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outer fide. This Iiernia may be diftingliirticd from other 

 difeafes of the fcrotum, with which it is hablc to be con- 

 founded, by the following maiks : 



I. By its dilating under coughing. 2. By its difappear- 

 ing in the recumbent, and re-appearing in the ereft poftiirts. 

 3. By the gradual progrcfs of the difeafc from the groin to 

 the fcrotum. 4. From its feel, which is irregular, and 

 doughy, where omentum is csntained, but elallic and regular, 

 if it contains inteftine ; and where the intcftines return into 

 the cavity of the abdomen, it recedes with a guggling 

 uoife. 



The Inguinal hernia is more frequent on the right, than 

 on the left fuie, probably, becaufe our ftrongell exertions 

 are made on that fide ; and the inguinal hernia in the male 

 is more frequent than any other fpecies, on account of the 

 magnitude of the abdominal rings. 



This hernia exills in the three following dates: 



I. Reducible, where the parts can be returned into the 

 cavity of the abdomen. 2. Irreducible, when they cannot 

 be returned. 3. Strangulated, when they are inflamLd and 

 obllruded by the eftcfts c)f prcifure. 



In the reducible (late, a lUcl trufs niuft be applied, the 

 pad of which fliould pnfs upon the upper abdominal aper- 

 ture ; for tlie objeft in wearing it is to clofe the communi- 

 cation between the hernial fac, and the abdomen, by adhe- 

 fion, which can only be effeftcd bv the prefTure being applied 

 upon the mouth of the fac. Trulfes are faulty in this re- 

 fpeft, being made to prefs upon the pubis, inllead of mid- 

 vay between the pubis and fpinous procefs of the ilium. A 

 double trufs is required if there are two hcrnix ; the con- 

 ftruflion ef which differs from the others, in having two 

 pads inilead of one. 



When irreducible, it grows to an enormous fize, the fcro- 

 tum often becomes difeafcd, and the perfon is always liable 

 to accidents. It is therefore ncceffary that fonne means 

 fiiould be adopted to prevent its increafe. If it is an omen- 

 tal hernia, a Iteel trufs may be fafely worn, which will pre- 

 vent any further prutrufion ; but if it is inteftinal, a bag 

 trufs (liould be applied, which ought to lace on its forepart, 

 and thus, by prefcrving a conftant prcffure upon the part, 

 any increafe of the tumour is prevented, and even its fize 

 will gradually diminidi. 



The ilrangulated (late is produced by the prefTure, either 

 of the abdominal rin^;", of the mouth of the hernial fac, of 

 the edges of the aperture furrounding the mouth of the fac, 

 or by a cord formed by adhtfion within the fac, which be- 

 comes entwined around the inteftine. 



Whatever is the caufe, it becomes necefiary to liberate 

 the part from prefTure, or the perfon cannot long fur- 

 vive. 



For this purpofe, it is proper to put the patient in a 

 fnpiiif pofituin, with the budy a little bent, and the thighs 

 raif d to a right angle with the fpine, lo as to relax the rings 

 through which t' e hernia has pafTcd. The furgeon then 

 embracing the lower part of the tumour wth his right hand, 

 and applying the fingers of the other oppofite the orifice of 

 the fa^-, lineads the fwellinu into the cavity of the abdomen. 

 If this pl=in, after a trial of a quarter of an hour, does not 

 fiicceed, the patient fiicjuld be bled copioufly, and put m a 

 warm bath, and when faint from the operation of brth thcle 

 caufe^, aiiothtr attempt to return the tumour is to be made. 

