394 OPEEATIONS ON THE DIGESTIVE APPARATUS. 



has frequently been remarked. Difficulty in the performance of 

 movements requiring effort has also been noticed, with conse- 

 quently a liability to suffer traumatic injuries from external vio- 

 lence. To this must be added a facility in contracting: 



2d. Inflammation. — Generally this occurs as the result of 

 external injuries, but it may also occur without any apparent 

 cause. Its seat is the sac or its contents, and it affects the serous 

 structures alone, or assumes a phlegmonous aspect. The inflam- 

 mation of the serous tissue is often overlooked, while that of the 

 phlegmonous cannot pass unobserved. It may sometimes assume 

 a very serious character, and become even more dangerous than 

 the true strangulation. 



3d. Obstructions or engorgements, common in intestinal her- 

 nias, are due to the accumulation of alimentary or stercoraceous 

 masses in the displaced intestiaes, or to gases which interfere 

 with the reduction of the hernia. This is often complicated with 

 strangulation, but is not in itself of a very dangerous nature. 



4th. Strangulation. — This condition has been already consid- 

 ered. It is the result of excessive pressure upon the blood 

 vessels of the displaced organ, and while under its three periods 

 or degrees of congestion, inflammation, and gangrene, has usually 

 a fatal termination. 



The general treatment of hernia has the two objects in view of 

 the destruction or obHteration of the sac, and the reduction or 

 closing of the ring. If the first is not always easy to accomplish 

 the reduction of the diameter of the ring often is so. Each form 

 of hernia demands some special directions for the realization of 

 these two objects, and these wiU each receive its ovm share of 

 attention as they may in turn come under our notice in further 

 treating the various forms of hernia. 



Inguinax, Hebnia. 

 Inguinal hernia results from the passage or presence of a 

 portion of the intestines, or of the omentum, or of both together, 

 in the testicular or vaginal cavity whose opening of communica- 

 tion with the peritoneum or inguinal ring continues in its normal 

 condition, having never closed. A brief survey of the general 

 anatomy of the region involved will be a necessary preliminary to 

 our discussion of the subject, which is one of interest and im- 

 portance. 



