HERNIA. 
{mallnefs of the aperture, and narrownefs of the neck of the 
fac 
. If-the rupture be very large and ancient, the patient 
far advanced in life, the inteftine not hound by any degree of 
ftricture, but does its office in the fcrotum regularly, and no 
other inconvenience be found to attend it but what proceeds 
from its weight, it will in general be better not to attempt 
reduction, as it will, in thefe circumftances, moft probably 
prove fruitlefs, and ‘the eset the parts in the attempt 
may fo bruife and injure t ifchief ; but this 
mutt be underftood to be ici of thofe only in which there 
is not the fmalleft degree of flri€ture, nor any fymptom of 
obftraction in the inteftine, fuch circumftances making re- 
duction crate at all times, and in every cafe. 
“ 1regard to the contents of -a hernia, #4 it be a 
portion ies omentum only, and has been gradually formed, it 
feldom oceafions any bad fymptoms, though its weight will 
fometimes render it very troublefome. But if it be produced 
faddenly by effort or vialence, that is, if a confiderable piece 
of the caul, by accident, flip down at once, it will fometimes 
prove painful, = caufe very difagreeable complaints ; the 
connection een the omentum, ftomach, — Se 
ifcera. 
» as I have more re than onc as a mete 
ovlestal hernia, it may fometimes ee fubject to great zard. 
But even though it fhould never be liable to the juft men- 
tioned evil, that i is, though the portion of the caul fhould 
remain uninjured in the {crotum, yet it renders the patient 
conftantly liable to hazard from another quarter ; it makes 
itevery moment poffible for a piece of inteftine to flip into 
the fame fac, and thereby add ta the cafe all the trouble and 
all the danger arifing from an inteftinal rupture. It is by no 
' Means an a thing for a piece of gut to be added to 
a rupture, which had- for many years been merely omental, 
be for that pine to be ftrangulated, and eager’. immediate 
‘Pe 
** An old omental hernia is often rendered not reducible, 
More by an alteration made im the {tate of the prolapfed 
It is very common for 
that I am fatisfied, that for one acon ae 
rendered irreducible by adhefions, many more become 
from the caufe above-mention 
“In the fac of old smite ruptures that have been: Jong 
down, and only fufpended by-a bag trufs, it is no very uncom- 
belly ake to have: a pretty confiderable quantity o of fluid col- 
i of differcat: colour and confiftence, and feldom fo much i in 
Q"antity as to occafion eee = particu 
6n the other han d, it fometimes is fo much i in quantity as to 
become additi 
an ional [ have more 
than once been od to 
the ferot become gengienn’. by 
raitit of this operation 
eee the © hernia be of the ate tbl aime oetiees 
from its weit and the aiftention of ¢ 
have feen 
detec : 
lation being from 
more likely to happen in this cafe, and more productive of 
mifchief when it has happened ; for the finaller the portion 
of Ss fe) ie is engaged, the tighter the tendon le 
and t re hazardous is the confi equence, Ihave feen a 
fatal sretaictie in a bubonocele which had not been formed 
forty-eight hours, and: in which om Home of inteftine was 
little more than half an inch. There are few practitioners, 
who have feen bufinefs, but sida ‘the intone of this; but 
When a-confiderable portion of 
inteftine paffes out from the belly into a hernial fac, it ne- 
ceflarily and unavoidably carries with it a proportional 
uantity of the mefentery, which every bedy knows is a 
itrong double membrane. When the prolapied part is at 
all confiderable this double membrane is hang in fome 
meafure, folded on itfelf, and takes off a deal of the 
effeét of the ftrifture on the inteftine. Now! ciao this 
circumftance will not prevent the effect if the means of relief 
be totally neglected, yet it will moft certainly retard the evil, 
and give more time for affiftance ; whereas, when there is 
little or none of the mefentery got ‘through the tendon, and 
the thin tender inteftine bears all the force of the ftricture, 
it is i soemncsren brought into rea ee 
F linference to be drawn from hence is tos’ 
obvious to oa mentioning. 
«In the inteftinal, as in the omental hernia, they hile: 
ion of the inteftine 
du ucib ble than if a 
will always remain 
omental one ee it has attained to a certain fize and ftate, 
ontained within the former “is liable to lefs- 
the 
alterationo fo rm than that within the latter, which alteration. 
: er is no infrequent hindrance of the return of an old caul-’ 
ce 
i. No t that the parts, within a mere inteftinal etna are’ 
rom fuch an rset as ma 
which 
ee hardened and thickened as to prove an 
perable obftacle to its udtion.. 
« Upon the whole, every thing contidered, I think it siegt 
faid that an inteftinal ject worte. 
pb em _ a he Ber 
ood is 
lar attention to it ; but, more 
