S. B., a Negro, aged 24, was admitted, April 14, 1930, to the surgical services of the Cook County Hospital, Chicago, because of a swelling in the right inguinal region, vomiting, and severe abdominal cramps for the past twenty-four hours.
The patient stated that he had had a right inguinal hernia for the past two years. The day before, about 2 p. m., he suddenly developed a sharp, colicky pain in the right inguinal region. An hour later he noticed a round, hard and tender mass in the same area. The pain was followed soon by nausea and vomiting, the vomitus consisting of food material and mucus. About 3 o'clock the pain had spread over the entire abdomen and was especially marked around the umbilicus.
He vomited again at 5 and at 6 a considerable amount of grayish material. He tried to go to sleep but was awakened again by