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t he tumour, parallel to Poupart’s liga-ment. ,A second incision was nextmade nearly at right angles with thefirst. The two triangular flaps of in-tegument were next dissected back,and the superficial fascia being exposedwas slit up ; the fascia cribritorma, orfor,e-part of the femoral sheath beingexposed,was also divided ; the hernialsac was next brought into view, andan opening carefully made into it.The omentum was found to be so

firmly adhering to the fore-part of thehernial sac, that it occasioned muchtrouble and delav in separating them. IThat being effected, the hernia wasfound to consist of a small knuckle ofintestine, with a portion ot omentum;the intestine was dark-colonred, buthealthy. The stricture was next

sought for, and ascertained to be atthe crural ring. A director was in-troduced, and by means of a bistoury,the stricture was carefully divided,upwards and inwards, in a line withthe umbilicus ; the intestine was rea-dily returned. The flaps of integu-ment were carefully brought together,and retained by means of a suture andadhesive straps.

26th. The patient passed a goodnight. She had a copious evacuationseen after the operation, and herbowels have been twice relieved since.Pulse, 84. Tongue slightly furred.27th. The symptoms are all favour-

able, and she had a tranquil night. Asthe bowels had only been acted upononee since yesterday, a common enemawas ordered to be administered im-mediately. She takes arrow-root andmilk.

28th. Onr report of to-day is favour-able ; the bowels have been well re-,licved, and the patient is in every re-spect doing well.

In the history of this case we forgotto observe that the patient was ope-rated upon by Mr. KEY about twoyears since for femoral hernia of theleft xide ; we well remember the case.The hernia had existed for a long time,and the gut was in a state approachingto mortification." it cannot rain but it pours," says

the Spanish proverb; in pi ont’ of this,two other cases of strangulated herniawere admitted on 26th. Mr. MORGANoperated upon one early on Sundaymorning; it was a case of scrotal her-

nia, and the patient is doing well. Inthe other case, the hernia was re-

duced, but the patient continited tohave symptoms of strangulated intes-tine, and he was operated upon onTuesday. Some difference of opinionprevailed amongst the surgeons, whe-ther there was any hernial sae; thisis certain, no strangulated intestinewas found. We shall speak of thiscase in our next number.

The accidents admitted last weekwere—a case of fractured ribs, aCcom.panied with fracture of the scapnla,two cases of simple fracture of thehumerus, a severe lacerated wound ofthe leg, and other cases of minor im.portance.The accidents admitted during the

present week, are-a case of fracturedribs, accompanied with fracture of thescapula; three cases of fractured hn-merus ; a fracture of the patella; audthree caes of strangulated hernia.

ST. THOMAS’S HOSPITAL.

No operation has been performedhere this week; and the cases whichhave been admitted are not of muchinterest.On Friday evening (19th June) a

poor man was brought to the Hospitalwho had attempted to commit suicide;by means of a t azor he had inflicted awound of about four inches in lengthabove the os hyoides, the anteriormuscles between that bone and thechin being divided, and thus an open-ing was made into the mouth. It wasfound necessary to secure two arte-ries, (branches of the tingnal,) and bymeans of sittures and adhesive straps,the edges of the wound were broughttogether. He was completely insane;and two or three times he tore off thedressings, and thus opened the woundagain. He died about four days afterhis admission.The surgeon who had visited this

man before he was brought into theHospital had stitched up the woundwithout securing the bleeding vessels,and there was consequently muchswelling of the neck, from the san-guineous engorgement of the cellularmembrane surrounding the wound.

411

Cases are upon record which have

proved fatal from this circumstance

alone, withont any wound of the la-rynx or pharynx.

The accidents admitted this weekare—two cases of compound fractureof the tibia and fibula; a compoundfracture of the ossa nasi; with otheraccidents of minor importance.

BARTHOLOMEW’S HOSPITAL.

Wednesday, Jnne 8. J. Parkerwas brought into Cotton’s Ward; halfafter -one o’clock, with an inguinalrupture of great magnitude on theleft side; in appearance it was like alarge pumpkin, 12 inches or more incircumference, and six in diameter.The septum scroti was nearly imper-ceptible, and the situation of the peniscould only be -discovered by a slightdepression on the surface of the tumour, resembling the navel on the ab-domen; the distended surface of thescrotum was marked with a nnmler oflarge swollen veins. He has had adescent of hernia since Saturday, andvomited every thing since Sunday.Has had inguinal hernia for 20 years ;but always succeeded in returning it.There has been no passage throaghhis bowels since its descent. Thematter vomited is of a dark green co-lour, thin, and free from smeil or

stercoraceous matter ; had been bledprevious to admission. He was order-ed by Mr. STANLEY to be put intothe warm hath. Mr. LAWRENCE, atMr. S.’s desire, saw him in the warmbath; and after examining and at-

tempting to reduce the hernia by thetaxis, said he thought it one of thosecases that lie beyond the reach of sur-gicalaid; that some purgative medicineshould be given him, and time allowedfor its action ; if it had not the desiredeffect, to trv the tobacco glyster: heended, however, by saying, if it washis own case he would not performany operation. When taken out oftlie-bath at two o’clock, he had extract.eol. c. gr. x. and hydr. sub. gr. ij. givenhim, and warm fomenting flannels ap-plied to the tumour. Mr.. STANLEYpromised to see him again at’llalf-aftersix, allowing the interim for theopera-tion of the purgative; at such timefinding the tumour less tense and

softer, and the pills not -rejected, or-dered a purgative glyster. At half-after eight, having had no stool, ttietobacco glyster was injected, j. tolbj., hal-a-pint first, and then theremainder; but producing no greatdegree of depression, and the taxisunsuccessful, the operation was de-cided on. Mr. S. commenced by mak.ing an incision, three inches in

length, over the upper part of thetumour, through the skin and fasciasuperficialis; exposing the ring, whichwas freely divided directly upwards,with a probe-pointed bistoury upon thecurved director. He then endeavour-ed to reduce the contents -of the sacwithout opening it ; but, after severalineffectual attempts at reduction inthis manner, he was induced to openthe sac to the extent of about threeinches ; it contained a large quantityof thin chocolate-coloured fluid. whichbeing discharged, he succeeded in re-turning a considerable portion of in-testiue into the cavity of the abdomen,but was deterred from any further at-tempts, by feeling what he supposedto be adhesion ; such opinion beingstrengthened by the recollection ofthe long duration of the hernia. Theman continued to vomit during theoperation ; the lips of the wound werebrought together by several stitches,a pad of lint placed in the direction otthe incision, and strips of plaster,,anda roller over all ; the man was put tobed. After the operation his pulsewas 120, quick and wiry ; belly verytense and swollen; ordered to havewarm fomentations to the abdomenand tuamour ; to -be left in perfectquietness, and -in an iaonr to take

snlphas. mag. j. aqua menth. j. everythree hours.

9th. Bad night; had an enema.at four, another at eight in the

morning, which produced a thin fluiddischarge from the bowels, colou-redwith fæces; expresses frequent in-clination to go to stool, but dischargesnothing; pulse 90, full ; belly tense,and complains of pain upon pressurein the left iliac region; vomits as fre-quently as before; had a glyster atsix, and another at ten at- night ; or-dered a purgative of calomel andjujap, and to take as little fluid as pos-sible.

10th. A very bad. night; threw