 If this io unluccefsful, a tobacco cly'.ler compofed of halt a 

 drachm of tobacco, infufed in a pint of boiling water, is to 

 be injefled, and after fome minutes (hould be repeated, if 

 the firft has produced but htilc effedl in exciting naufta and 

 fainting, .'\nother, and often fiiccefstul mode of atteinpt- 

 iDg the rcdu^ioo, is by the apphcatiok of ice enclofcd iu a 



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bladder, and JaiJ on the part; but if the abdomen is fore 

 upon prefTure,. no time fliould be loft in any of thefc trials, 

 but an operation to liberate the bowels fliould be immedi- 

 ately performed, in tlie following manner : the pntient is 

 to be placed on a table three feet fix inches in height, the 

 body to be horizontal, and the legs hanging from the knees 

 over the table, and the furgeon, Handing between them, 

 makes an incifion from the upper part of the tumour through 

 the fldn, and then fncctfiTively and cautioufly, through the 

 fafcia and cremalKr niufcle, and this expofc's the furface of 

 the hernial i'ac. This being pinched up between the fingers, 

 is to be opened by a very fmall incifion, and a direflor ueiiif 

 introduced, the fac is to be cut to within an inch of the ab- 

 dominal ring, in the oblique miifcle to its lower part. The 

 iiitefline or omentum is thus e.<pofed, and a fmall quantity 

 of fluid generally tfcapes. The finger is then to be pafTcd 

 into the lac towards the abdomen, and the feat of the llric- 

 ture examined. If the ftridure is at the abdominal ring, 

 the probe-pointed billory (hou'.d be paffed between the fac 

 and the ring, and the latter only cut in the dircdiiun of the 

 tum.our, and no danger whatever refults from doing this. 

 And, if the llriclure arifes from the prefTure of the parts 

 forming the upper aperture, the knife is fliU to be pafTcd in 

 the fame diredtion as before, but further under the tendon 

 of the external oblique, and the upper part of this aperture 

 is to be cut in the fame direflion as the former. But when 

 the mouth of the fac itfcif girts the content?, it mull be di- 

 vided as follows : The finger is to be thnill within the fac 

 to the llriflure, and then the probe-pointed biflory carried 

 along the middle of the finger is infii.uated within the flric- 

 ture, which is to be cut upwards or forwards at the middle 

 of the anteiior part of the hernial fac. The epigaftrie ar- 

 tery has been found on cither fide of the mouth of the fac, 

 but it is never fitnated on its anterior part, and this, there- 

 fore, is the part which fhould always be cut. 



When a band is entwined around the inteftine, or omen- 

 tum, it is eafily feen, and as readily divided. 



The flridnre icing divided, and the inteftine or omentum 

 being found free from, mortification, they arc to be returned 

 into the cavity of the abdomen by fmall portions, and by 

 gentle p!-ifii"ure ; but if the quantity of omentum is large, a 

 portion of it ftiould be cut away, and ligatures applied upoil 

 the divided vcffels. 



When the hernia is very large, and has been long irredu- 

 cible, it is right to divide the ftritlure at the abdominal 

 ring, (which is in a large hernia the uiual feat of the ftric- 

 turc) without opening the hernial fac. The incifion for this 

 purpofe is to be made through the fkin, over the neck of 

 the tumour, fo as to cxpofe the ring and the fafcia, which it 

 fends off: an opening is io be made through the fafcia, and 

 a director paffed under the abdominal ring, which being di- 

 vided, the contents of the tumour will be liberated from pref- 

 fure. 



When an inguinal hernia is fo fmall as to extend no further 

 than the upper part of the fcrotum, the operation is to be 

 begun mid-ivay between the pubis and the ilium over the tu- 

 mour, and the incifion carried as far as the hernia extends, 

 Tlie tendon of the external oblique miifele winch is expcfcd 

 by the divifion of the (kin, is next to be cut through, and 

 the hernial fac being then fecn, is to be opened in a very 

 cautious manner. The ftricture whieh is fituated, either in 

 the fac itfcif, or occafioned by the edges of the upper ring, 

 is then to be cnt in a diretlion parallel with the liiiea alba. 



The inguinal hcrni'a in the female is not fo frequent an oc- 

 currence as in the male, becaufe the abdomii^al rings are Icfs. 

 It paiTes through the fame apertures as in the male, and 

 wbealarge, extends ilfelfiuto the labium pudcndi. It requires 



the 



