i go Anatomy Applied to Medicine and Surgery. 



the external ring, at the free edge of the internal oblique 

 muscle, or, at the internal ring, and, in the operation for 

 the relief of this condition, the position and relations of 

 the deep epigastric artery should be borne in mind. If 

 the stricture be at the internal ring then the incision for 

 its relief should be directed upwards, or, upwards and out- 

 wards so as to avoid this vessel, but if the stricture be at 

 the external ring, then the direction of the incision should 

 be as in the case of direct inguinal hernia. In a direct ingui- 

 nal hernia the seat of stricture may be at either the conjoin- 

 ed tendon through which the bowel has been forced, or, at 

 the external ring itself; in either case the incision to relieve 

 it should be upwards, since all that is necessary, as a rule, 

 to relieve the strangulation, is to simply "nick" the obstruc- 

 tion, and, hence, the epigastric would be in no danger of 

 being wounded since it lies some distance above this point. 



Radical Cure of Hernia. The object of the 

 radical cure is to obliterate the sac and prevent a recur- 

 rence of the rupture. The latter result is arrived at by 

 uniting the lower margins of the internal oblique and con- 

 joined tendon to Poupart's ligament, and, of the different 

 methods employed, Bassini's, in which the cord is raised 

 and transplanted, gives the best results. Coley reported 

 five hundred and forty-five cases of inguinal hernia on 

 which he had operated, following Bassini's method, and, 

 out of this number, there were only six relapses. Should 

 the surgeon be unable to suture the lower edge of the in- 

 ternal oblique and conjoined tendon to Poupart's, then 

 Bloodgood's method of opening the outer aspect of the 

 sheath of the rectus on its posterior surface and suturing 

 the muscle thus exposed to Poupart's ligament in lieu of 

 the internal oblique may be followed. 



Bassini's Operation. The external incision begins 

 nearly on a level with the anterior superior spine, and con- 



