IMAGE EVALUATION TEST TARGET (MT-3) // •V S" /. Il ^ 1.0 I.I 1.25 1^ IIIIIM IIIIIM I4£ 1^ III— li& i;£ 12.0 1.8 1.4 ill 1.6 % <^ m f 7 V M Photographic Sciences Corporation %^ <* ■^ ». 4^ U 23 \MEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 M ^% 1? % ih.. CIHM/ICMH Microfiche Series. CIHIVI/ICMH Collection de microfiches. Canadian Institute for Historical Microreproductions / Institut Canadian de microreproductions historiques vV Technical and Bibliographic Notes/Notas techniquas at bibliographiquas The Institute has attempted to obtain the beat original copy available for filming. 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This item is filmed at the reduction ratio Ciiecked below/ Ce document est filmd au taux de reduction indiquA ci-dessous. 10X 14X 18X 22X 26X 30X y mk 16X 20X 24X 28X 32X Tha copy filmed hare has baan raproducad thanks to tha ganarosity of: Medical Library McGill University Montreal Tha Imagaa appaaring hara ara tha baat quality posslbia considaring tha condition and lagibllity of tha original copy and in Icaaping with tha filming contract spacificationa. L'axamplaira fiimi fut raproduit grica h le gAnirositi da: Medical Library McGill University Montreal Laa imagaa suPv^ntaa ont 4t4 raproduitas avac I* plus grand soni. compta tanu da la condition at da la nar. >f^ da l'axamplaira fiimA, at an conforr:!vUi avac las conditions du contrat da filma^a. Original copias in printad papar covars ara fiimad beginning with tha front covar and anding on tha last paga with a printad or illustratad impres- sion, or tha bacic covar whan appropriate. 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(Maps, plates, charts, etc.. mey be filmed at different reduction ratios. Those too large to be antireiy included in one expoaura ara filmed beginning in the upper left hand comer, left to right and top to bottom, as many frames aa required. The following diagrams illustrate the method: Lea cartes, planches, tableaux, etc., peuvent Atre filmte A dee taux da rMuction diffirents. Lorsque le document est trop grand pour Atra raproduit an un saul cliche, il eat fiimi A partir de i'angia sup^rieur gauche, de gauche A droite, et de haut an baa, er prenant la nombra d'imagas nicessaire. Les diagrammas suivants iliustrent la mAthode. 1 2 3 1 2 3 4 6 il 6 i\ 0, / i. '• m 0, C/ECAL HERNIA. DY FRANCIS ;. SHERHERD. M.D., CM., i . Senior Surgeon to the Montreal General Hospital. Cxcal hernia, pure and simple, is seldom or never seen, for in nearly every case the protrusion, in addition to the c?ecLim, consists of the vermiform appendix, ascending colon, or a por- 10 tion of the ileum. It was formerly thought that there was no sac about a Ciccal hernia, or if it existed, that it was rare, but p more recent and extended observation, especially since the parts ihave of late years been so frequently exposed during the radical cure, have proved that absence of sac is the exceptio.i. When any other portions of the intestines accompany the (Ca?cum, they are usually found floating? free in the same sac. Cxcul hernia is nearly always congenital, and is more common than was formerly believed. The writer has seen at least half a dozen , cases in the last ten years, in only one of which., the case re- ported below, the tumor consisted solely of ciccum. The explanation of the occurrence of ca^cal hernia is simple, and is , connected with the descent of the testicle. From the globus major of the testicle to the ciecum, appendix, ileum, and mesen- tery, is a fold of peritoneum (plica vascularis) which contains the spermatic vessels and the gubernaculum testis, and during the descent of the testicle the cxcum may be carried down with it. On the other hand, the cttcum may prevent the descent of the testicle and so cause the retention of the testicle in the abdo- men in inguinal canal. C?ec;il hernia may be sometimes recog- nized by its size and irregularity. It does not feel like an ordinary hernia. The following case came under my care during the past summer. F. C, net., three and a half years, was brought to the Montreal General Hospital by his parents on August 15, 1895, for a painful swelling in the right inguinal region and scrotum. The child was in perfect health, and the parents gave the following history. When a year old, a small swelling or lump the size of a walnut was first noticed in the right groin. It was not painful and caused the child no incon- venience, so nothing was done. Six months later the child complained of pain in the abdomen and cried a great deal, and then it was noticed that the swelling had increased in size, and had descended into the scrotum. The child was brought to the Outdoor Department of the Hospital, and a diagnosis of inguinal hernia was made. The tumor was easily reduced, and a truss was ordered. The truss was worn irregularly until a few weeks before the patient came to the hospital, when it was discarded, S) ■A r t F e f] IHM Gal 5 for without it the hernia never came out and the parts were perfectly normal and painless. A few hours before entrance into the hospital the child had fallen from a gallery, a distance of about six feet. After this he complained of severe pain in the groin, and on examinmg the site of the hernia they found a large, firm, tender tumor, much larger than they had ever seen it before. Hot applications were employed, but these affording no relief the child was brought to the hospital. There was no vomiting. On examining the patient a large, firm, oval swelling was seen, extending from the internal abdominal ring to the scrotum, in the course of the inguinal canal. The swelling was dull on percussion, tender and fluctuating, the least movement seemed to cause great pain. The child's face was Hushed, tongue dry, respirations quick and shallow, and temperature loo*^. Soon after entering the hospi- tal the child commenced to vomit, so he was immediately put under ether and attempts at reduction were made. These being without effeci. the parts were cleansed and an operation imme- diately undertaken. On cutting down, the sac was reached and easily recognized. On opening it, a large quantity of clear fluid escaped. The contents of the sac were then seen to be caecum only, coming down through a large opening and not constricted. There were posterior adhesions which prevented its return. These were freed and the bowel was returned without difficulty. The appendix was not seen. The sac was then dissected out and cut off, the opening being closed with several catgut sutures. The external wound was closed with silk-worm gut sutures, and the usual dressings were applied. The child made an uninterrupted recovery, the wound healing by immediate union, and has remained well ever since. The pain and vomiting in this case were, no doubt due to the tension caused bv the exu- dation of fluid which followed th^ fall. Before operation the case was regarded as one of incarcerated hernia and of no great urgency, but operation and radical cure, considering the circum- stances, were deemed to be the best procedure. In one case, operated on sometime before, there was a hernia of small intes- tines in front of the citcum, the csecum being behind the sac proper, or rather having the sac in front of it only. In the pres- ent case, however, there was a distinct sac in which the caecum floated free. 1,52 Mansfield Street.