portunity is afforded him of ufing a beft mode of treatment, 
his fuccefs will be the greateft when the operation is not 
long del » Hey declares, "fit when he firft en- 
tered the profeffion of furgeon, it was cuftomary to con- 
By this dilatory mode of 
e patients in five, upon whom the- 
operation was pes ae After having more yee 
he made it a cuftom, when called to a patient, who 
laboured two or — days under the difeafe, to wait ity 
about two n order to try the effeét of bleeding, 
(when this was a forbidden ,») and of the tebacco glylter. 
By this method he has only loft about two patients out ~ 
nine, after the operation. This comparifom is faid to 
rawn from cafes ae fimilar, inftances with alias 
being excluded ~ the computation. See Pract. Obf. 
in Surgery, p. 128—130. edit. 2 
Every one sis coincide nicks Mr. Afiley Cooper, that 
it. would be a fortunate thing if furgeons: were poffeffed 
any criterion, whic 
truded parts, would enable them to judge of the lateft time, 
-to which the operation could be fafely delayed. This gen- 
tleman remarks, that hiccough has been named as the deci- 
five fymptom of mortification ; but that this opinion is now 
known to be inaccurate, fince the operation has feveral times 
been performed in the hofpitals of the Borough, after this 
_fymptom has occurred, when the parts have been found free 
from. mortification, and the patients have recovered. 
the other hand, the body of a woman was poster who 
© 
ae) 
= 
mation to contend 
with, which, unfortunately, is likely to > varanvg bythe - 
Speenae the only means of relieving t ure. Hence 
s gentleman is ef opinion, that as Gicicias as bleeding, the 
, warm bath, the tobacco glyiter, and topical cold, have been 
‘fairly tried, and have proved unfaceefetal if the abdomen is 
-becoming affected, the operation thould be no longer delayed. 
Indeed, fays he, if the warm bath ¢ 
and. quickly procured, it is better to omit it altogether, 
shea, are the patient’s life by the de’ 
The forenefs, upon prefling the abdomen, is reprefented 
AS. being a much better criterion than the time ope has 
elapfed fince the occurrence es the firit fyn Gaiiat 
—_ : re-is the variety in shel time ik “me 
termination. 
s, that in the mufeum 
LW of a e ins 
ria, ick Mr. Elfe ufed to {tate i 
atal in Aaa om the: firft ap 
» by fhewing the exact fate of the pro- : 
annot be coriveniently : 
the. protruded: p 
mto. conta 
ring. 
formed from the pulfe, and from the patient's general aps 
pearance. If the pulfe be fo fmall as to be fcarcely: pera 
ceptible, and the abebdies anxious and funk, no time is 
be | He has known the operation fueceed i in the 
circumftances, t though conjoined with hiccough.’ Indeed, 
the operation may fave life, even w the parts are gan- 
grenous, by promoting uh feparation of the floughs. On 
Liga Hernia, &e. ae 
mall hernie more frequ ntly demand the operation than 
tine ones, and epi iolneiess _ esata {fpeaking, admit of 
rather more delay than enteroceles 
e fhall next ‘enter upon an adcountof ape bernie, 
and = mode of operating in different ca 
Inguinal Hernia, or Bubonocele. —. this caf the bed 
are protruded from the abdomen 
~* 
“) 
ie) 
a 
gre the hernia be unchecked, it proceeds, by degrees, 
Shliqnely downwards and inwards, as far as the abdominal 
rm the tumour lies within the ring, the difeafe is 
often unfufpeéted by the patient. The tumour then 4 
{cends through the abdominal ring into the ferotum, w: 
ing lefs confined, its exiftence becomes completely wish 
feft, and it is apt to increafe to an enormous fize, fo as even 
to reach down as far as the knees. 
Upon diffeéting an inguinal hernia, we find under the fin 
of the ferotum a fafcia, which is more or lefs thick in pro- 
portion to the duration and fize of the fwelling. This 
fafcia is given off by. the tendon of the external oblique 
mufcle 28M the abdominal ring. 
Beneath fuch fafcia lies the creeiettes mufcle, which forins 
another contin of the hernial fac, and is often found much | 
thickened and expanded. 
When the fafcia and own hee mufcle are récacveds the 
proper hernial fac comes into view, being thinner than the 
two former coverings; but fomewhat thicker than the peri- 
pore ee from which it is d 
the hernial fac the fpermatic gordi is fituated above, 
araicibtelRicls below. Thefac, therefore, | are mee thecord 
and the cremafter mufcle, anterior to the form r,and potte- 
rior-to the latter. Above the abdominal ring oe ‘owe 
of the hernia is obliquely upwards and outwards toware® 
— oblique mufcle, the fpermatic cord bemg 
yet ce backward, ries nude of the oon mete 
ol tranfverfalis mia foles and the above fafcia. Att 
aes sa seh in the fak cia, the fac penetrates th ie abdomen 
mouth eb the ra nor exteraly beeen it’ ent the 
- procefs of the ilium : 
_ From the very accurate accounts publifhed by this gen 
an, it appears, that in old and large hernize the ore 
of the internal and external openings of t the ring are pe 
in relation to the tumour, by the conitant Lee be oimolt 
s, the mouth of the fac com 
with, ~ aoe sg. he pee 
gba are W Wea Pe a 
the "anil 
ear 
eee 
