go PHILOSOPHICAL TRANSACTIONS. [aNNO 1736. 



known till the operation was over; for this appendix coeci, which was the only 

 gut found in the rupture, was so contracted, carnous, duplicated, and changed 

 in its figure and substance, that it was impossible to determine what kind of 

 gut it was, or to find out that it was only this appendix elongated, and in 

 disguise. 



None of these difficulties were apprehended when the operation was under- 

 taken, in which Mr. A. proceeded as usual ; the omentum, lying uppermost in 

 the hernial bag, was dissected from the parts it was knit to, and particularly the 

 gut it was embodied with, and afterwards cut off close to the abdominal muscles, 

 without any previous ligature, the vessels in it being small, and its substance 

 more like a sweet-bread than a caul. 



Much time was spent in this dissection; the operator being straitened for 

 room, and greatly disturbed by the discharge of the faeces coming out of the 

 gut, on every motion the pin lodged in it, and the omentum suffered, on the 

 separation of these from each other. The gut forming a double tube, like a 

 double-jointed syphon, continuing in the curve as it passed over the testicle and 

 spermatics, was separated one part from the other, and from the adjacent parts, 

 as far as the aperture in the abdominal muscles, where its imperforated end was 

 separated from them, and thence stretched out and unfolded, which brought in 

 view the aperture made in it by the pin, hitherto concealed, through which 

 that part of it, which was incrusted with chalk, had just made its way out on 

 an occasional pressure, as a cork out of a bottle. It was the opinion of the 

 physicians and surgeons present, to amputate this gut: to which end a circular 

 ligature was made about the sound part of it, 2 inches above the aperture; and 

 this, being cut off an inch below the ligature, was replaced in the abdomen, in 

 such a manner that an artificial anus might be made there, if the patient's case 

 should require it. Afterwards so much of the hernial bag as had been detached 

 from the skin, the spermatics, &c. was cut off, which, as they appeared in a 

 sound state, were preserved in situ. The fistulous opening adjoining to the 

 thigh, and answering to the aperture in the gut, was opened; some angles of 

 skin in the way removed ; the aperture in the muscles, which had been enlarged 

 by incision, was stopped up with a tent; and the rest of the dressings and the 

 situation of the patient ordered so, as to remove from the wound all such pres- 

 sure from within, as might disturb the cure. 



It is easy to conceive that this operation was as painful to the patient as labo- 

 rious to Mr. A ; it was a continued dissection, attended with danger on parts 

 not well distinguished; it lasted near half an hour, during which the patient 

 vomited largely, and had several stools, but was soon composed by i oz. of 

 diacodium, and emollient embrocations and fomentations, frequently applied 



