HERNIA, OR RUPTURE. 3^3 



case to their examination, and obtaining their opinion. They urged me 

 to attempt to retnrn the protruding viscera, and secure them by a surgical 

 operation ; and Mr. Spooner kindly offered to be present, and to give me 

 his valuable assistance. 



' On the 24th, our patient was considered to have had sufficient prepa- 

 ratory treatment, and she was operated upon. We availed ourselves of 

 the opportunity of putting to the test that which some among us had 

 doubted, and others had positively denied, but which had always been 

 maintained by our talented chemical lecturer — the power of opiam to lull 

 the sensation of pain in the horse. We therefore gave her two ounces and 

 a half of the tincture of opium, shortly before she was led from the box to 

 the operating house, and the power of the drug was evident through the 

 whole of the operation. 



' After a careful examination, externally, as well as jier 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 in- 

 cision was about seven inches in length. This, as we had hoped, proved 

 to be directly upon the ajDcrture in the muscular parietes of the abdomen. 

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

 opening to permit the introduction of the hand, they were quickly returned, 

 portion after portion, into their proper cavity, together with a part of the 

 .omentum, which we found somewhat annoying, it being frequently forced 

 back again through the laceration. 



. ' At times it required the exertion of oar 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 Ave were satisfied that 

 we had placed them all Avithin their proper cavity. At about the central 

 part of the aperture, we decidedly found the greatest pressure of the in- 

 testines to effect an escape. 



' A strong metallic sutiu'e of flexible Avire Avas then passed tlii-ough the 

 edges of the laceration, taking in the peritoneum and portions of the 

 transversalis, rectus, and internal abdominal muscles ; and other sutures, 

 embracing the same parts, Avere placed at conA'enient distances, so as nearly 

 to close the aperture. Tavo sutures of smaller metallic Avire, and three of 

 stout silk cord, Avere then passed through the external abdominal muscles, 

 and their aponeuroses, which effectually shut up the opening into the 

 abdomen. The integument Avas then brought together by the interrupted 

 suture, taking care to bring out the ends of the other sutures, and Avhich 

 had been purposely left long, so that in case of supervening inflammation, 

 or sAvelling, they might be readily examined. The whole operation 

 occupied rather less than an hour, our poor patient being occasionally re- 

 freshed Avith some Avarm gruel. 



' The hobbles Avere noAv quietly removed, and, after lying a few minutes, 

 she got up, and was placed in a large loose box. A compress and a sus- 

 pensory bandagOj that could be tightened at pleasure, were applied to the 

 Avound. The result was very satisfactory, and at the end of three months 

 she returned to her usual Avork.' 



In umbilical hernia Ave get a protrusion of the intestines into the um- 

 bilicus. On examination, a tumour varying in size Avill be found about 

 the centre of the abdomen, Avhich is soft to the feel, aiid can generally be 

 reduced by pressure, when the rounded edges of the peritoneal caAaty 

 from Avhich the intestine has escaped will be distinctly felt. By way of 

 treatment, persistent pressure, in the form of a truss, will sometimes be 

 effectual ; but the folloAAdng method Avill generally be attended AA'ith the 



