390 OPERATIONS ON THE DIGESTIVE APPARATUS. 



the spheroidal, the convex, the i^yriform, to which Zundel adds 

 the clustered and the multilobular. 



The relation as to dimensions between the body of the hernia 

 and the measurement of the ring is a point of importance in re- 

 lation to estimating the more or less serious nature of a case. It 

 will readily be inferred that with a narrow and contracted open- 

 ing, an obstruction may easily take place, and at an early date, 

 and that in due time the result will be manifested in the legitimate 

 form of a strangulation, an accident which will be accompanied 

 with various phenomena, according to the degree of pressure and 

 the duration of the period of formation, and all of them attended 

 with trouble and danger. 



At first, as the capillary circulation becomes retarded and diffi- 

 cult, the intestines assume a red color, which passes successivel}' 

 through many shades, from deep red to brown or a blue-black, 

 indicating the arrest of the blood, of which the dreaded sequel 

 may be looked for in the appearance, a httle later, of signs of mor- 

 tification of the parts involved. 



The blood then transudes through the walls of its vessels, and 

 filtrates into the sub-serous and sub-mucous cellular tissue, thus 

 increasing the bulk of the contents of the sac. At the same time 

 the external sm-f ace of the protruding intestines becomes the seat 

 of what is at first a yellowish exudation, but which becomes a 

 bloody deposit, ready for organization if the patient hves long 

 enough to survive the pains of the strangulation. By the eight- 

 eenth or towards the twent^'-fourth horn-, however, signs of total 

 gangrene make then* appearance and the hernial portion becomes 

 flabby, cool, and insensible ; the odor becomes very offensive, and 

 the tissues easily lacerated or torn. The fatal end is then near, 

 being rarely deferred beyond the twenty-fourth horn-, unless im- 

 mediate relief has been interposed. 



But, of course, every case does not observe this regular succes- 

 sion of symptoms, nor reach the same final termination, and in 

 the instances in which the interference with the cu'culation is less 

 pronounced and the degree of pressure upon the protruding 

 organ is lighter, probably not more than sufficient to interfere 

 moderately with the movement of the intestinal contents, we have 

 a modified evil to contend with in the obstruction or engorgement 

 of the hernia, with consequences in view less discouraging to con_ 

 template The exudation ujDon the surface of the contents of the 



