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away, more especially at night, and even in the daytime when he threw himself on his back, it would frequently go in with a gurgling noise. On the 22nd September, he rode on horsebaek and got cold and chilled through. On the evening of that day, the lump had increased in size and was painful ; it was only partially reduced during the night, and as soon as he arose in the morning it came out again. He continued to work up to mid-day, and on taking a heavy lift, which occupied a few moments, he was seized with violent vomiting which has continued more or less severe up to the present time.
A surgeon was called and the taxis applied, but it failed to reduce the hernial protrusion ; other means were also resorted to but failed of success, and as the case appeared to be urgent, he was sent to Montreal for surgical treatment.
On admission he looked pale and distressed, vomiting was persistent. The vomited matter had the usual feculent odour, and was dark in colour, hiccough was almost constant, his pulse was full and bounding, and there was some mental disturbance, more of the character of low muttering than actual delirium. The eyes were suffused, and he complained of great tenderness in the region of the hernial protrusion near the neck of the sac. The bowels had not acted since the morning of the day in which these symptoms had been declared.
At the hour of visit on the day of his admission into hospital, the taxis was applied but failed, and the operation was at once determined on. He was removed to the operating theatre, placed under ether, and another unsuccessful attempt at reduction was made. A free incision was then made in the usual way, the operator cutting down carefully until the sac was reached. This was opened at its most dependent part, and a quantity of bloody serum evacuated. The sac was opened and a coil of small substance came into view. The coats were found much congested and ædamatous, the bowel feeling thick, hard, and brawny, and the surface was covered with a layer of lymph. The stricture was found to be at the internal abdominal ring. This was incised in the usual way, and the operator then proceeded to reduce the protruding bowel. Some difficulty
was experienced; in its reduction a portion of the healthy bowel was drawn down with the object of removing any recent bands which may have formed attaching the bowel to the mouth of the sac. After some manipulation and considerable difficulty the hernial protrusion was returned in whole, the wound closed by carbolized ligatures, a compress with spica-bandage applied, and he was removed to his bed. The hiccough continued for a short time after the operation. This, however, ceased after the administration of a hypodermic injection of morphia. In the evening his temperature was normal, he was a little restless, pulse full and soft, but there was some tenderness about the neck of the sac. There had been no vomiting since the operation, he had taken milk sparingly. Opium was ordered to be given in grain doses if necessary.
September 27th.—Patient feels comfortable. Had one grain of opium during the night and one this morning. Parts about the wound and the scrotum are swollen and tender. The bandage which had become loose was reapplied. Temperature 99o. No bad symptoms present.
28th.— Tenderness less marked to-day. Still a good deal of inflammatory effusion. One of the stitches having been removed the wound is open in part, the rest shows signs of uniting by first intention. Water dressing ordered. Bandage and compress removed. Temperature 99o. Pulse normal. Patient says he feels comfortable. Urine has been drawn off since the operation.
29th.—Is restless. Temperature (morning) 1001°. Tongue furred; tenderness in hypogastric region ; bowels still constipated, and scrotum red, swollen and tender. Wound is healthy and is beginning to granulate. Pulse is bounding, and 100 in the minute.
30th.—Condition nearly the same as yesterday ; pulse not so bounding; scrotum increased in size, and redness more diffused.
October 2nd.—Pulse and temperature normal to-day. Tenderness over abdomen less. Tongue cleaning, and scrotum less painful and red, but still containes effusion. Took opium gr. i. last night and spent a good night. Ate an apple to-day and some custard.
3rd.— Temperature and pulse still normal. Bowels not acting. Efusion into scrotum going down, and tenderness less marked. Wound is covered by healthy pus, and is granulating freely.
6th.-Had a regular stool to-day; for the first time complained of a sense of desire tn go to stool, but an inability to evacuate the contents of the bowel. Dr. Fenwick ordered an injection which gave him great relief. General condition good. Wound looks well, ædema almost gone; no tenderness, but testicle is large and feels firm There is also a good deal of thickening along the site of the cord. A suspensory bandage was ordered.
14th.— Wound almost closed; adema entirely gone; testicle large but less tender than a few days ago. Does not complain of any pain, &c. Bowels regular and health good in all respects. He walks freely about the ward, and sleeps well, and in every respect has properly recovered. The scrotum is still suspended, and he will return home in a day or two. The hernia so far has not descended, nor does there appear any tendency thereto.
