(58) BISTORT of the SOCIElT. 



Acconnt of bonoccle had, from inaccurate obfervatlon, been often defcribed 



Vi'. Humiltcn. . , 



for femoral hernia. From the time 1 began to have thefe fuf- 

 picions, I have miffed no opportunity of determining my point ; 

 and I have been hicky enough to have the diffeclion of two wo- 

 men, with the apparent femoral hernia; which turned out bubo- 

 nocele. I have likewife had five or fix living patients with her- 

 nia, where I had an opportunity of a careful examination, and 

 have again operated in a fimilar cafe. As the refult of thefe 

 ten or twelve cafes is againft the common opinion, I fhall (late 

 my obfervations at full length. 



*' The idea that a bubonocele in women was to take the fame 

 road with a fimilar hernia in men, has, I fancy, mifled ; for we 

 find; that this is the account commonly given of the difeafe, that 

 the gut paffes do-wn into the labium. Now, if we compare the 

 two cafes, we will find there is no fimilarity. In men, the gut 

 and. fack are furrounded by the cremafler, and are therefore 

 conducted towards the tefticle. The cellular membrane of the 

 fcrotum is free of fat, and therefore yields more eafily to the 

 preffure of the gut than that of the parts around ; and thus the 

 hernia paffes more eafily in this direcflion than in any other. 

 In women, when the hernia has pafl the ring, it has no crema- 

 fler to condu(fl it to the labium, it may therefore pufh in any 

 other dire(5lion ; but as the cellular membrane of the labium, 

 and from it to the ring, is very much loaded with fat in moft 

 women, it will find more obftru(5lion in this diredlion, and will 

 therefore be pufhed where the parts yield more readily. The 

 parts on the groin are lefs loaded with fat, the gut therefore will 

 be prefTed here. This I found corroborated by all the three 

 cafes, where I either operated or was afliftant ; and in the two 

 difledlions the hernia was pufhed outwards from the ring, and 

 in one it had gone up along the belly above the ring. This on- 

 ly takes place when the hernia is fmall. If the ring is much 

 opened, and a great quantity of gut forced out, the motion of 



the 



