lAAAGE EVALUATION TEST TARGET (MT-S) // ■ttf 1.0 I.I 1.25 1^ 14^ 112.8 Tu m III 1^ iiiii M 1.8 U ill 1.6 ^. V] (^ /^ A ^> y /^ Photographic Sciences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 ^S^ <^ ^ # CIHM/ICMH Microfiche Series. CIHIVI/ICIVIH Collection de microfiches. Canadian Institute for Historical Microreproductions / Institut Canadian de microreproductions historiques Technical and Bibliographic Notes/Notes tachniquas at bibliographiquas Tha Instituta has attamptad to obtain tha bast original copy availabia for filming. 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L'exempiaire filmA fut reproduit grAce i la g^nirositA da: Medical Library McGill University Montreal Lee Imeges suh/antee ont 4ti reproduites avec le plus grend soln, compte tenu ( meaning "CON- TINUeD"), or the symbol V (meaning "END"), whichever appliee. Un dee symbolee suivants apparattr* «ur la dernlAre imege de cheque microfiche, selon le caa: le symbols — »> signifie "A SUIVRE". le symbols V signifie "FIN". Maps, plates, charts, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one exposure ere filmed bt^ ginning in the upper left hand corner, left to right and top to bottom, aa many frames as required. The following diagrams illustrate the method: Les cartes, planches, tableaux, etc., peuvent Atre filmAe A dee taux de rAduction diff Arents. Lorsque le document est trop grand pour Atre reproduit en un seul clichA, 11 est fllmA A partir de I'angle supArieur gauche, de gauche A droite, et de haut en baa, en prenant le nombre d'Imeges nAcesssire. Les diagrammes suivants illustrent la mAthode. 1 2 3 1 2 3 4 5 9.0 :s^^.":s, SOME UNUSUAL CONDITIONS MET WITH IN HERNIA OPERATIONS. it JAMES liELL, M.D,, Montreal. (Repriv ltd from the Montreal Medical Journal, November, 1893.) :^s XTsr %. SOME UNUSUAL CONDITIONS MET WITH IN HKRNIA OPKRATIONS.^f- By James Bki,i., M.I)., Surgeon to tho Montreal (Icnenil Hospital ; Aesistiint Professor of Surgery and Clinical SurKory McGill University. As DUvigJitoi'H by common consent and for mutual benefit map out roofs, shouls and other impediments or dangers to navigation when they aro discovered, so, too, physicians and sui'geons for simihir reasons have adopted the method of re- coi'ding in the literaluio of the profession, such rare and unusual conditions, mot with from time to time, as may add to the sum of sciontltic knowledge and contribute to a better undoi'staiiding of its separate departments, as well as serve as guides to future practitioners. It is with this object that 1 venture to call the attention of the Association very briefly to the following cases: (/ASE I. — Right Femoral Hernia with Sloughing Sac and Con- tents Simulating Large Intestine. — J. W., a farmer's wife, aged 55, was admitted to tho Montreal General Hospital on the night of tho 24th of March; ir-iOO, complaining of swelling in right groin, which was causing severe constitutional disturb- ance. Tho patient was a large, fleshy woman, tho mother of eleven children, and accustomed to hard work. Her intelli- gence was of a low order, and a clear history of her illness was obtainetl with diflftculty. Tho family history was not remarkable and had no bearing on tho present illness, which began ten days before admission (March 14th, 1890), when she discovered a lump in the groin as large as a "doubled up fist." This lump was painful and tense and gradually increased in size and became rod and swollen and very tender, so that on tho 20th of March, four days before admission, she consulted a doctor, who diagnosed hernia and partially reduced it, giving her marked relief. The mass did not entirely dis- appear and the swelling continued to increase till she came to tho hospital. During all this time the bowels had been moved regulai'lj' and there had been no vomiting or other symptoms of strangulalion bej'ond tho acute local symptoms described. On admission tho })atient was in great pain and was unable to stand on account of the painful mass in the groin. Tempera- Read before the Canadian Medical Association, September 21, 1863. turo, 102" F.; pulHe, 100; ton bottom of tho sac.) '/ 6 Case III. — Congenital Ca-cal Hernia.— H. K., agod three ycai'H, WHH admitted to ho.spitul Septomber 8tli, 1891, with right Hcrotal liornia, which was naid to have exinted from birth and to have been irrodiicii)lo. Operation foi- radical cure on the 'Jrd oi' November. On hiying open the sac (which was identical with the sac of tho tunica vaginalis testis) a thin, semiti-ansparcnt, diaphragm-like protrusion of peri- toneum, through wiiich the hernial contents conid be recogni/.od as the ciccum and ileum and which was adherent to the spermatic cord and the borders of the ring was discov- ered. It was found to be impossible to reduce the hernia, even after slitting u)) the inguinal canal, until the peritoneum was opened and retraction made upon the ileum, when it readily slipped back into its place. The superfluous tissues of the neck of the sac were dissected away and the remainder sutuied down ground the cord, the conjoined tendon brought over and sutured to Poupart's ligament, and the canal closed by suture. Recovery was uninterrupted, and the patient when last seen (September 15th last) was in perfect health, with no sign of j'oturn of the hernia. Case IV. — Jlernia of Tubercular Ooary and Tube through Inguinal Canal In Female Infant. — S. G., aged 12 months, a pale, foverish female child, was admitted to hospital Decem- ber 20th, 18U2, with a tumour in the right groin, which was thought to be an irreducible inguinal hernia. She had con- tracted whooping cough four months previously and one month afterwards the hernia appeared. Several unsuccessful attempts liad been made to reduce it under chloroform, and the tumour had trebled in size from the time of its first appearance. Tt was solid to the feel, freely moveable, dis- tinctly pediculated, and could bo traced into the inguinal canal. As far as could be made out it was at most very slightly sensitive and gave no impulse when the child cried. The bowels moved legularly, but the child was poorly nourished and fed badly. There was marked tubercular history in the mother's fumily. Omental hernia was diagnosed and opera- tion proceeded with December 21st. On exposing the mass it could be distinctly traced through the inguinal canal into the abdomen and the sac was adherent throughout. It was separated without much trduble and exposed a mass as large 1 an a Hmiill |Mjx«'on'« fj^^ ftiul covorod with ii ulistcnin^ mein- biune. It WHS rloiiily iiot omiMitiuii. iiml tor tliu mumoiit I wur* noiiplii-'.-oil ll l()i»kc'i| liko 11 Nvvolloii testicle. I inciHcd it uixl t"UiiiiiiM, lull that it waw iiiulc'i';;oiii<; cy>tic tit'^joiioni- tion. The pedicle wum well drawn out and lij^atuiod anil the rnaHH removed. Iho canal was ( losed hy Huturing the con- joined tendon to Poupiirt's ligament, and the patient maUe u rapid and. uneventful recovery. Prof. Adaini, who kindly took the Hj)ecimon in hand, domonwtrated that it conHisted of a;i ovary and fallo|)ian tube in an active condition of tubercular diseaHO, giant ccIIh and tubercle bacilli being both found in abundance. Case V. — Suppurative Inffamniation of Hernial Sac Simulat- ing Stran