Reviews and Notices of Books.
Transactions of the Pathological Society, Philadelphia
Vol. seventh, containing the report of the proceedings from
Printed for the Society by J. B. Lippincott & Co., 1878. This is a very neatly got up book. The first part of the volume gives a list of former Presidents; of officers and committees at date of issue ; of members; of specimens exhibited at the meetings of the Society; of specimens reported on by the special committee on morbid growths, and list of illustrations. The special work of the volume then begins.
The first paper is a report on the osseous system. Dr. John Ashhurst, jr., reports two cases of compound fracture of the skull, occurring in children, with remarks. In the second case death ensued from abscess in the anterior lobe of the right cerebral hemisphere, which is attributed to injury to the brain substance from contre-coup. This, we think, admits of doubt; it appears to us to have been due to extension, as the veins of the diploe were most probably inflamed, pus had formed, and was evacuated at the time the trephine was applied in removing the depressed portion of the bone. Dr. William Pepper likewise reports an interesting case of abscess formed between the bone and meninges evidently from a former injury. Dr. Ashurst also reports a case of amputation at the hip-joint in a young man of 22 years, for osteo-sarcoma of the femur. At the time of the report on the 9th day after the operation, the patient was doing well. There are altogether nine articles in the report. The other writers being Dr. T. B. Reed, for Dr. Reynolds, in a case of amputation after compound fracture in which the injury was followed by necrosis of the tibia and fibula and disease of the ankle-joint. Dr. Lenox Hodge on ostitis of the tibia, two cases. Dr. J. C. Wilson, on intra-capsular fracture, and again, Dr. Hodge on caries of the sacrum and great trochanter, with diseases of the ankle-joint.
The second section is on diseases of the digestive apparatus. Dr. William Pepper reports a case of typhoid fever in which there was septic-poisoning and death from exhaustion. Other lesions were found on post-mortem examination affecting the spleen, intestinal glands, endocarditis, with ulceration, abscess of the femur and suppurative parotitis. Cancer of the stomach is next reported on by Dr. Louis Starr. There are other interesting and important cases reported in this section, altogether twelve in number.
A like number of cases are reported in the section on the Vascular System, the opening article being on“ dissecting aneurism of the abdominal aorta,” reported by Drs. Edwards and Stone, and again we notice an interesting case of aortic aneurism opening into the oesophagus, reported on by Drs. Starr nad Bodine. The other cases reported are all of interest.
The fourth section, on the organs of respiration, opens with the report of a case by Dr. Pepper, in which there existed
extreme diseases of the pericardium, pleura and peritoneum, and in which tapping of chest and abdomen had to be practiced to relieve the patient's distress. There is also a paper on embolic pneumonia by Dr. John Guiteras. This gave rise to a discussion, animated in character, which is reported, and adds interest to the case. There are several other interesting papers in this section.
In section five, the genito-urinary apparatus is considered. In division a we have cases of contracted kidney, interstitial nephritis, large white kidney, cystic disease of the kidney, and tubercular degeneration of the kidney. This forms the first division. The second division b, includes diseases of the female generative organs, and in c, the third division, will be found cases having reference to the male organs of generation.
In the sixth section, affections of the nervous system are reported on. Under section VII, will be found a report on affections of special sense, and at VIII, tumours not otherwise classifiable are given. This is followed by a miscellaneous collection of good things thrown in at the end, some of much interest. We must commend the careful manner in which this work has been edited. The collection is highly interesting and instructive.
A Treatise on the Science and Practice of Midwifery.—By
W, S. PLAYFAIR, M.D., F.R.C.P., &c., &c., with notes and additions by ROBERT P. HARRIS, M.D. Second American from the second and revised London edition, with two plates and one hundred and eighty-two illustra
tions. 8vo. pp. 639. Philadelphia: HENRY C. LEA, 1878. Nothing can be more gratifying to an author than a full appreciation of the value of his work. That Playfair's system of Midwifery was fully appreciated by the profession is attested“ by the rapid exhaustion of an unusually large impression.” This led to the issue of a second edition before the expiration of two years, and in this edition the author undertakes a careful revision, so that we have here a useful and valuable textbook, and one which is freely recommended to the student and