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It is to be recollected, that this practice of long conti tinued pressure, was first founded on the idea, that the stricture, or more particularly the tendon of the oblique muscle, was capable of dilatation and contraction. If any doubt of this theory at that time remained, it has been subsequently done away, by a circumstance that will be. related in the case of Susanna Hamshaw,

CASE. II.-Thomas Marsden, aged 78 years, of an athletic form, and who had enjoyed a good state of health the greatest part of his life, was seized with symptoms of strangulated hernia, the 18th of June 1806. Two days after this event, I first saw him, and found him suffering great distress. The vomiting was frequent, and his belly was painful, and rather tense. He was thirsty, but his tongue was not much furred, and he also had not had a stool since the strangulation commenced. The hernial swelling was of the femoral kind, was large and painful to the touch, and of an elliptical form, whose greatest diameter extended in an horizontal direction, and consequently nearly parallel to Poupart's ligament, He said, the first symptom of strangulation was perceived on his getting over a style, but the hernia he had been troubled with fifty-eight years, though not always in the same degree. His pulse was at 90, soft, and contracted; he moaned much, appeared dejected, and had frequent incitements to make water. Fifteen grains of the vitriolated magnesia, dissolved in a table spoonful of water, were ordered him every half hour; but this did not agree well with his stomach, and was accordingly discontinued. Six drops of the tinct, opii, diluted with a small portion of water, were next given him every ten minutes. This seemed to agree well with him, and evidently relieved his sickness and vomiting. Gentle pressure was had recourse to, and continued for three hours, but without success. The tobacco clyster and the operation were both proposed, but neither of which were acceded to, On taking my leave of this patient, I recommended cold applications to the swelling, together with occasional pressure. I afterwards learnt, he called in another practitioner, and that he languished about ten days, six of which he was troubled with a diarrhoea, which only terminated with his existence.

CASE III. Robert Green, a healthy man, aged 65, and who had been afflicted with a scrotal hernia about two years, was seized with symptoms of strangulation on the 20th of August 1806. On the 24th I first saw him, and, found he had been four days in great distress from retch

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ing and vomiting, which were accompanied with great pain all over the abdomen. He was costive, his tongue somewhat furred, and rather parched, and was thirsty, with a pulse at 75. The hernia was down in the scrotum, was somewhat large, but bore handling well. A finen cloth wrung out of the aq litharg. acet. comp. was ap plied to the tumour, on which gentle pressure was also made by the hand for seventeen minutes, when the hernia retired, with no other indication than a diminution of the tumour. Previously, I had ordered him six drops of the tinet. opii to be taken as in the preceding case. After the first dose his sickness and vomiting considerably abated. On the following day I found this man without any thirst, or pain in the abdomen, yet his pulse had increased both in force and velocity, being now full, and at 96; but something of this kind I had formerly observed, after the re duction of that specics of strangulated hernia, comprising the first class of symptoms, as before mentioned.

CASE IV. Susanna Hamshaw, a widow woman, aged 68, and who had been subject to an inguinal hernia, for several years, was on the morning of the 10th of January 1808, attacked with symptoms of strangulation. These were a violent pain in the right groin, which extended up to the stomach, and all over the abdomen, and attended with excessive sickness, which was succeeded almost immediately by a stool. In this distress she continued all the rest of the day; but had not vomited till within three hours of my first seeing her, yet in this interval she had thrown up frequently. I visited her fourteen hours after the commencement of the strangulation, and found her, complaining of great pain in the before mentioned parts. The swelling in the groin extended down to the labia pudendi, and was painful, as well as the rest of the abdomen, on being handled. Her pulse was tense, and at 104, her thirst considerable, but her tongue was tolerably clean. She made water well; in short, her principal complaints were excessive pain and sickness. I gently pushed up the tumour to the abdominal aperture, and retained it in this position by gentle pressure for four minutes and a half, when it receded with slight borborigmi.

There was no medicine given in this case, nor any other means used, save pressure, and in performing which, I was constrained by the position of the patient, to retain the hernia with two of my fore-fingers and thumb, instead of following the directions heretofore given. These, as

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soon as the reduction took place, were pushed along with the skin, within the opening, (for she was a very thin subject) and I could plainly perceive the ring to contract almost immediately around them.

CASE V.-Sarah Taylor, a married woman, aged 46 years, and of a delicate constitution, and who had been troubled with a femoral hernia twenty-six years, was, on the 13th of October 1809, seized with symptoms of strangulation, which were succeeded by two motions. Five days after this event, I saw her, and found since the first attack of strangulation, she had vomited five or six times. every twenty-four hours, and in the intervals had frequent returns of sickness, attended with acrid eructations. The hernia was large, but bore handling well, and her belly was rather tense and not much painful to the touch; her pulse was at 100, and in force; her thirst considerable, and her tongue was furred, and appeared as if stained with ink; her urine also was in small quantities, and rather high coloured. I made pressure on the tumour for an hour, and recommended it to be repeated for half an hour at a time, every four hours, during the night; as from circumstances I was prevented from performing the operation till the following day. The aq. litharg. acet. c. was ordered to be applied frequently in the form of stupes, and six drops of the tinct. opii to be taken every ten minutes, for two hours only, along, occasionally, with a small quantity of the vitriolated magnesia dissolved in water.

