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 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, 
 
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 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.