SURGERY. 
covered by a cold and clammy sweat. 
Mortification and death now speedily suc- 
ceed. The intensity of the symptoms and 
their duration before the occurrence of the 
fatal event, are modified by numerous cir- 
cumstances, as the age and strength of the^ 
patient, size of the rupture, closeness ot 
the stricture, &c. ; so that a case may tei • 
minate fatally within twenty-four hours, or 
it may be protracted for two or tliree 
weeks. Hence the strangulation has been 
distinguished into the acute and chronic. 
The treatment of a reducible rupture 
comprehends the return of the protruded 
parts, and their retention within the abdo- 
minal cavity by means of an appropriate 
truss. Various proceedings were recom- 
mended by the older surgeons for producing 
a radical cure, as castration, caustic, the 
royal stitch, &c. ; but as these expose the 
patient’s life to the most imminent risk, 
without affording any greater chance ot an 
etfectual cure than the use of trusses would 
bestow, they have gone entirely into disuse. 
Herniary bandages are of two kinds ; the 
elastic and non-elastic. The former are 
constructed with a piece of steel nearly en- 
circling the body, and termed .the spring, 
by means of which they maintain a cotistant 
pressure on the opening, through which the 
parts protrude. 
If their use be continued for a sufficient 
length of time, it even affords a prospect of 
a radical cure. Since the constant pressure 
of the pad of the truss keeps the neck of the 
sac empty, and thereby brings on a gradual 
contraction and obliteration of its cavity. 
Non-elastic trusses are so inferior to the 
others, that they are now universally laid 
aside. As the best constructed trusses 
will not afford a certain protection from 
descent of the bowels, the ruptured person 
should avoid all great bodily exertions ; and, 
if the hernia should descend, he should im- 
mediately go to bed and send for surgical as- 
sistance. 
As an irreducible hernia does not admit 
of the employment of a truss, the tumour 
must be supported by a suspensory bandage, 
and the patient, by temperance in diet, con- 
stant attention to the state of his bowels, 
and avoiding all great exertions, must en- 
deavour to obviate the risk of strangulation, 
to which he is constantly exposed, and to 
prevent the incretise of the tumour. Con- 
finement to bed for a few weeks, with 
bleeding, mercurial medicines, purges, and 
low diet, has sometimes caused irreducible 
hernia to go np ; but great caution is ne- 
cessary in adopting such a plan. 
In the treatment of strangulated heniia 
we attempt first to replace the protruded 
parts ; which operation is technically termed 
tlie taxis. The patient should lie down, 
with his pelvis placed higher than the shoul- 
ders, with the thigh, in inguinal and crural 
hernia, bent and rolled inwards ; the blad- 
der being previously emptied, and a caution 
being given to abstain from coughing, hold- 
ing the breath, &c. Gentle pressime must 
now be made on the tumour, and increased 
to a certain extent, but, if possible, not so 
as to give pain. A general pressure may 
be made with both hands, or the tumour 
may be grasped with one, while the otlier is 
placed at the aperture, and employed in 
facilitating the entrance of the parts, or in 
keeping up those which have been already 
returned. The pressure should be exerted 
according to the course in which the parts, 
have been protruded ; i. e. upwards and 
outwards in the bubonocele, backwards and 
then upwards in the femoral hernia. Small 
hernise are the most difficult of replace- 
ment; and the taxis succeeds also oftener 
in the early than the later periods of stran- 
gulation. It should not be persevered in 
when the rupture becomes painful. Mild 
purgatives and clysters should be used, even 
if the taxis succeeds. When we have not 
succeeded in replacing the parts, various 
means may be adopted in the treatment of 
a strangulated rupture. Tliose which are 
the most to be relied on are, bleeding, the 
warm bath, clysters of the decoction or 
smoke of tobacco, and ice or other cold ap- 
plications to the part. The former remedy 
must not be used indiscriminately, nor with- 
out a due attention to the patient’s age and 
strength, nature of the symptoms, &c. Yet 
it should be employed with vigour when we 
have resolved on its use ; and a considerable 
quantity should be drawn suddenly from a 
large orifice to induce fainting. Tliis, with 
'the warm bath, and the employment of ice, 
or of the freezing mixtures, made by tlie solu- 
tion of salts, are the means to be employed 
first; and if they fail, the tobacco clyster 
made by boiling one dram of tobacco for 
ten minutes in a pint of water, should be 
instantly tried. If this does not succeed 
after two or three attempts, the operation 
must be performed without delay. A smart 
purge of calomel and jalap will sometimes 
succeed in the ^arly stage of strangulation, 
particularly in old and large hernia, where 
