318

22d. Semicupium vespere:-R Pulv. Ipecac. c gr. x. hac nocte

sumend.. ,

Haust. Salin. ziss.Potassœ nit. gr. v.Tinct. opii, gr. v.-M.

Quart. quaque hord sumend,April 23. The bowels operated

three times during last night, and heis this morning greatly. relieved.

April 24. In the evening he hadretention of urine, and with difficultythe house surgeon sncceeded in pass-ing a small flexible gum catheter intothe bladder, where it was left.

April 25. Continues much the same.Cue. cr. Perineo ad,zvi.

April 26. The symptoms have beenmuch relieved ; the catheter was with-drawn, and the bladder examined byMr: JEFFREYS, with a sound, withoutfinding a stone in the bladder ; makeswater freely.

April 27. Complains of rheumaticaffection in the left hip.

,

R Emp. Galb. comp. ad coceygem.R Pulv. Ipecac. ,comp. gr. x. lwr. s.

sum.

R Decoct. Uvœ Ursi ziss.Liq. Potassaœ zss. Tinct. Opii

gr. x.-M. ter in die sumend.Appl. Hirud. xii. ad Perin.

May 2. Sir EVERARD HOME sound-ed the patient a second time, butcould not, on examination, detect thepresence of stone in the bladder;bowels costive.R Ol. Ricin. zi.

Cras-Mane suinend,June 6. The prostate glatid is much

diminished in size ; up to this date hehas been using the nva ursi, with theliq. potassa, and is now quite well.

MIDDLESEX HOSPITAL.

Case of Strangulated Inguinal Hernia.William Dunlay, a tall thin man,

aged 20, was admitted into the Hos-pital on Sunday evening 5th June,(abput nine o’clock,) with an inguinalhernia of the right side, which hestated to have existed upwards of

three years, during which tim he hadconstantly worn a truss; it freqnentlydescended, but. was easily returnedwhen in the recumbent postiare.

It came down on the Sunday morn-ing about ten o’clock, .and he was not

aWe to return it in the evening hesent for a surgeon, who bled him andattempted reduction of the hernia bythe taxis, but failing to do so sent himto-the Hospital.The tumour was about the size of

a goose’s egg, occupying the inguinal-canal, not protruding through theexternal abdominal ring, it was firmand painful upon pressure ;- the inte-guments not discoioureJ. The test!..cle of the right side had not descend.ed into the scrotum, and it might rea.dily be felt, much diminh-hed in size,at the external abdominal ring.. Hecomplained of much p;in in the abdo-men, with tenderness upon pressure,and had vomited several times beforehis -admission. We learn that theHouse Surgeon employed the taxis fora short time, and then put the patientin the warm bath ; he again attempt.ed -to reduce it, but finding, thesemeans unsuccessful, Mr. BELL wassent for about 11 o’clock. Upon hisarrival, he employed the taxis, verygently, for about forty minutes, andfinding the hernia could not be re-duced, Mr. B. proposed the operationto the patient, to which he consented.The patient had now been in the

Hospital only three hours.

Operation. _

Mr. BELL commenced by makingan incision over the whole length ofthe tumour, terminating opposite theexternal abdominal ring, in this partof the operation cutting through thecommon integuments and snbjacentcellnlar membrane, and exposing thesuperficial fascia. A large branch ofthe external pudic artery was divided, which it was necessary to tie.The tendon of the external oblique,

being now exposed, a small openingwas made through it, into which adirector was introduced, and it wasdivided by means of a probe-pointedbistoury; this exposed the liernialsac, which being also carefuUy divid-ed brought into view the intestine,which appeared to be highly vascular,but not very dark coloured.

Mr. B. endeavoured to ascertainthe situation of the stricture, whichwas found to be formed by the neckof the sac at the internal abdominalring ; having ascertained this, he in-troduced ,a director, and upon it a

319

probe-pointed bistoury, by means ofwhich the stricture was divided di-

rectly upwards, and on this being com-pleted, a considerable quantity of in-testine rushed out. The testicle was

distinctly seen at the lower part of thewound, and, as before mentioned, wasmuch diminished in size. The intes-tine being returned, the integumentswere carefully brought together andretained by means of two sutnres,assisted by adhesive plaster, and overthese a pad and bandage were placed.A common oleaginous injection was

directed to be administered imme-diately.

6th. We find him this morning withfebrile symptoms; pulse 86; tonguefnrred, and thirsty. The enema onlyproduced one scanty evacuation ; hehas much tenderness upon pressureover the whole abdomen. A purga-tive injection of salts and senna wasdirected to be administered imme-diately, and twelve leeches to be ap-plied to the abdomen.

7th. In consequence of an increasein the pulse, both in force and fre-

quency, he was bled in the night fromthe arm, he took yesterday a dose ofcalomel, followed np by castor oil,which produced three evacuations.Still much tenderness of the abdomen;pulse 84, and moderately firm.

8th. The patient is much betterthis morning; tenderness of the ab-domen diminished ; bcwels open ;eight leeches were applied to the ab-domen last night.

The treatment of this case exhibitsa very striking contrast to the ma-nagement of the last case of a similardeseription which we had occasion toreport. Cases of hernia occur butseldom at the Middlesex Hospital, andthe results have been almost uniform-

ly unfavourable. This cannot be in-deed wondered at, if such treatmentbe adopted as in the case of Moore.We felt it our duty to express theseverest censure of the means then

employed, and the tardiness withwhich they were put into execn-o

tion. Dunlay, on the contrary, hadbeen only in the Hospital three hourswhen the operation was decided on,and there cannot be a doubt thatthe preservation of his life is owing to

the promptitude with which it was per-formed. Thus the utility of our ob-servations on the management of thecase of Moore is demonstrated by thebeneficial results which we have nowthe pleasure of recording.

[To be continued.]

TO CORRESPONDENTS.

EDA is in error.The second Letter of R. X. has come

to hand, but before we can publish it,we must be furnished with the nameand address of the writer.

The Letter of DON MORBLIEU is notcalculated for publication.The communication on the subject of

Mr. BLACKETT’s Tourniquet shall bereturned to the Author, to whom we

apologize for not having done so at anearlier period.

R. S. is informed, that we never in-terfere with the private affairs of anyman. We cannot publish his letter.

Thecase of "HOUR GLASS CONTRAC-TION" sent to us from LEAMINGTON,is not sufficiently interesting for inser-tion. -

We s7iall very shortly say a fewwords on the abuse alluded to by R. W.

If Q. R. S. will favour us with hisaddress, we will write to him.The Communication of a SINCERE

ADMIRER is not sufficiently explicit; towhich of tlte " Learned Bodies" doesit allude?We are sorry that the Letter of S.

was not inserted at an earlier period.He must be aware that we are in thehabit of receiving a vast number ofCommunications, and that it is abso-

lutely impossible to attend to the wholeof them as soon as received.VINDICATOR has acted wisely in

forming a resolution to read the " WICK-ED LANCET" no more.

If CHIRURGUS of Birmingham 21‘ilt

forward us his address, we will writeto him.The Letters from a WELL WISHER,

and RAHERE’s GHOST, shall appear inour’ next, together with a few remarkson the late Election for a Surgeon toSt. George’s Hospital.The Communication of JUNIOR Wehave not as yet been, enabled to decry-

pher.