VOL. XXXIX.j PHILOSOPHICAL TRANSACTIONS. Ql 



warm on the belly; he was blooded, and an emollient carminative oily clystei* 

 was ordered to be applied in the evening; but as he was easy, and the belly not 

 tense, that was omitted. He was confined to a very spare diet, and his body 

 kept open by clysters, injected every second day, when stools were wanted, to 

 prevent straining. When dressed on the 4th day after the operation, every 

 thing appeared well, and there was good reason to hope for a cure, especially as 

 the discharge by the anus was natural. The tent put into the abdominal aper- 

 ture was not removed till the 8th. On the ]Oth, the ligature round the ap- 

 pendix coeci, where it had been amputated, dropped off, and no faeces followed 

 it; and as it was then plain they had taken the natural course, from that time 

 the wound was treated like an ordinary one, only care was taken to keep a 

 strong and constant pressure over the abdominal aperture, as well to fence 

 against the intrusion of the viscera into the wound, as by a strong incarnation 

 and cicatrix, effectually to secure the patient against a rupture. During the 

 time of the cure he was confined to his bed, always kept to spare diet, and or- 

 dered never to go to stool but in a bed-pan; by these means the wound was 

 completely healed up in less than a month, and the patient soon after dis- 

 charged with a truss, which he was ordered to wear some time, to confirm the 

 cure. 



That the appendix coeci should be the only gut found in this rupture, is a 

 case singular in practice : this was full of excrements, and occasionally could be 

 distended with an additional quantity, which on pressure was returned into the 

 colon, with that kind of noise which guts replaced generally give. This had 

 occasioned a diminution of the tumour when compressed, before the operation 

 was performed, as the patient was lying backwards with his head downwards, 

 and an increase of it as he stood erect, when the faeces from the colon could 

 get into it again. 



The patient does not remember when he swallowed the pin, which had per- 

 forated the gut within the rupture. But as this rupture was from his infancy, 

 fixed and unreducible, it is likely the pin had then made its way into the ap- 

 pendix coeci prolapsed ; and that an inflammation ensuing, had occasioned an 

 adhesion, by which the increase of the tumour had been checked, and the 

 reduction of the prolapsed parts rendered impracticable. 



The surgeons who constantly dressed the patient before the operation, ob- 

 served then, as they have since, that the humour discharged formerly at the 

 fistula, had frequently the appearance and the smell of excrements, so that 

 there is no doubt that the cause of it was the wound made in the gut, by the 

 pin giving way occasionally to such a discharge. The patient also perfectly 

 remembers, that the imposthumation or gathering", preceding the fistulous dis- 



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