19th. Her pulse was at 108; her thirst considerable; her tongue rather more furred, and her belly was somewhat inflated, and rather more tense, but not much painful on pressure. The convulsive and acrid eructations much the same as yesterday, but had not vomited since she took the opium, though appeared often sickly, and there also was little alteration in the appearance of the hernia. Her countenance was however considerably changed, and cold clammy sweats were beginning to be perceptible on the

extremities.

In this situation the operation was proposed and submitted to with great reluctance. After denuding the hernial sac, I passed my fore-finger, between it and the apo neurosis, with very little resistance, except when I introduced it within Gimbernat's ligament, which was divided as in Case 1. After this I pressed gently on the sac with my fingers, for about half a dozen seconds, when I perceived something to give way, and on which the patient cried

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out as if something hurt her. The hernial swelling now became less by more than one half. A florid suffusion overspread her countenance, and which was soon after succeeded by perspiration. Her eyes became more lively and elevated within their sockets, and though laid upon a table, the greatest part of the time she was asleep, à visitation she had not experienced since the commencement of the strangulation. Although I was satisfied that the stricture was removed, yet the gentleman who took a part with me in the operation, still having some doubts, founded on the circumstance of the convulsive eructations remaining undiminished, notwithstanding no other symptoms of strangulation had appeared for the space of an hour. On the ground of this objection, I thought it right to proceed with opening the sac, which was horizontally elongated thus, The fundus pointing towards the os ilium, and containing a portion of omentum in a diseased state, more thickened and indurated than natural, and in one place to the size of a small sixpence, dark coloured. About half way between the fundus of the sac and Gimbernat's ligament was a greater quantity of omentum, apparently sound, enveloping a certain portion of intestine, except a space of the magnitude of a small shilling, which was uncovered. This part of the intestine I gently pinched up with my finger and thumb, and with the fingers of my other hand broke the adhesions, which united the intestine and omentum. These were however slight and not extensive. This being accomplished, I pushed up the intestine very gently with my fore finger, and it entered the abdomen, and was followed by the principal part of that portion of omentum which surrounded it; but the remainder at the bottom of the sac adhered so firmly to the anterior part of it, as to induce me to leave it within the wound, which it rather more than completely filled. Dry lint, and a small digestive pledget were the dressings, and these were secured by straps of adhesive plaster, with a view of preventing any protrusion of the hernia; over the whole, also was applied a proper bandage.

20th. Pulse 103; thirst considerable, and her tongue equally furred as yesterday. Her belly was rather more tense and inflated, but she had however slept tolerably in the night. Ordered a table spoonful of the castor oil to be taken every three hours, interposing now and then a little of a solution of the magnes. vitriolat. These medicines procured three loose stools in the course of the day,

which relieved her belly much, but still the belchings were nearly as troublesome and frequent as ever.

21st. Pulse 92, and slept tolerably in the night at intervals. Her tongue was rather better, and her thirst some little abated, but her belly continued yet rather tense and painful. She had three motions this day from her medicines.

22d. Pulse 94, and in other respects much the same. She had had five stools since yesterday, which, together with the eructations, she complained of as being very hot.

23d. Her pulse was at CO, and her belly rather softer, and less sore. Her thirst was some little abated, and her tongue appeared rather less furred. The eructations continued hot and troublesome, and she had only one loose stool in the course of the day. Ordered a little magnesia alba to be taken frequently along with her liquids.

24th. Pulse 90, and in other respects no variation. She had five loose motions to day. The dressings were removed for the first time, and the wound looked well, but the appearance of the omentum was more gangrenous. Dry lint dipped in one part of the ol. terebinth. and two parts of the bals. copaiv. were applied, and a similar pledget and straps as before. In this manner the wound was dressed daily. On the ninth day, the gangrenous portion of omentum sloughed off, and appeared to be about two or three drachms in weight, and to have increased in a ten-fold degree since the operation. The wound was healed in seven weeks. It was sixteen or seventeen days before the pulse subsided to its natural standard, and before her tongue became clean, and her belly soft and flaccid. Her eructations continued some little time longer, and after having apparently left her, were easily re-excited for several months, on any thing greasy being taken into the stomach.

One circumstance attending this case is of some importance, and although already mentioned, yet I will beg leave to recapitulate it. On dividing the stricture, the pulse was at 108, and in an hour afterwards, being at the time of opening the sac, it was reduced to 101, and at the expiration of a second hour it remained stationary, but in the space of other fourteen hours they had advanced to 103. These circumstances tend to confirm so much of the above theory, as relates to the sudden diminution of more bid symptoms, on removal of the stricture, when the sac is unopened, and vice versâ.

I have no doubt that on Gimbernat's ligament being divided,

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