A Letter from Monsieur Le Cat, M. D. First Surgeon at the Hotel Dieu at Rouen, Royal Professor and Demonstrator of Anatomy and Surgery, Member of the Royal Academy of Surgery at Paris, and of the Academies of Sciences at Paris, London, Madrid, and Rouen, to Dr. Mortimer, Secretary of the Royal Society, concerning the Dissection of a Rupture. Translated from the French by Tho. Stack, M. D. F. R. S.

LIV. A Letter from Monsieur Le Cat, M.D., first Surgeon at the Hotel Dieu at Rouen, Royal Professor and Demonstrator of Anatomy and Surgery, Member of the Royal Academy of Surgery at Paris, and of the Academies of Sciences at Paris, London, Madrid, and Rouen, to Dr. Mortimer, Secretary of the Royal Society, concerning the Dissection of a Rupture. Translated from the French by Tho. Stack, M.D. F.R.S. SIR, Rouen, June 1, 1750. N.S. Read Jan. 23, 1752. IT is now about eleven years since I had the honour of sending you an account of an incomplete hernia, the strangulated part of which mortified, and by nature's resources alone suppurred, threw off the gangrened parts, and was converted into a fistula: thro' which fistula, in process of time; the two ends of the gut, that were near the strangulation, passed, and fell into the groin, turning inside out, so that the villous coat was on the outside; which gave me an opportunity of making experiments on the effect of purgatives. This observation, which I barely mention here, is printed in Phil. Trans. N. 460, p. 716. When I sent you those remarks, sir, on the inguinal hernia of Catherine Guillematre, I had already made some fruitless attempts to cure her, but had not then lost all hopes of success. I imagined, that a long use of emollient cataplasms might restore suppleness to the intestine B (Fig. 2. Plate IV. N° 460. and the figure hereto annexed) which constantly kept out of the belly, and was turned inside out, because it was the portion continuous to the cæcum, colon, rectum, and anus, which could be of no use, but much incommode the patient by this extraordinary situation. But all my trials were of no avail, altho' they were carried so far, as to render this gut quite bloody: its long exposure to the air made it become too thick and hard; and at the same time so robust or insensible, that all these vigorous applications made no bad impression on the rest of the animal economy. In fine, Catherine Guillematre quitted our hospital without any other benefit but that of having afforded us an opportunity of instructing ourselves. From that time I had no news of this woman till the 6th of May of this year 1750; when I was informed, that her body actually lay in our dead ward, and that she died in our hospital of old age and a broken constitution, as much as of any disease. I was extremely curious to embrace this opportunity of having ocular demonstration of the probable conjecture, which I had made in this woman's lifetime, and a confirmation of my having solved the ænigma, arising from this singular hernia. The annexed figure, which I drew from nature, represents the state of the parts, somewhat less than he natural size. In order perfectly to understand what follows, it will be necessary to have Plate IV. of N° 460, before the eye, together with this drawing. Explanation Explanation of the Figures. A, The herniary fistula, which does not appear in the figures of No. 460; because the issue of the two portions of the gut, forced into this place the bottom (or back part) of the gut; which unites these two portions; that is, the part of the bore of the gut opposite to that which was mortified, and fell off in an eschar, by the strangulation and suppuration of this incomplete hernia. B, Part of the ileum situated between the strangulation and the anus, and consequently continuous to the caecum, colon, rectum, and therefore useless: it is also the same, that is marked B in Fig. 2. Plate IV. No. 460, which I said always continued out, and on which I had made so many unsuccessful trials, in order to reduce it. b, Is the continuation of this useless portion of the ileum, which at one end is immediately continuous to the caecum d, and at the other thrusts itself into the thick portion B, at the extremity B of which it turns up, the villous coat outward. This portion b is, as may be observed, become very slender, both by its want of action, and by its situation within the other portion B. C, The other portion of the ileum, situated between the strangulation and the stomach, marked A, No. 460, actually returned into the belly but moving out and in alternately, and performing the office of an anus, while the patient was alive. e, The part of intestine, which (after the mortification) remained common to both portions B, C, the edges edges \( f, g \), of which are cicatrised to the edges of the herniary fistula. This drawing affords an ocular demonstration of the solidity of the conjectures made in the observation N. 460. \( D, d \), The cæcum, and its vermicular appendix. \( E \), A portion of the colon, filled with somewhat like faeces, but which had no other smell than what is natural to the intestines, without the least mixture of a stercorarious stench. This substance was of the colour of white resin, and of a fat viscid consistence: and it seemed to be formed of lymph; and the intestinal juices thickened by heat. \( F \), A portion of the colon, which was empty, and its cavity was about three lines in diameter. \( G \), The continuation of the ileum. I have the honour to be, sir, with the highest esteem, Your most humble, and most obedient servant, Le Cat. LV.