78 



The operation for the relief of stricture is thus performed. The 

 patient being properly placed upon a table, and the parts beino; shaved, 

 the skin is pinched up and divided by transfixion, in order that there 

 may be no injury to the important parts beneath. The wound of 

 the skin may be crucial in shape, or resemble an inverted T. 



After dividing the skin, the superficial fascia is exposed ; this being 

 divided, the fascia propria is brought in view ; that fascia is some- 

 times much blended with the sheath of the vessels. Under the fascia 

 propria will be found the hernial sac. It is opened in the same cau- 

 tious manner as before, when a smaller quantity of fluid will escape 

 than in inguinal hernia, and the convolution of intestine be readily 

 recognised. The seat of stricture is then to be sought; it may be at 

 Hey's ligament, at Gimbernat's ligament, or, at the mouth of the sac. 

 The stricture is to be divided with great care, for fear of an irregular 

 origin of che obturator artery, the neck of the sac being surrounded 

 by'it. 



The gut being returned, the after treatment will be the same as in 

 inguinal hernia : the patient is to be kept in a recumbent position, 

 and under antiphlogistic regimen. If there is no movement of the 

 bowels in the course of several hours, a dose of castor oil may be 

 given, or a mild enema may be useful ; should there be inflamma- 

 tory symptoms, leeches, calomel, and opium will be serviceable. 

 Occasionally the patient is troubled with tympanites and flatulence, 

 which will be relieved by a carminative, or enema of turpentine. 



UMBILICAL HERNIA. 

 This is common in infants in whom the umbilicus is not consoli- 

 dated. It is produced by crying ; and appears as a soft, compres- 

 sible tumour. 



