mouth and neck; a feeling of tightness in the abdomen, especially about the navel ; spasmodic pain at the pit of the stomach ; bowels constipated ; sickness of stomach ; being intensely thirsty, he drinks frequently, and he throws up every time he drinks; has eaten nothing since the commencement of the attack ; the pulse and respiration quick and feeble ; the unfortunate patient feels and looks restless, low and miserable; the countenance anxious ; is troubled with incessant hiccup ; the integument over the tumour hard, thick, sodden, and ruddy. Under such circumstances the risk of an operation was trivial in comparison with that of attempting at reduction ; and if the hernia cannot be safely reduced without operation, the operation must be done; and as Sir J. Paget- enjoins, " You must instantly operate, though you may have only the slenderest and further, it is just in instances such hope of doing good as this that surgery must incur the risk of seeming to do harm rather than miss the opportunity of doing good. As the patient was quite fatigued from the journey, I ordered an enema and the following draught:?
P>.
Spt. ?
eth. chlorici ammon. aromat.
...
...
in
x.
5ss*
3 j. in. ft. haust. Camph. enjoined fomentation. After five hours' rest, during which interval hot fomentation was persisted in, the unfortunate patient slumbered for about an hour ; when he awoke, lie felt hungry : some milk was kept ready for the purpose, and he greedily swallowed it; his hiccup
Mist
...
...
and
and A
nauseousness
subsided, and he felt easier.
gentle effort was once made at reduction under the influence of chloroform?failing, I proposed an operation, to which the patient gave a 'willing assent. At 5 p.in. the patient was placed on the operating table, in
a suitable position. After shaving the parts when sufficiently anajsthetised with chloroform, just at the part of the right side where the impulse ceased, a transverse fold of the skin was pinched up between the fingers, which I transfixed with a sharp pointed straight bistoury, in a direction parallel with the long axis of the tumour; then continued the linear incisions, and divided the fascists by pinching up a little bit of the successive coverings with forceps, passing a director into the aperture, dividing it to the same extent as that of the skin, until the sac was reached. Reduction was now attempted, but failed. I then opened the sac near its mouth, passed a director, and followed the incision to the full length of the external opening; then passing a blunt pointed bistoury flat on the tip of my left index finger, I cut or rather incised the seat of strangulation by pressing its sharp edge directly upwards, at the level of the internal
ring.
\
mozuffernuggur CASE OF
By Honorary
dispensary.
STRANGULATED HERNIA. Assistant
Surgeon
P. A. Minas.
looking, strongly built individual, named Meerklian, Mussulman, Pathan by caste, aged about 35, employed as a chowkeydar in a canal chowkey, in the village Kheree, belonging to this district, presented himself at 11 a.m. of the 2nd September in the civil charitable hospital, when lie stated that he has been subject to rupture" for the last five years, and has been in the habit of wearing a native made truss. Whilst straining at stool five days ago, the hernia descended, when he felt a little pain, and was unable to reduce it in the customary way. Assistance of friends and village barbers was sought for eagerly, but without avail; the tumour began gradually to exceed its A. healthy
"
i.aual size, became harder and tenser; All endeavours to reduce failing, one friend of his, getting tired of using the hands, sat on the tumour, and pressed as hard as he could. Whilst suffering under such tortures, the swelling, instead of disappearing, not only increased in size, but beeanie painful; fever set in, with urgent thirst, nausea, and hiccup, and as a dernier resort, he came here for the amelioration of his sufferings. At present the testicle is as large as the patient's head, tense, firm, and hard ; painful and tender on pressure, especially at its
The fluid contents of the sac were turbid ; the intestines were of natural hue, glistening and tense ; the bulk of the sac consisted of highly inflamed, ruddy pink, agglutinised omentum. Breaking the adhesions, when the bleeding stopped, I returned it into the abdomen, the wound was brought into apposition by three stitches of silk ligature, adhesive plaister put on, a large tow padding placed, and the whole secured by a figure of eight bandage round- the thigh and pelvis ; a dose of spirit ammon. aromat. was given, and the patient removed to his ward. After three hours ordered tr. opii ?i.; the same to be repeated at
night.
On the
following day,
3rd
September,
the abdomen became
distended above the umbilicus, where pain is felt slept well last night. Calomelenos gr. iii.
on
pressure;
...
gr. i. ft. pil i. every 3rd hour. Hot water fomentation Vespere.?Continues the same; troubled with hiccup and vomiting ; thrice he attempted to take sago and milk, but could not retain it in his stomach ; swelling and tenderness of the abdomen increased a good deal:? xxxvi. Hirud. med. xv. Haust effervesce, with spt. eth chlorici. Ext,
Opii
...
