THE BRITISH MEDICAL ASSOCIATION 191 



The catgut ligature has other apphcations of such interest, that I must 

 beg you to hsten to some cases in illustration of them. Those to which I wish 

 to refer are two of irreducible hernia, which failed to yield to the treatment 

 which Mr. Syme long advocated, that of keeping the patient lying on his back, 

 giving a spare diet, with frequent doses of castor-oil, and daily application of 

 the taxis. One was a ventral hernia in a young woman, originating apparently 

 in deep-seated abscess of the abdominal wall. It was of large size, causing 

 extreme inconvenience, and the treatment to which I have referred having 

 failed, I laid the sac freely open so as to expose the adherent intestines and 

 omentum which it contained, and separated the adhesions under the com- 

 paratively inconvenient antiseptic means which we then used, freely sponging 

 with I to 40 watery solution of carbolic acid, and protecting such portions of the 

 viscera as were not being immediately operated on by a cloth dipped in the 

 lotion. When the adhesions had been all detached, by tearing or by the knife, 

 I reduced the viscera under the antiseptic cloth as under a substitute integument, 

 and then pared the edges of the orifice by which the sac communicated with 

 the abdominal cavity [an oval aperture about three inches long], cutting off 

 the peritoneum from the muscular and fibrous structures, and then stitched 

 those edges securely with closely applied interrupted sutures of prepared catgut, 

 the ends being cut off near the reef-knots. The external wound was then stitched 

 and treated antiseptically like an ordinary one. During the introduction of 

 the deep stitches the patient vomited violently, so that it was only by exerting 

 very firm pressure that I prevented further visceral protrusion, and after going 

 back to bed she vomited again — a tremendous test for our catgut stitches ; 

 but they stood the test. The young woman left the hospital without any hernia ; 

 and though a very small protrusion did afterwards appear below one part of the 

 cicatrix, it was readily reducible and amenable to ordinary treatment b\' means 

 of a truss. 



The other case was a large umbilical hernia in a cook. It interfered with 

 her duties very much, and at last she could hardly walk about at all. This case 

 was treated like the last ; but, in the absence of the spray, ii I had known wliat 

 I was about to encounter, I should not have entered upon it. It was a most 

 laborious and protracted business, dividing ver}^ complicated intestinal adhesions 

 by cutting and tearing, and at the same time maintaining constant vigilance in 

 protecting the exposed intestines with the antiseptic cloths. Tlie thing, how- 

 ever, was at length accomplished, and the entire mass was returned into the 

 abdomen. The edges of the deep opening were pared and sewn together closely 

 with catgut sutures with their ends cut short, and the external wound was 

 closed with carbolized silk stitches, leaving an opening for a ' drain '. A large 



