FEMORAL HERNIA. *" 77 



bowel subsequent to its reduction. The antiphlogistic treatment will 

 be most serviceable. After cicatrization a truss must be worn to 

 prevent a return of the protrusion, though occasionally the operation 

 produces a radical cure. Such is the course in an ordinary case ; 

 but, it may be found upon opening the sac, that the hernia is irre- 

 ducible, owing to the intestine adhering to the sac ; the stricture is 

 to be relieved, and the wound dressed, and no attempt made to 

 restore the intestine, unless the adhesion be recent or slight. 



Should the intestine be extensively mortified it is not to be re- 

 turned, the only chance of life being through the establishment of 

 an artificial anus ; but, if mortified only in a few spots, the spots are 

 to be included with a fine ligature, and the intestine returned ; the 

 ligature finds its way into the interior of the gut, and is discharged 

 with the faeces. 



In case there should be a gangrenous condition of the omentum, 

 the gangrenous part should be cut off, and the vessels secured by 

 fine ligatures ; the remainder may then be returned to the abdomen, 

 or be allowed to remain impacted in the outlet, and thus prevent 

 future tendency to protrusion. 



Some have successfully divided the stricture exteriorly to the sac, 

 the sac being reduced with the hernia. The objection to this opera- 

 tion is the danger of there being a stricture within the sac ; and if 

 the gut should be gangrenous it will not be discovered. 



Usually the cord will be found behind the sac, but sometimes it is 

 split up, and its constituents found lying upon the sac ; caution is 

 then required to avoid wounding the artery and duct. 



The operation for direct or ventro-inguinal hernia, is very much 

 the same. There will be no cremasteric covering, but in place of it 

 an expansion of the conjoined tendon of the internal oblique and 

 transversalis muscles ; sometimes this is wanting, owing to the ten- 

 don having been split, especially if the protrusion is sudden, and 

 the result of great violence. 



In a concealed inguinal hernia, the tendon of the external oblique 

 must be divided, as well as the lower portion of the internal oblique 

 and transversalis muscles. 



FEMORAL HERNIA. 



This is most common in women, owing to the natural form of the 

 pelvis. The descent occurs at the crural ring ; in order to under- 

 stand which, it will be necessary to refer to the anatomy of the part, 

 (see Anatomy, page 89.) 



The tumour is more spheroidal usually than in inguinal hernia, 

 and will be found to be beneath Poupart's ligament, instead of above. 

 The fundus of the tumour is bent upon its neck, which curvature 

 must be attended to in producing taxis. Strangulation is more 

 common and more severe than in -inguinal hernia. 



7 



