ft 
* firmer to the feel. 
“eounces were. rem 
HER WIA. 
ring, by which means the furgeon will be enabled to divide 
the tendon with eafe. he itri€ture having been thus re- 
moved, the parts are to. be returned into the abdomen b 
preflure, or at lealt fuch of them as are capable of reduc- 
tion. Laftly, the edges of the incifion are to be brought to- 
gether with Wicking platter, and united, if poffible, by the 
firft intentio In Cooper’s work on hernia, 
part I, p. ye and 46, two. convincing cafes are related, one 
exhibiting the advantage of this pian of operating ; the 
other fhewing the ees of laying open the whole fac o 
large hernia. Mr. Lawrence records an additional euch, 
in which Mr. Crow chee fuccefsfully operated upon a large 
ftrangulated hernia, without laying open the whole of- the 
tumour. According to r, Lawre rence, the honour of pro- 
oling this method of opening belongs exclufively to Jean 
Louis Petit, who is ftated in Garen meot’s treatife on the 
operations of furgery, publithed in 1719, to have adopted the 
plan the preceding year, in a cafe of crural hernia. 
ration where the Tumour has not paffed the Ring —As in 
this cafe the {welling is inconfiderable, the difeate i is apt te 
be miftaken both by the furgeon and ‘the patient ; 3 nor ca 
the tumour be expofed, without dividing sean a 
the external oblique mufcle. The sae through the in- 
teguments and aha fhould be made in a direction 
parallel to the cou the f nat cord within the ring. 
The itri€ure wi sons be found fituated at ies inner 
Objervations refpedting theTreatment of the Omentum found inthe 
Ffernial Sae.— ready obferved, that when the cafe is 
an sabnicnapinlsinde the aatesh if found, is to be reduced 
before the omentum. n, however, it is much difeafed, 
thickened, and a gs as tt is frequently found to oS 
remainin ng HY confiderable time in a hernial fac, the 
morbid part is cut off. It is accurately explained in 
Mr. Lawrence’s Pee ni le. that of all the parts 
which form the contents of herniz, the omentum is found to 
aevete mott frequently from its healthy ftructure. Indeed, 
ffeffes very feldom a perfe€tly natural appearance, when 
been inclofed for fome time in a hernial fac. It be- 
eee confiderably thickened below the ring, and hence § is 
That part which refides in the neck of 
fac is fometimes thickened and indurated, while the 
When it has 
which fargeous have ee peacelly defcribed under the term of 
An incifion into the part, under ne circum- 
‘ances, is not ome with any bleeding ; but 
brane admits of b expanded as aa flate. 
etimes, in a of hernia, the protruded omentum is 
sileaaerver: into a folid fatty mafs, where every veftize 
‘original itruéture is loft. In_an old umbilical pao 
ge gent 
a cwetae ounces and a anda vhalf i in eeieet: and he 
notices a cafe, deferibed tn Ponkes, | in sich forty oe 
oved in the maa © hardnefs of 
‘the protruded , omentum 
been called 
‘and Mr. Pott. (Lawrence on Rt tures, Mb. ee 246— 
248.) In fome examples, xem ia eed sa 
fac from the te 
is found actually ¢ gangrenous. Suppofing the omentum to 
e in a difeafed, th oe Se or indurated flate, its reduétion 
into the cavity ll the abdomen ge bi highly objeétion- 
able. In fact, the diated mafs ¢ not be returned, 
oucit to be taken up with a reuacalass, sedk tied "feparstely 
with a thread or fmall. ligature. [he apprehenfion of hemor- 
rhage, gave rife to the barbarous pra .ctice of including the 
whole fubftance of the omentum in a tight ligature, which 
was applied juft above the portion about to be removed. 
Monfietr Pipelet, in an able ages has expofed the 
dangers of this metho Mém. Acad. de Chirurgie, 
tom. 3. 394). Our countryman, mes Pott, in 
writings the moft decided condemnation of the plan. He 
has, with great candour related (fays 42 Hey) the = 
effe& of fuch a aloe ina patient of his o I faw 
upon it, and the p et 
which fucceeded are thus accurately defcribed (in 
Pott’s own wor ws ‘Thave feen’a whole train of bad iyaine 
as high as the ee and t 
Mr. An 
very objet of the operation, i 
from its itrangulated itate, arifing from the preffure of the 
furrounding tendon, and no fooner has this been done,, than 
the blind - urgeon includes it in a ligature, w 
a more perfect conftri@ion, than that which exifted eons 2 
Let it not be infe 
ever, from any thing here ftated, that there is no rifk 
P- 7 
of i1) otek =e fays, “the fe 
almoft, if. = st aR without foundation, as T ha 
tes need.” And again, “I will not Pp po 
never was a dangerous, OF fatal flux 
of the omentum without pet $ 
