Mr. D. G., aged 78, was sent into the Chicago Hospital with a diagnosis of probable strangulated inguinal hernia. Patient was found suffering intense abdominal pain, and unable to pass feces or flatus; temperature was 101.4, pulse 110, respirations 34. There was no nausea or vomiting. He gave a history of having had right inguinal hernia for over sixty years, with small hernia on left side for about twenty years. He had worn a truss and had suffered no previous pain or particular inconvenience other than an obstinate constipation. Bowels had not moved for ten days previous to entering hospital. It was impossible to get a satisfactory history.
Physical examination revealed a greatly distended, generally tender, and markedly tympanitic abdomen. Hernia on left side was protruding at the external ring, about the size of a hen's egg. Right hernia was very large, scrotum extending downward nearly twelve inches. In the