238 PHILOSOPHICAL TRANSACTIONS. [anNO J 738. 



might easily have been made, without enlarging the annular slit; for this made 

 no stricture to prevent it. 



But the quantity of the omentum within it being large and bulky, and the 

 gut in a very diseased state, it was thought more expedient to enlarge it, to 

 make the reduction of the whole easy : afterwards the omentum was detached 

 from its adhesion round this place, and pulled farther out, and a ligature being 

 made upon the sound part of it, that was also replaced in the belly, and the 

 entrance stopped with a conical tent, dipped in the yolk of an egg, &c. the belly 

 was embrocated, and the dressings well secured ; for as the patient was very 

 much oppressed with an asthma, so she was obliged to be sitting in bed. 



From this time the hiccough and excrementitious vomitings disappeared, but 

 the retchings and vomitings continued near 5 days longer, before the faeces de- 

 tained above the strangulated gut, could make their way downwards, though 

 they were frequently visited by clysters and lenient purges. 



The patient was blooded immediately after the operation, and soon after took 

 an emollient and carminative clyster, which was repeated night and morning, 

 and an oily laxative every 4 hours. 



A.t first the evacuations were exceedingly fetid, black, griping, and frequent ; 

 but they became more moderate, as she took absorbents and diluents ; but yet 

 so frequent, that it was thought proper to restrain them by gentle astringents. 



In 5 or 6 days the stools had removed the tension which appeared on the 

 belly after the operations ; the retchings and vomitings, and the remaining 

 symptoms went off, the wound digested well, and the patient continued in a 

 mending way. 



It has been already observed, that this old woman was very much afflicted 

 with an asthma: she had at times violent fits of it, and the 14th day from the 

 operation she had one, with a total stoppage of the discharge from her lungs, 

 which choaked her on the 17th day. 



This case was a proof of what Mr. A. had frequently observed, on similar occa- 

 sions, viz. that as the omentum is the principal obstacle to the reduction of theguts 

 in ruptures; so it is the occasion of the greatest accidents that attend that evil. It 

 wraps up an^ incloses the prolapsed gut like a net, whose fastened end within 

 the belly strangulates the part detained in the rupture without the abdominal 

 apertures, where it is confined, and is productive of such folds in it, and pres- 

 sures of the gut wrapped up therein, as is oftener the cause of a strangulation 

 and miserere mei, than the tendinous slits of the external oblique muscles in the 

 inguinal rupture, or tendinous opening in the navel, which upon these is 

 seldom found inflamed, and can never contract so suddenly, as to obstruct the 

 return of the gut into the abdomen, when the omentum is wanting : agreeably 



