MONRO’S OBSERVATIONS ON CRURAL HERNIA. 773 
the pad orpads of the truss; and from 
time to time.an outer slip or two may be 
changed at pleasure, -for the purposes of 
cleanliness, or restoring the cushion to a pro- 
per degree of thickness. 
~« This cushion, when judiciously made, 
even with a bad truss, if it be in a line with 
the aperture, will materially assist in keepin 
upon a reducible rupture. 
«« The properties of the calico cushion are, 
*« First, That it protects the spermatic 
cord from being injured by the hard pad of 
the truss; which injury, in cemmon trusses, 
often produces hydrocele, inflammation of 
the spermatic vessels, hernia humoralis, &c. 
&e. 
~** Secondly, By protecting the spermatic 
yessels from the injuries of pressure, it fulfils 
a desideratum never before abtained. It en- 
ables the patient to girt the truss round the 
body with such an effective degree of tight- 
ness, that the rupture cannot descend. 
««'Thirdly, By uniting the properties of 
softnéss and solidity, it yields to the form of 
the abdomen, and thus completely fills up 
the aperture or ring in the external oblique 
Art. XLII. 
abdominal muscle through which the rups 
ture descends. 
« Fourthly, It affords an additional co~ 
Jumn of pressure; and the truss being tightly 
fastened keeps the omentum and intestines, 
all round and above the aperture, in a state 
of quietude; preventing any internal or par- 
tial descent of the bowels, &c. 
«Tt is necessary to repeat, that this eu- 
shion, to obtain all its advantages, must be 
formed of separate slips folded over each 
other, and not of one piece of calico.” 
Familiar directions are given for the 
use of the ruptured. Beyond the pre- 
cise object of this little treatise, the au- 
thor’s improvement, they are but tri- 
fling. He takes upon him to forbid the 
use of dumb bells to children, because 
he once saw arupture produced by using 
them! He might with equal propriety 
forbid a boy ever to mount a horse, since 
many ruptures have come down when 
on horseback. 
Observations on Crural Hernia; to which is prefixed a general Account of 
the other Varieties of Hernia. Illustrated by Engravings.. By Avexaxprr Monro, 
jun. M.D, FLR.S. E. and Professor of Anatomy and Surgery inthe University of Edin- 
burgh. 8voe pp. 120, 
THE title page of this work excited 
pur particular attention. It professes to 
contain a series of observations (we sup- 
posed practical as well as speculative)" 
on one of the most delicate and im- 
portant points in surgical pathology ; it 
is the first production of the professor of 
anatomy and surgery in the first medical 
school in Europe ; and we are informed, 
by an advertisement, that it has been 
read before the Royal Society of Edin- 
‘burgh: In looking at the table of eon- 
tents our expectations were raised still 
higher, for we found twenty-five differ- 
ent subjects enumerated, some of them on 
difficult and controverted points, and all 
of them very interesting to practitioners. 
This delusion began to vanish on refer- 
ring to the size of the book, as we saw 
all these subjects, which have filled vo- 
lumes, discussed and determined in nine- 
ty-two octavo pages, with the assistance 
of large type, frequent spaces, and 
abundance of margin! ! Perhaps our 
expectations were raised too high, for 
certain it is, that all our hopes of instruc- 
tion and improvement have been follow- 
_ed by disappointment and regret, The 
following analysis of this work will, pro- 
bably, be sufficient to satisfy our readers. 
To the observations on crural hernia, 
which is the professed object of the book, 
a general account of all the varieties of 
hernia is prefixed. Here are strange 
and wonderful cases, some related at full 
length, others: only hinted at, none of 
which serve to illustrate any theory, or 
to furnish any practical conclusion. 
Next follows a dull enumeration of the 
causes of hernia, and some general re- 
marks on the nature of the:hernial sac, 
on the diagnosis, prognosis, &c. At page 
44, the observations on crural hernia be- 
gin; and first, an anatomical description 
of the crural arch is given. Mr. Gim- 
bernat, a Spanish surgeon, first pointed 
out the peculiar termination of the ob- 
lique muscles, and described the forma- 
tion of what he called the crural arch. 
He showed the propriety of attending to 
this structure in performing the opera- 
tion for crural hernia, though his de- 
scription is not very accurate or easily 
understood. Dr. Monro has not been 
more successful in his description, but 
he has excelled Mr. Gimbernat in his re- 
presentation of the crural arch, in,a 
drawing. The situation of the blood 
vessels, in respect to the hernial sac, then 
engages our author’s attention, and some 
acute and pertinent remarks are made 
on the course of the epigastric artery. 
ry te 
