46 
A Description of All the 
Sea. IX. 
We may therefore conclude, without a doubt, that the danger of the ope- 
ration of hernia is not owing to the mere divilion of the tendon or of the pe- 
ritonaeum ; but that it depends chiefly, and almofl; folely, on the handling of 
the bowels, and the expofure of thefe and of the inner fide of the fac to the 
air: Nay, in fome cafes where the operation of the hernia had proved fatal, I 
obferved, on opening the abdomen, that portions of the inteftine, and likewife 
of the peritonaeum, at a diftance from the herniary fac, were much inflamed, 
although the patient had not before the operation complained of pain, except 
at the place of the rupture. 
When we now review the opinion and the pradlice of furgeons, we ihall 
perhaps find they are not a little inconfiftent with each other: for ‘‘ if the 
“ mere ftriclure made by the tendon is, in the generality of incarcerated rup- 
‘‘ tures, not only a fufficient, but the primary and indeed the foie caufe of the 
“ fymptoms, and of all the mifchief,” why, after the fldn is divided, do fur- 
geons firfl; lay open the herniary fac its whole length, and then cut the ten- 
don ; inftead of merely cutting the ftridlure made by the tendon, without 
opening the fac, and then reducing the bowels by prelTure, pofture, and agita- 
tion, if the latter fliould ever be necclTary ? 
' They pretend indeed to aflign as reafons for their pradHce, that unlefs the 
fac is laid open, w’e cannot know in what flate the bowels are ; that the in- 
teftines or omentum are liable to mortification ; that collections of fetid wa- 
ter are apt to occur, which, on being puflied back into the abdomen, might be 
produdive of mifchief ; that fometimes the caufe of ftrangulation has been de- 
teded either in the entrance to the fac or among the bowels protruded ; or 
they tell us there are adhefions of the bowels to the inner fide of the fac, 
which ought to be feparated. 
But fuch kind of reafoning, if it has weight, goes farther than is intended; 
for it ought to prevent furgeons from attempting in any cafe, at leafl from at- 
tempting in mofl: cafes, the redudion of a hernia. 
Yet 
