A young man, aged 22, who suffered pain and inconvenience from an inguinal hernia of six years’ standing, was admitted into the Hospital for operation, which was done according to Lockwood’s method, which is a modification of Bassini’s and the one I have adopted for many years.

There was nothing unusual about the operation, but the patient was violently sick after the anaesthetic (A.C.E. mixture). This lasted, with intervals of ease, for three days. He then complained of severe abdominal pain, and the upper part of the abdomen became somewhat distended. During the day the vomiting continued, but never became faecal.

On the following morning the distention had increased, so Dr. Ewart washed out the stomach, which contained a small amount of brown-coloured liquid, and ordered a turpentine enema, which acted, but without reducing the distension. I saw him the same morning, and finding that the distension had much increased since the previous day, I decided to open the abdomen, and did so as soon as he could be prepared for operation.

Speculating as to the probable cause of trouble, I favoured the diagnosis of a perforated gastric or duodenal ulcer, as he had a history of long-standing dyspepsia. It seemed also just possible that a small knuckle of intestine might have got nipped between the two ligatures carrying the stump of the sac, which are passed through the abdominal wall; but I did not think this likely, as the symptoms did not indicate intestinal obstruction, Moreover, the distension seemed to be peculiarly limited to the upper zone of the abdomen.

I first made a small incision in the median line just above the pubes, through which I explored the site of the hernia and found all right there. I then opened above the umbilicus, as for gastric or duodenal ulcer. Some free fluid escaped, but no gas. I explored the duodenum and both surfaces of the stomach, but there was no perforation. The jejunum was much distended and deeply congested, a small portion of it almost black. I noticed near the pylorus a small quantity of effused blood between the layers of the transverse meso-colon where they ate reflected over the surfaces of the stomach and colon. On making a close examination of the jejunum, I found that about 2 ft. of the gut had passed through a rent in the meso-colon, and become partially strangulated. The right side of the abdomen was filled with a large clot of blood which had come from a vein in the meso-colon.

I discovered afterwards that the patient’s mother several years ago died of internal haemorrhage after an operation. There was nothing at the operation to indicate that he was a bleeder. The cause of death was hernia of the jejunum through a laceration in the meso-colon, with subsequent bleeding from a torn vein. No haemorrhage was going on at the time of the second operation, nor did it recur, but he died about eighteen hours later from shock.

If any major operation in surgery can be said to be without risk, it is that for the radical cure of hernia, and yet here a death occurs in the most unexpected manner, and one may say from a cause totally apart from the operation. The same thing might happen after any other operation involving the prolonged administration of an anaesthetic.