...
...
...
Repeat pills.
September 4th.? At dawn, when the compounder made the patient swallow a pill, he desired to be assisted to sit to stool, wlten he passed nothing but flatus; when replaced on the charpoy, covered himself with a sheet, with a desire to sleep again, but an hour after, when the compounder went to see him again, he called out to him ; receiving no answer, he unoovered his face, when he was found dead. Mozufpeknugguh, 29th September 1873.
P>.
Spt. ?
eth. chlorici ammon. aromat.
...
...
in
x.
5ss*
3 j. in. ft. haust. Camph. enjoined fomentation. After five hours' rest, during which interval hot fomentation was persisted in, the unfortunate patient slumbered for about an hour ; when he awoke, lie felt hungry : some milk was kept ready for the purpose, and he greedily swallowed it; his hiccup
Mist
...
...
and
and A
nauseousness
subsided, and he felt easier.
gentle effort was once made at reduction under the influence of chloroform?failing, I proposed an operation, to which the patient gave a 'willing assent. At 5 p.in. the patient was placed on the operating table, in
a suitable position. After shaving the parts when sufficiently anajsthetised with chloroform, just at the part of the right side where the impulse ceased, a transverse fold of the skin was pinched up between the fingers, which I transfixed with a sharp pointed straight bistoury, in a direction parallel with the long axis of the tumour; then continued the linear incisions, and divided the fascists by pinching up a little bit of the successive coverings with forceps, passing a director into the aperture, dividing it to the same extent as that of the skin, until the sac was reached. Reduction was now attempted, but failed. I then opened the sac near its mouth, passed a director, and followed the incision to the full length of the external opening; then passing a blunt pointed bistoury flat on the tip of my left index finger, I cut or rather incised the seat of strangulation by pressing its sharp edge directly upwards, at the level of the internal
ring.
\
mozuffernuggur CASE OF
By Honorary
dispensary.
STRANGULATED HERNIA. Assistant
Surgeon
P. A. Minas.
looking, strongly built individual, named Meerklian, Mussulman, Pathan by caste, aged about 35, employed as a chowkeydar in a canal chowkey, in the village Kheree, belonging to this district, presented himself at 11 a.m. of the 2nd September in the civil charitable hospital, when lie stated that he has been subject to rupture" for the last five years, and has been in the habit of wearing a native made truss. Whilst straining at stool five days ago, the hernia descended, when he felt a little pain, and was unable to reduce it in the customary way. Assistance of friends and village barbers was sought for eagerly, but without avail; the tumour began gradually to exceed its A. healthy
"
i.aual size, became harder and tenser; All endeavours to reduce failing, one friend of his, getting tired of using the hands, sat on the tumour, and pressed as hard as he could. Whilst suffering under such tortures, the swelling, instead of disappearing, not only increased in size, but beeanie painful; fever set in, with urgent thirst, nausea, and hiccup, and as a dernier resort, he came here for the amelioration of his sufferings. At present the testicle is as large as the patient's head, tense, firm, and hard ; painful and tender on pressure, especially at its
The fluid contents of the sac were turbid ; the intestines were of natural hue, glistening and tense ; the bulk of the sac consisted of highly inflamed, ruddy pink, agglutinised omentum. Breaking the adhesions, when the bleeding stopped, I returned it into the abdomen, the wound was brought into apposition by three stitches of silk ligature, adhesive plaister put on, a large tow padding placed, and the whole secured by a figure of eight bandage round- the thigh and pelvis ; a dose of spirit ammon. aromat. was given, and the patient removed to his ward. After three hours ordered tr. opii ?i.; the same to be repeated at
night.
On the
following day,
3rd
September,
the abdomen became
distended above the umbilicus, where pain is felt slept well last night. Calomelenos gr. iii.
on
pressure;
...
gr. i. ft. pil i. every 3rd hour. Hot water fomentation Vespere.?Continues the same; troubled with hiccup and vomiting ; thrice he attempted to take sago and milk, but could not retain it in his stomach ; swelling and tenderness of the abdomen increased a good deal:? xxxvi. Hirud. med. xv. Haust effervesce, with spt. eth chlorici. Ext,
Opii
...
...
...
...
Repeat pills.
September 4th.? At dawn, when the compounder made the patient swallow a pill, he desired to be assisted to sit to stool, wlten he passed nothing but flatus; when replaced on the charpoy, covered himself with a sheet, with a desire to sleep again, but an hour after, when the compounder went to see him again, he called out to him ; receiving no answer, he unoovered his face, when he was found dead. Mozufpeknugguh, 29th September 1873.
