- 
c 
: eiteatitsina as a ve 
becomes: 
the italy and does not 
“The. moft em 
HRM A is 
an SS 
6s The firft appearance of a sstpture may okie. hic- 
cough, vomiting, and pain; and the fame fymptoms may be 
exhibited in an old‘cafe, fone the patient has taken much ex- 
ercife, or remained long in the ere& pofture, in eka 
of irritation, excited by the protruded vifcera in the con- 
tents of the a ne emen. Here, tao, ftools may fe “ealily pro- 
cured by pur 
«“ The moit Cesjieik cafe, however, is where a patient 
with a Aa cag has an attack a: ileus from fome other — 
arife from the hernia would here be not ous ufelefs, but 
even injurious ; e furgeon would ne thofe means 
which th alascihtiant of the bowels fo urgently de- 
a 
sé Whenever we fee a patient labouring under the fymp- 
toms of -— we fhould fufpeé the exiltence of a rupture, 
and make thofe enquiries and examinations which fuc 
{ufpicion ‘would naturally fuggett, particularly in females, 
n led to concealment by — of falfe deli- 
A fa peri examination is not fufficient on thefe 
mall betes of saicienes not forming 
any external tumour, may, by its incarceration, caufe the 
fymptoms. If the latter —“ appeared fuddenly, and under 
eircumitances which might ea rupture, if the pain have 
been firft felt about the ring, or crural arch, and if preffure 
in thefe fituations he ngs it, and laftly, if the patient, 
fhortly before, had been in ae = there is ftrong 
reaton to fufpeé the exiftence o 
“When a perfon, labouring ations aie has a hernia, 
which can be reduced eafily, there is no gro 
If, on the con t arts cannot be sare ced, itrangu- 
lation may be reafonably fufpected, although we cannot im- 
mediately conclude, with oe that the {welling is the 
caufe of the inflammation. We fhould firft afcertain whether 
the parts could be re replaced dteineithe to the attack; if they 
could not, and the {welling be large and old, they are pro- 
bably adherent ; and the pian’ d of reduétion proves 
an ES the oe be 
~ e certain. 
“ The following circumftances will enable the: pate sie 
to decide, in fimilar cafes, that the fymptoms are not pro- 
duced by the hernia; that it is not flrangulated ; and that 
the ileus sea from an internal caufe. ‘The pain is felt in the 
men and not in the fwelling, which continues foft, while 
the belly is inflated, hard, and tenfe, The attack is fudden, 
and not preceded by any of the occafional caufes, — 
eould he rupture; and the rin 
rEg 
_ affection extends i in the fequel to the fweiling; which eg 
painful and tenfe ; ie: — appears later here than in 
o fo great ad 
I is is, where dinllaieslinins 
und for doubt. feared than 
“mediate reduction; and con‘tant care 
kept up, its immediate 
the 
The . fary, as 
{welling is the feat, and not the caufey of the difeafe.» The: 
diftinétion muft be very difficult. he want of tenfion and 
of pain at the ring while the {welling ‘elf was painfitl ; 
and the p of feverifh rigour; might lead us to 
fufpec inflammation f the protruded inteftine. If the ring 
afterwards became tenfe, and the included parts confiderably’ 
ae we fhould conclude that {trangulation had fuper- 
ven a we accordingly.” Lawrence on Ruptu uEEh 
cha ne 
Unlete a Atangulated hernia is fpeedily reduced, it almoft 
always proves fatal. However, a tew examples do occur 
in which the floughs are thrown off, and the patient furvives ” 
with a fiftulous opening in of the tumour, through 
which opening the feces are aichanged during the remainder 
of his life. 
Prognofis of Hernia.—It has been ‘remarked, by that oy 
eminent furgeon, Mr. Pott, that the fame kind of rupture, — 
in different ead and under different circumftances, athe 
a very verious ; the age and conilitution of the fubject, 
she oe the difeae its Cae free or not free from Itric- 
ure mation, the fymptoms which attend it, and 
x probability or aprobability of its being returnable, ne- 
ceflarily producing much variety. re degree of hazar 
a attending this complaint will be aifo more or lefs as it 
happen to be circumftanced. 
« If the fubjeé be an infant, the cafe is not often ava 
with much difficulty or hazard, the foftnels and ductility 
of its fibres generally rendering che reduction eafy as we 
as the deed and though, from neglect or inattention, it 
may fall wn again, yet it # as eafily replaced, and eldom 
fay feldom,”’ repeats ‘Mr. Potts 
with all the fymptomis of mortified inte(tin 
_. © If the patient be adult and in the oak of life, the 
confequences of negle&t or of mal-treatment are more to 
at auy other time, for reafons too obvious to 
relating. reat and principal mifchief to be wee 
ended, inan inteltinal hernia, is an inflammation of the guty 
and an ‘obfieedtion. to the paflage of the aliment and feces 
through it, which inflammation and obitruction “— general 
ve 
that dts are sta 
antony fcdtoieen and that, * fuch fh 
infirmity of old age is no —— circumitance in 
ment which may become n 7 
* If the difeafe be cea Ba the patient one, 
re to prevent its pl ng 
out again, are the only means whereby it is potinle te to obtailt 
Se Je€teds 
_ Hf the sdifends be of long flanding, has been neg: little 
or fuffered y be frequently down, and has given and 
er no trouble, the aperture in the abdominal mufcle, 
the necke of the hernial fac, may both be _ peeiuees to 
large ; which circumftances in general ren oe all 
dathion lefs neceflary and lefs difficult, — ‘aif fruftrate Fs 
rational expeétation of a perfe&t cure. On the ai So 
the rupture be recent, or, though old, has gente 
&ion is more abfo nies) 
rifk of ttri€ture ia greats fromthe (spp ‘ 
2 
* 
