76 



SURGERY. 



these fibres, the next covering will be the fascia transversalis, which 

 is continued from the abdomen upon the cord ; this being done the 

 hernial sac is then exposed. 



The sac being formed of peritoneum, has been mistaken by some 

 for the intestine, from which it is to be distinguished by not having 

 a flexure, or crease, which the intestine always has. The sac is to 

 be opened carefully, pinching up a part and rubbing it between the 

 finders, in order that no portion of intestine may be included ; a 

 small opening is to be made, and into this a director may be intro- 

 duced and the sac divided freely. 



Bloody serum will escape freely, and the contents of the sac be 

 thus exposed ; the convolution, or knuckle of intestine will vary in 

 its colour, according to the period and intensity of its strangulation, 

 between a light red and a deep chocolate colour ; very often the in- 

 testine will exhibit patches upon its surface when the inflammation 

 has been intense. The finger is then to be introduced to examine 

 the point of stricture ; if none should exist, an attempt at reduction 

 should be made, if the intestine be in a proper condition. The 

 stricture having been detected, a probe-pointed bistoury with a cut- 



Fiff. 21.' 



ting edge only near the extremity, is introduced flat upon the finger, 

 and a slight cut made directly upwards to the extent of one or two 

 lines. The only danger to be apprehended is the wounding of the 

 epigastric artery, and this is avoided by making a vertical, instead 

 of a lateral incision. The sac may be strictured by the external or 

 internal ring, or in the canal by the lower edge of the transversalis 

 muscle. 



The stricture being relieved, the gut is to be returned, the edges 

 of the wound are to be carefully approximated, and a compress 

 applied to support the part, and prevent accidental reprotrusion. 

 A mild laxative may be given in a few hours if there is no peristaltic 

 motion of the bowels ; sometimes the bowel seems to have been pa- 

 ralysed by the compression, and its peristaltic action is not recovered 

 for several hours. Dansjer results then from the accumulation of 

 medicines, food, &c., and life rtiay be lost by inflammation of the 



