HERNIA 
émimediately between them and the opening, at = the 
— occurs. The mem mibrate,: 1 in fa&t, becomes elon 
um in its natural ftate. But in aie old ruptures, A 
hernia fac is fometimes found to be of an extraordinary 
thicknefs. It deferves notice, however, that the thick ap- 
pearance a the peritoneal fac is rather owing to the thick- 
ened ft fome me e coverings which it has, 
hence arofe the ufe of the term rupture. 
now repeatedly proved, that a laceration of this defcription is 
exceedingly uncommon, an Hae oe hernial Ea is phi 
by an elongation of *the periton of the co 
tinual diftenfion and preffure w hich the fac fuaftaine from itd 
ed it gee undergoes a gradua al enlargement, — 
eularly when the mafs of the protruded vifcera is from: tim 
to time Waking additions. ln this manner immenfe bint 
nial facs are fometimes formed, extending to various 
_ tances down the thigh, and, in fome inftances, even to t 
knee. 
It is remarked by Mr. Aftley Cooper, that a long con- 
tinued preffure of moderate force will produce an elon- 
gation and thickening of fibre ; but that a greater degree 
will bring about an entire abforption of parts. This, he 
fays, is proved, in the fir cafe, by the vatt increafe of fize 
and thicknefs which the tunica vaginalis undergoes in old 
3 and, in the fecond, by the — remeval of 
the fternum and cartilages of the ribs in aneurifm. It is 
upon the firft of thefe principles that the her fac is a8 
aneds for in fome very large ruptures indeed, the preffure 
upon ‘the containing parts exceeds that de e which occa- 
fions them to become thickened, fo that they are affected 
with an oppofite change, and grow thinner and thinner. 
This is the reafon why, in fome ruptures of vait fize and 
uration, the convolutions and 
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o intimately corietest rhe. adhefions 
that every idea of getting it back 
en 
ler set ‘Their 
the fac 
its pro- flan a certain e 
herniz. Tt ay appears = probable, from Mr. Aftley Cooper's 
obfervations, that if the accounts of {trictures being formed: 
a thickening of = neck of the fac are not always mif. 
re rpreletatons thefe cafes are, at all events, exccedingly 
o 
e 
re. 
ies fome fubjeéts feveral hernial facs exift at the famettime, — 
The foregoing author has a preparation of two hernial facs 
in each groin, and of one in an incipient ftate on the left 
fide. In thefe cafes, the vifcera do not generally protrade 
into all the facs at the fame time. (Cooper, part i. p. 3 
Examples are recorded of hernial facs being barft b 
(See Supplement au ‘Traité de J. L. Petit fur les 
Mal. Chir. p. 113, and Cooper, part i. -) In this cirs 
FS the vifcera may project immediately under the 
fkin, and muft be returned into the fac rea there is a pol- 
fibility of getting them back into the abdom 
Although the flatement, that the peolspied bowels are 
xa 
blows. 
ftance, to employ his knife 
confequences might be of is moft fatal nature to bis pa- 
tient, and of the moft difgraceful kind to himfelf. Thole 
herniz which occur through unnatural holes, left by the 
imperfect formation of the mufcles, are faid to be fometimes 
without any covering of peritoncum. The hernia of the 
ladder has no hernial fac, neither has the common congenital 
ernia. Such ruptures as occur after wounds of the abdo- 
men, or return after the operation, or after the practice of 
fome method for the deftru€tion of the fac, are alleged to 
be without any peritoneal inveftment. The vifcera, in fome 
umbilical herni, are afferted to have been deftitute of a her- 
nial fac, though we are rather inclined to believe that ac- 
counts of this laft kind are founded i in miltake, as will be 
more particularly noticed. 
Canfes of Hernia —Thefe are divided into the exciting and. 
predifpofing. The principal cee caufes are fuch as ope - 
rate, either by diminifhing the cavity of the abdomen and 
pee aaa | the vifcera, or by erealiag the volume of the 
the _ ao what the refiltance of the con 
taining parts can 
The abdominal vatouine may be confidered as occupying 
— where they are expofed to the pane ‘enon 
ome exceedingly powerful organs, n 
and abiondie nischea In the apne pot continual. 
fun&ion of fs oe thefe mufcles are ceflan ae 
a bows 
of 
wever, is 
he vifcera 
and sian no re fa 
abdo ee sraikes ‘acting, fo as to ee up 
t diaphragm, which is then paflive, and thus ae in ras 
the cavity of - — — in the perf fa 
funétion of brea 
cline tect 
"of the ee ns ne 
into the — of Pe belly again is vain, fince it can th t 7 Ke. Rat ti ; fions on 
parated from its attachments by the knife of diapl ao i ete al a all aét at once in 6m 
in the’ dead fubjeét. wlesuuc aaa ie Fo els and leffening the fpace allotted for Sh 
techie Hierheraidl ine Sroxh the furro rrounding parts, elpecialh @ the flate of things, we mult not feel fi 
: Sm Besos cord, will ever a en re of ar roto =A the vifcera are becomes ‘the mott comma 
ing to a D« wit aos ace. : estes 
efieCing a radieal‘cure. ° . : ececa the domi mufcles, from “whatever 
ae the fedy ob “of the fa ee not the fac itfelf, as estes may arife, may be accounted he molt fre aa 
—_— obierved, which is chiefly thickened in old <seoution OF Hiotar Hines the diffe often bee he 
