Success has proved that in females this practice, which at first sight will appear bold, is, however, by no means rash. "In man," says Arnaud, "it is otherwise: here the crural arch cannot be divided without wounding the spermatic artery." The surgeon must be prepared for this and make up his mind to it, if, on laying open the intestine on the side, he does not obtain a sufficient escape for the fæces: for it is better, in my humble opinion, to sacrifice the testicle than allow the patient to die; and this is inevitable if the surgeon does not make up his mind to tie the spermatic artery.

To lay open the intestine, if this afford a sufficiently free egress to the accumulated fæces, and, if not, to divide both the intestine and Poupart's ligament, with the cruel certainty of dividing at the same time the spermatic cord, which must afterwards be tied, is the advice given by Arnaud, Teal, and others, who, as Arnaud confessed, had only thrown upon this subject a glimmering of that light which must lead the way to a more perfect enlightenment.

The thorough investigation of the anatomy of the parts concerned in hernia, by recent writers on this subject, has amply verified the prediction of Arnaud, and I need not add that there can now, in no case, be any excuse for wounding the cord whilst operating for crural hernia.

JOHN H- -, a colored man, thirty-two years of age,tall, slim, but muscular, a fisherman near Cape Vincent, St. Lawrence Co., N. Y., consulted me in September, 1867, in regard to a tumor in the left groin and anterior part of the thigh, which caused great pain, extending to the knee and foot of the affected side and rendering walking painful and extremely difficult. The patient stated that the tumor had first made its appearance about a year ago. Upon examination it was evident that there was an aneurism of the external iliac artery, immediately below Poupart's ligament. It had attained an elevation of about four inches above the crural arch, and extended down along the front of the thigh. The circumference of the tumor at its base measured sixteen inches; pulsation was distinctly obvious, and expansive synchronously with the heart's action. The integuments at the apex of the tumor had become considerably thinned. Auscultation over the aneurism and external iliac revealed the bellows sound very distinct; pulse 120, small and hard. This, together with the dejected appearance of the patient, resulted wholly from the local disease, as a critical examination left no doubt of the normal condition of all the viscera.

On examining the integuments of the tumor, they were found thinned; and there was no time to be lost, if a trial was to be made to save the patient's life. It was therefore determined to operate the following day.

Sept. 2. With the assistance of Dr. John Loucks, and two medical students, I proceeded to tie the artery in the method pointed out by Velpeau, but modified to suit the circumstances of the case. Not knowing to what extent the artery might be involved, and fearing that it might be necessary to tie the common iliac, the incision was commenced about twelve lines above Poupart's ligament, and continued to the extent of five inches upwards, terminating at about fourteen lines from the anterior superior spinous process of the ilium. This incision divided the skin, superficial fascia, and the superficial epigastric artery, to which tortion was applied. A second incision divided the external and internal oblique, and transversalis muscles, and the fascia transversalis, the latter being divided on the director with a probe-pointed bistoury. The peritoneum and intestine then presenting, they were held out of the way by an assistant, while the attachment of the former was separated from the fascia iliaca, and turned upwards. The artery was now plainly seen, and, being free from disease, the fascia, which covered it and the vein, was divided with great caution, the vein being kept out of the way by the index finger of the left hand. The artery-needle armed with a strong ligature, was now passed under the artery. The artery was tied, both ends of the ligature being left outside. The pulsation ceased immediately; and, by the time the wound was dressed, the tumor had diminished in size more than two inches.

The patient was on the table twenty minutes, and only partially under the influence of chloroform, sufficiently to blunt the pain, leaving consciousness undisturbed. Five minutes after the patient was placed in bed, the left extremity became very hot; but an hour afterward the temperature was quite equal with that of the rest of the body. The pulse soon increased in fullness and frequency; the pain grew intense in the leg and foot for which he took Aconite and Bell. in alternation, with decided

success.

Sept. 3. Pulse 120; heat of the body uniform; mind watchful and apprehensive; abdomen tense and tympanitic. Ordered an injection of warm water, which produced an abundant evacuation, dark and foetid. Cham. was administered during the night, to relieve general restlessness.

Sept. 4. All the abdominal symptoms had disappeared with the exception of tenderness upon pressure. Pulse 110, and wiry. Ordered Bryonia, and rice-water for nourishment.

Sept. 5.- Pulse 100. Pain has subsided; wound slightly suppurating; tumor diminished by one-half. No pulsation to be felt in the tibial artery; heat of limb natural. Ordered beef-tea diet. P.M. Fever; pulse 120; vomited. Ordered Acon. every second hour.

Sept. 6.- Pulse 95. Suture-pins withdrawn, except two, and the wound dressed; about an ounce of pus discharged; no medicine; beef-tea diet.

Sept. 7. The last two pins withdrawn.

Sept. 8. Wound healing. Continued same diet, with chocolate and bread.

Sept. 9 to 12.- Patient convalescent, wound nearly healed; diet of bread and fowl.

Sept. 16. No appetite; vomits food; anxiety, severe pains in the limbs; great prostration; tumor and wound inflamed, with fœtid suppuration of wound; tumor about to suppurate. Warm water dressings. Carbo veg. every fourth hour, and beef-tea diet.

Sept. 17.- Pulse 135. Tumor very tense; vomiting; patient indifferent to everything. Diet and medicine the same as yesterday.

Sept. 18. Ligature came away. Pulse small and weak; great prostration; fluctuation in the tumor; wound opening; a free incision was made into the sac, and about two pounds of coagulated blood was discharged. All the coagula were removed, with the exception of what was supposed to be a plug § V.-5*

over the opening into the sac from the artery. Diet,-beef tea and porter. China every second hour.

Sept. 19. Tongue dry; face hippocratic; pulse 130. The wound of the sac being dressed, an enormous quantity of decomposed blood was discharged. Same diet and medicine continued.

Sept. 21. Pulse 100. Tongue moist, countenance natural; patient able to assist in removing the dressings; wound of the abdomen healing; wound of the sac suppurating, and the sac itself becoming clean.

Sept. 23.

Pulse 80; strength and appetite improving; full diet. Gave Hepar sulph.

Sept. 26 to Oct. 10. Pulse natural; sac clean and granulating.

Oct. 25. Wound of sac healed.

Nov. 10. Well, but was not allowed to resume his labors until the 20th, when he had the perfect use of the limb.