Case of Strangulated Hernia.

THOMAS BOON, aged 25, labourer, tall, well-formed, and rather muscular, was, on the 5th of June, 1852, suddenly seized with the following symptoms:-nausea and vomiting, accompanying a very painiful tumour in the right inguinal region and correspondinig side of the scrotum. First visited at one A.M. on the 6th of June, when he gave the following account of himself:-Had been quite well the whole of the day previous, and had made a hearty supper as usual ; had then felt sick, had vomited; had passed a natural stool, immediately on which the pain and tumour supervened, the pain being confined to the tumour. Further inqniry elicited the fact, that twelvemonths previously a horse had kicked him precisely over the painful spot, causing considerable inflammation of the testicle, and pain in the inguinal canal, which yielded to warm fomentations without surgical aid, the rarts having been perfectly well ever since. On examination I found the skin cool; pulse 70, regular, and firm, but not hard; tongue natural; countenance indicative of much suffering; no vomiting since the commencement of the attack; the right inguinal canal, and right side of the scrotum, were much distended, having precisely the form and feel of a swollen testicle, and inflamed spermatic cord. There was no impulse on coughing. Suspicion pointed to strangulated hernia, but the taxis had not the slightest effect.-Ordered a warm bath, a full dose of calomel and opium, with Antim. Pot. Tart., in one-third grain doses every four hours. 10, A.M.-Matters just in the same state; pulse and countenance good; had slept a little; no vomiting, but nausea, from the medicine; taxis again failed.-To continue the mixture. Apply twelve leeches to the scrotum, and to have a warm bath every four hours, keeping a strict watch for any more urgent symptoms of strangulation. June 7th.-Still the same. Consultation with Mr. Hey, of Bridport. Both of opinion that, without more decisive symptoms of strangulation, a continuance of the antiphlogistic treatmlent was proper.-Ordered venesection to thirty ounces, a strong purgative dose large tepid-water enemata, and turpentine stupes over the abdomen, in case of any tenderness arising. 9th.-The patient continued in much the same state, and undergoing similar treatment, getting weaker, when stercoraceous vomiting occurred early in the morning, or during the night preceding. Assisted by Mr. Hey, I at once operated, and found the tumour to consist chiefly of omentum, with about eight inches of small intestine, both intensely congested. The hernia was easily returned, the patient bearing the operation well on the whole, but there was a considerable tendency to syncope. lOth.-Had a very restless night; symptoms of rapid astlienic peritonitis ; pulse 150, and almost imperceptible; extremities cold; vomiting still stercoraceous; no movement of bowels.-Ordered nine leeches to the abdomen, turpentine stupes, and tolerably full doses of calomel and opium every three hours. In the evening tlle patient was worse in every respect; prostration complete; bowels not mlioved; vomiting continues.-Ordcred an aperient pill every hour until the bowels act. 11th.-To my surprise the patient feels relieved in some measure; bowels have acted freely; vomiting not so incessant, but still in a state of collapse.-Ordered six drachms of port wine every hour; to be supported frequently with arrowroot, beef-tea, &c,, &c. In the evening there was little improvement; still great tympanitis and vomiting; state of bowels such as to require Mist. Cretoe cum Opio every third hour. 12th.-Improvement continues; speaks cheerfully; wound dressed, looked well. Chalk mixture with nourishment to be continued. 13th.--Worse; alarming heematemesis and moelena. -Ordered Spr. Terebinth., gtt. xv., tertiis horis, with chalk mixture. To continue wine. 14th.-Improving; hbematemesis, but not so frequent. To go on as before; wound dressed, edges have separated, but they look healthy. ]5th.-Better, and continued to progress until recovery was complete. At the proper 'time a well fitting truss was adjusted, and towards the latter part of August, he returned to his employment of carter to a neighbouring farmer, with the strictest caution on my part, to take every care of himself and particularly to avoid all excess in drinking. Being from home from the 26th to the 28th of August, I found the patient had died in my absence, under the following circumstances:-He had returned to his work on the 22nd, and the weather being very hot, he had drank freely of cider, more especially on the 26th, on which day he was seized with severe symptoms of entero-peritonitis, which, resisting all treatment, carried hiim off on the 28th. I was fortunate enough to obtain a post-mortem examination of the abdomen, when I found sufficient evidence of intense peritonitis and enteritis. One band of false membrane amongst others, united that portion of the ileum which bad protruded to the inner inguinal ring, and this band was, as well as the adjoininq bowel, intensely congested. No strangllation existed at any part. At the commencement of the ileum, and adherent to it, was a gelatinous-looking mass as large as a hen's heg, which much resembled the white of an egg just commencing to coagulate under the influence of heat. I have no doubt the proximate cause of death was peritonitis, brought on by excess in cider drinking, during the period of unwonted exertion at harvest season, and I have deemed the case worthy of note, in several points, as for example: 1st. The length of time that elapsed ere decided symptoms of strangulation appeared. 2nd. The prolonged period of collapse recovered from.