*¢ Waying more experience of the urgency 
of the disease, I made it my custom, when 
called to a patient who had laboured two or 
three days under the disease, to wait only 
about two hours, that I might try the effect 
of bleeding (if this evacuation was not for- 
bidden by some peculiar circumstances of the 
“ease) and the tobacco glyster. la this mode 
of practice I lost about two patients in nine 
upon whom [ operated. This poms 
is drawn from cases nearly similar, leaving 
out of the account those cases in which a 
gangrene of the intestine had taken place. 
«© T have now, at the time of writing this, 
performed the operation thirty-five times ; 
-and have often had occasion to lament that I 
had performed it too late, but never that 1 
had performed it too soon. ‘There are some 
cases so urgent, that it is not adviseable to 
lose any time in the trial of means to produce” 
areduction. The delay of a few hours may 
cut off all hope of success, when a speedy 
operation might have saved the life of the 
patient.” 
The author particularly describes the 
mode of operation to be pursued in 
strangulated scrotal hernia, and annexes 
many remarks, which are well worthy 
of attention. The strangulation of the 
femoral hernia, he is of opinion, does 
not arise from Poupart’s ligament, but 
agrees with M. Gimbernat in thinking 
that it is from a ligament existing in the 
aponeurotic sheath, which envelopes the 
great vessels of the thigh, and is strongly 
attached at its superior part to the ossa 
pubis. 
This ligament “* runs transversely, but 
does not descend oblicuely, as that ligament 
does. On the contrary, it rather ascends as 
it approaches the symphysis of the ossa pu- 
bis, passing behind, and decussating, ‘the 
extremity of Poupart’s ligament.” 
The author denominates it femoral 
ligament, and it is by the division of this 
that the return is effected. 
Several useful practical observations 
fre made on the proper treatment of the 
omentum, which may be inciuded in 
the herniary sac. 
A new species of scrotal hernia is de- 
scribed by the author, as havifig occurred 
in an infant of fifteen months old. 
«© This hernia differed both from the com- 
mon scrotal rupture, in_ which the hernial 
sac lies on the outside of the tunica yagina- 
lis; and also from the hemia congenita, 
where the prolapsed part comes into contact 
with the testicle, having no other hernial sac 
besides the tunica vaginalis.” 
In this case the hernial sac was in 
HEY’s PRACTICAL OBSERVATIONS IN SURGERY. 
781 
contact with the testicle, and therefore 
within the tunica vaginalis. The author 
terms it hernia infantilis. He thus enu- 
merates the species of scrotal hernia : 
«¢ 4. If the abdominal aperture of this 
process is open when the jutestine or omen- 
tum. is protruded, the rupture is then called 
hernia congenita. 2. If the upper part of 
the process remains open, but the abdominat 
aperture is closed, and is capable of resisting 
the force of the protruding part, the hernia 
then becomes of that species which. I have 
now described, the hernia infantilis. 3.. 1 
the cavity of the upper part of the process is 
obliterated, and the septum is formed a little 
above the testicle, as in the adult state, the 
hernial sac then descends on the outside of 
the tunica vaginalis, and forms the most 
common species of scrotal rupture, which 
may with propriety be called hernia virilis.”” 
The following description is given of 
a new truss for the exomphalos, ins 
vented by an ingenious mechanic of 
Leeds : 
*« It consists of two pieces of thin elastic 
steel, which surround the sides of the ab- 
domen, and nearly meet behind. At their 
anterior extremity they form conjointly an 
oval ring, to one side of which: is fastened a 
spring of steel of the form represented. At 
the end of this spring is placed the pad or 
bolster that presses upon the hernia. By the 
elasticity af this spring*the heraia is repressed: 
in every position of the body, and is thereby 
retained constantly within the abdomen. A 
piece of calico or jean is fastened to each side 
of the oval ring, having » continued loop at 
its edge, through which a piece of tape is 
put that may be tied behind the body. ‘This 
contrivance helps to preserve the instrument 
steady in its proper situation.” 
Chapter 4th. Of the Fungus Hema- 
todes.—This disease has not been notic- 
ed by any author, whose works have 
come under the knowledge of Mr. Hey, 
previous to the completion of this pa- 
per. But a species of it he has since 
found, described by Mr. Burns, of Glas- 
gow, under the name of Spongoid in- 
flammation. 
The following case will give a view of 
the origin and progress of this singular 
and serious disease. 
« August 20th, 1801, James Richardson, 
a stout man, aged fifty years, consulted 
me on account of a large tumour on the 
posterior part of his left shoulder. Upon 
a careful examination I could not doubt of 
its being a tumour of that intractable species, 
to which I haye given the name of Fungus 
Heematodes. 
