THE TREATMENT OF FEVERS

A good deal has been said on both sides as to opening the sac or not opening it in the operation for strangulated hernia. Mr. STANLBY had two cases of hernia recently under his care, which demonstrated very clearly the advantges likely to accrue from opening the sac or not opening the sac in specific varieties of the same disease; and showed that perhaps, after all, we must be guided very much by hospital experience, rather than any abstract rule. J. B., aged 54, was admitted into Lucas Ward, Sept. 26th, wit.h strangulated femoral hernia. The strangulation, from the account given by her friends, had existed for nine or ten days, during which interval there had been no operation on the bowels, and there had been constant sickness and vomiting. On her admission, Mr. Stanley noticed that, even with this formidable history, the countenance Was still tranquil, the tongue clean, the pulse unaltered, and the patient manifested less anxiety than one would be led to expect. But as the strangulation had existed so long, Mr. Stanley believed it better to operate at once, as the taxis had failed, and to open the sac. Accordingly, as soon as the patient was broug,ht under the influence of chloroform, the operation was performed, the sac opened, the intestine returned, and a piece of adherent omentum left in the sac, as it might form a plug to prevent subsequent descent of the bowel. Cases like this are very often seenl in this and the two Borough hospitals; and where the intestine has not been injured by rough handling out of doors, such cases do well, even with the sac opened. A young man, aged 30, was admitted on October 1, with femoral hernia. It had been down only six hours. The symptoms were mild; there was no vomiting; very little tension or pain; the pulse quiet. This patient having heard of deaths from chloroform, could not be persuaded to take it. Mr. Stanley accordingly, after placing the patient in a warm bath. found that the intestine would not go up, and therefore determined to operate; hut, as the intestine was sound, to operate witiont openinq the sac. An incision was made in the upper arid inner part of the thigh, dividing the fascia propria and coverings, with some bands of fascia between this point and Poupart's ligament. The intestine at once went up. Both cases have done well.