipulation, the abdominal tunic was discovered to be 

 ruptured, and slightly above this rupture the muscles were torn 

 through. In order to confirm the diagnosis (of ventral hernia) the 

 parts were explored per rectum. Four to five inches in front of the 

 inguinal ring was a tear about six inches long in the abdominal wall, 

 running obliquely forwards and outwards. 



During the afternoon the animal was cast on the right side and 

 chloroformed; the left hind leg was abducted, as in operation for 

 strangulated inguinal hernia. After disinfecting the parts, M. Almy 

 made an incision about six inches in length through the skin, in an 

 oblique direction backwards and inwards, exposing a loop of slightly 

 congested small intestine. This having been reduced, the muscles and 

 aponeuroses forming the abdominal wall were seen to be irregularly 

 torn, the several layers being ruptured in different directions. The 

 muscular tissues were brought together with a line of silk sutures, which, 

 however, were very difficult to insert on account of the condition of the 

 tissues. A second row of silk sutures, crossing the former in an 

 oblique direction, was inserted in the aponeurotic portion ; lastly, the 

 skin was brought together. A cotton-wool dressing was applied. 



After removal of the hobbles the patient remained recumbent, not 

 rising until the end of a couple of hours. Food was confined to gruel 

 and milk. The evening temperature was 38"8° C, respirations 16, 

 pulse 50. 



During the three following days the temperature oscillated between 

 38*8° C. and 397° C. A considerable oedematous swelling developed 

 around the wound. 



Between the 17th and 20th the temperature rose to 39-' C, some- 

 times even to 39*5^ C, and the respirations became more frequent — 

 45 to 50 per minute. 



On the 20th the wound, after cleansing, was bright red, and almost 

 entirely covered with granulations. A few small fragments of the 

 aponeurosis, which had become loose, were excised. Some of the deep 

 sutures were removed, the parts were dusted with iodoform, and a 

 gauze dressing applied. Fever continued distinctly high, respiration 

 was rapid and shallow. 



From the 22nd to the 25th general disturbance diminished. The 

 patient consumed all its food. On the 30th June it left hospital in a 

 fair way to recovery. 



When again seen on the gth July the wound had healed, and the 

 swelling disappeared ; the hernia was cured. 



* In France carts used for carrying casks are provided with a windlass for tightening 

 the ropes by which the load is secured. — Jno. A. W.- D. 



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