J.W. Stapleton
1845 The Lancet  
317 toms had subsided. She recovered rapidly, without any check whatever. The operation was tedious. I have seldom been engaged in a more difficult or anxious dissection. I was requested by Mr. Shillito, of Putney, to see a female labouring under strangulated hernia. Mr. Shillito had seen her about an hour before, for the first time, when he learned that she had been labouring under symptoms of acute peritonitis for three days previously. On examination, the hernia (a femoral) was rather large,
more » ... ) was rather large, somewhat tense and tender; the abdomen very tender, enormously swollen, and tympanitic; eountenance anxious; tongue furred, but not dry; hiccough, eructation, sickness, and occasionally vomiting. The patient appeared very weak. As it was quite evident that not a moment was to be lost, I gently manipulated the hernia, convinced myself that it was irreducible, and operated immediately. On opening the sac, I exposed a considerable piece of omentum, in a very dark condition, underneath which lay a moderately large knuckle of intestine, of so black a colour, that I had considerable doubts as to the propriety of replacing it in the abdomen. After a little hesitation, however, I proceeded to divide the stricture, and, with great gentleness, to replace the bowel. The bowel appeared to be adherent to the opposing surface within the abdomen, and this connexion I took care not to disturb, since, should the bowel slough, it would be an indis-
doi:10.1016/s0140-6736(02)71145-8 fatcat:z7waghv3mfbjjib7ydi67yalfa