HERNIA. 
viate from their ordinary fituation, in refpe& to the hernia, 
and lie more or lefs in front of the fac, every operator ought 
to endeavour to afcertain fuch variations, if poflible, before 
hand, in order that he may avoid parts which fhould never 
be injured. Whea the hernial fac has been in this manner 
opened, and its contents fairly brought into view, the next 
cbieet | is to liberate thes nm from the ftate ot ftridture in which 
they are. In a few examples, indeed, the parts may be now 
reduced with the soul and without any farther employment 
of the knife. oit inttances, however, it is otherwife ; 
the firiGiure muit be cut, and if this ftep be negleéted, the 
furgeon will either not ie able to effeét the redudtion at 
all, or will only fucceed by exerting fuch force and rough- 
nefs on the protruded vifcera, as mutt i i: tae be followed 
by the moit pernicious effects. efore, whenever the 
parts cannot be returned with eafe ees opening the fac, it 
1s the duty of the fargeon to refrain from all manual vio- 
lence, and proceed to dilate the ftri€ture. With this view he 
mutt firft try to afcertain its fituation by gently introducing 
his finger into the neck of the fac. The requifite divifion_ 
fhould be executed with a curved probe-pointed biftoury, 
y the finger of the operator, which will protect 
Should the t a eee of il ‘con- 
finger, is pufhed forwards towar 
ie and epee by the finger iaich proteéts the 
vifcera. The length of the incifion fhould not exceed what 
3s fuficient to allow the vifcera to be replaced with eafe.”’ 
Lawrence, Pp. 203. edit. 2. e direétion in which this 
‘tut is made is of confiderable importance fince the proxi- 
mity” of the epigattric artery to the m oi au the hernial 
fac eysesy fuch weet to injury. Sharp and Pott have ad- 
itione make oe divifion of the flricture i in 
‘direction Seegets and outwards, a method w . i 
pe with fafety in all peti cafes, and is 0 ex- 
<eptionable when the vifcera are Sek on the inner fide 
ef the epigaftric artery. Yet, even in the laft-mentioned 
example, the veffel is fo diftant from the external an 
‘the ring, that in general it cannot be wounded by cutting 
upwards and outwards, unlefs the incifion be carried to a - 
er extent than is ufually requifite. On 
“neous fuppofition that the artery has the fame ay to the 
_abdominal rin g bo th in found and difeafed ftate; Richter 
“and randi advife e furgeons to divide the Rabie upwards 
and Aa ean a plan’ which is high go ge in common 
eafes, as the preceding artery would be c the 
bet Pmt be be followed in the lefs Srefient Site where 
wh 
es its protrufion on the inner fide of that 
every ‘d(taniee 3 in whi cae 
the } 
= ae fagerior opening of 
the erro- - 
bowel Saeed becaufe it is of a 
itts - conten may t be embarraffed as to what line of 
ty is he ou 
fituated at the inner margin of the neck-of the hernial fae, 
When the itridture is of this kind, it may be divided much 
in the fame way as the aperture in the tendon of the external 
oblique ge ae namely, with a probe-pointed a 
guided by the fore-finger of the left hand. Mr. A 
Cooper employs for this. purpofe a very good ia heneaail 
which is a bittoury, that has a cutting edge reaching only a 
little way from the point, and which is introduced with the 
flat fide towards the finger, until the probe-point has pafled 
under the firicture, when its edge may be inclined up fo as 
to divide the margin of the tranfverfe mufcle as far as cir 
cumftances require. ‘The external opening of the ring in 
this cafe ought never to be dilated, unlefs there fhould not be © 
room enough to get at the itri¢ture, an event which can 
happen only feldom. he {tricture may be fituated both at 
the outer and inner opening of the ring, and require to 
divided in each place, ere the reduétion can be accomplithed 
with se due degree of facility. 
ttley Cooper has conjectured, that it might be ad- 
denageoes to leave the neck of the hernial fac undivided, 
and in dilating the fcri€ture, he has been in the habit, there- 
fore, of intro¢ ucing the curved biftoury between the abdo- 
minal ring, and the portion of peritoneum, which conttitutes 
the upper part of the fac. He thinks, that as, in this me- 
thod, the wound is further from the peritoneum, inflamma 
tion of that membrane is lefs likely to be induced by the 
Operation; and that in cafe. the epigailric artery fhould be 
wounded, the blood cannot infinuate itfelf into the abdomen. 
The propriety of this plan has been ably examined by Mr. 
Lawr =a in his Ae treatile on npENa- The vwo rea- 
Ta = which the a — to atchieve in the 
ity of the 
bdstnca: a sna Sia which may be yee! aot ae 
riety of never pete deal from retu 
dark brown ¢olour, te 
€ mortification is the only {tate hich can Muon 
in 0 part back 1 ae 
TL acienie. &e. . 
In many cafes the practitioner may feel. uncertain, W whe 
a difcoloured of inteftine is. ‘mortified or nots 
condu set 
or she peepelg et Eales ee 
Ss 
e 
33 
: 
Fear aif Meet ge 
