One  remarkable  case  Mr.  Teale  cites,  in  which  Mr.  Nourse  removed  the
ovaries  which  formed  a  hernial  tumour  in  each  groin  of  a  young  woman  in
St.  Bartholomew's  Hospital.  "  The  tumours  had  become  so  painful  as  to
incapacitate  her  from  pursuing  her  usual  avocations,  on  which  account  she
desired  their  removal.  After  the  operation  she  enjoyed  good  health,  but
ceased  to  menstruate."  Mr.  Teale  also  points  out  the  peculiar  anatomical
relations  of  the  caecum,  as  influencing  its  hernial  state,  remarking  that
*' after  it  has  descended  as  low  as  the  internal  ring,  its  posterior  surface  is
the  part  usually  first  protruded  into  the  inguinal  canal.  Hence,  when  the
protrusion  is  of  small  size,  it  is  constituted  by  a  portion  of  the  caecum
altogether  devoid  of  peritoneum,  and  a  true  hernia  without  a  sac  is  pro-
duced." Again,  "  as  we  can  seldom  be  quite  certain,  before  operatmg,
whether  the  caecum  or  the  floating  viscera  constitute  the  hernia,  we  should
bear  in  mind,  even  in  small  hemiae,  the  possibility  of  the  caecum  being
protruded,  and  also  the  anatomical  peculiarities  of  this  form  of  hernia ;
but  still  more  should  we  remember  the  possibility  of  this  being  the  case
when  the  hemiae  of  the  right  side  are  unusually  large."  We  may  add  that,
as  it  is  not  at  all  unfrequent  to  find  the  caecum  entirely  encased  in
peritoneum,  and  to  a  certain  extent  floating  in  the  iliac  fossa,  the  above
relations  of  this  portion  of  large  intestine  are  not  constant.  There  is  con-
nderable  analogy  between  the  ordinary  relations  of  the  caecum  and  the<«
bladder,  as  regards  their  serous  investment;  and  the  latter  organ  has  been
in  many  instances  found  to  occupy  the  sac  of  a  scrotal  hernia.  But  this
condition,  as  Mr.  Teale  remarks,  can  only  exist  under  circumstances  which
have  a  tendency  to  produce  an  abnormal  state  of  this  viscus,  and  which
enable  it  to  find  its  way  through  the  hernial  apertures  when  undistended.
