VENTRAL HERNIA. 405 



the colon had protruded." There was little or no constitutional dis- 

 turbance. She was bled ; a cathartic given ; and the tumour constantly 

 wetted with cold water, and supported by a bandage. The next day 

 Mr. Simonds submitted the case to Messrs. Morton, Spooner, and' Youatt. 

 They urged him to return the protruding viscera, and secure that 

 return by operation. On the 24th she was operated on. Opium was 

 given to lull sensation and pain, — a dose of §iiss tinct. opii. She was 

 cast and secured, and propped upon her back by straw. Her head was 

 made fast to a ring in front, and one hind leg was fixed to another ring. 

 The effects of the opiate were manifest throughout the operation. 

 " After a careful examination, externally as well as per rectum, in order 

 to ascertain the situation and probable size of the laceration of the 

 muscles, an incision was carefully made through the integument into the 

 sac, in a line with the inferior border of the cartilages of the false ribs ; 

 which incision was seven inches in length. This, as we had hoped, proved 

 to be directly upon the aperture in the muscular parietes of the belly. 

 The intestines were exposed ; and, after having sufficiently dilated the 

 opening to permit the introduction of the hands, they were quickly re- 

 turned, portion after portion, into their proper cavity, together with a 

 part of the omentum. At times it required our united strength to 

 prevent the escape of the intestines, and which was only effected by 

 placing our hands side by side, covering and pressing upon the opening. 

 By these means we succeeded in keeping in the viscera until we were 

 satisfied that we had replaced them all within their proper cavity. A 

 strong metallic suture of flexible wire was then (by means of a suitable 

 needle) passed through the edges of the laceration, taking in the perito- 

 neum and portions of transversalis, rectus, and internal abdominal 

 muscles, and other sutures embracing the same parts were placed at 

 convenient distances, so as nearly to close the aperture. Two sutures of 

 smaller metallic wire and three of stout silk cord were then passed 

 through the external abdominal muscles, and their aponeurosis, which 

 effectually shut up the opening. The integument was then brought 

 together by the interrupted suture, taking care to bring out the ends of 

 the other sutures. The operation occupied rather less than an hour, our 

 poor patient being occasionally refreshed with some water gruel." After 

 she was risen, a compress and suspensory bandage that could be tight- 

 ened at pleasure, were placed upon the wound. Next day, the sac which 

 had contained the hernia was filled with serous effusion. A dependent 

 opening was made, from which three or four pints escaped. — 26th, Sup- 

 puration. — 30th, Enabled to walk out ; skin sutures came away. — 

 November 4th, Sloughing, in which three metallic sutures came away. 

 A sinus formed towards the mamma through which tape was passed. The 

 appetite up to this time had been tolerably good, and the pulse had 



