SURGERY. 
disorder of the bowels may have been the 
cause of strangulation, and wliere the symp- 
toms are not very urgent. Opium is of use 
to allay the sickness. The surgeon should 
act with the greatest decision in these cases, 
and should particularly avoid all unnecessary 
delay. He should try at once the most 
powerful means, and operate as soon as it is 
found that they will not succeed. Surgeons 
are now universally agreed, that the danger 
of the operation arises chiefly from its being 
deferred until the local or general distur- 
bance Iiave proceeded to such a height, that 
a favourable result can hardly be expected ; 
and that the chance of recovery is very con- 
siderable when it is performed unticr more 
favourable circumstances. We shall des- 
cribe the operation in speaking of inguinal' 
hernia. 
Inguinal hernia. The spermatic chord in 
the male subject, and the round ligament of 
the uterus in the female, pass through a 
canal in the lower and front part of the ab- 
dominal muscles, called the abdominal ring. 
This canal is oblique in its course, com- 
mencing at the mid space between the spine 
of the ilium and angle of the pubes (upper 
or internal aperture), running downwards 
and forwards, and terminating just over the 
pubes (lower, or external aperture). ' The 
upper opening is formed in a fascia, which 
ascends from Paupart’s ligament, behind 
the abdominal muscles, and it is crossed 
above by the under edge of the internal, 
oblique, and transversalis muscles ; the lower 
opening is formed by the tendon of the ex- 
ternal oblique alone, and the distance be- 
tween these is about two inches and a half. 
The inguinal hernia generally descends di- 
rectly over the spermatic chord, which is 
consequently placed Just behind the hernial 
.gac j but it sometimes comes out directly 
from the abdomen, through the tendon of 
the external oblique, without traversing the 
canal of the abdominal ring; and here con- 
sequently the spermatic chord is on the 
outer side of the rupture. In the former 
and most frequent case, the epigastric ar- 
tery runs along the inner edge of the mouth 
of the sac, while in the latter its course is on 
the outer side of the same part. The stric- 
tm-e may be situated, either at the upper or 
lower aperture of the ring, or in both. 
Besides the common symptoms belonging 
to all heyniae, there are certain local cha- 
racters which designate this species. Tiie 
tumour descends from the abdominal ring 
to various distances in the scrotum ; appear- 
ing first in the grmn, and passing down- 
wards in front of the spermatic chord. The 
testicle may be felt below or behind the 
swelling, which always appears to extend 
into the ring, and is hence distinguished from 
most other affections of these parts. It is 
much more frequent in the male than in the 
female subject. It must be distinguished 
from hydrocele, varicocele, sarcocele, hernia 
humoralis, and bubo. 
In operating for bubonocele, the patieut'.<» 
thigh should be bent, and the hair shaved 
from the swelling and neighbouring parts. 
An incision should be carried through the 
integuments from an inch above the ring to 
the bottom of the tumour. The cellular 
substance intervening between the skin 
and hernial sac is then to be divided, layer 
by layer, with the knife and dissecting for- 
ceps ; and the sac itself should then be 
opened with the edge of the knife held ho- 
rizontally. A small portion of fluid is usually 
discharged at the aperture, which must be 
enlarged so as to expose the whole tumour. 
The stricture, in whatever part it may be 
situated, must now be divided by the probe- 
pointed knife, cjonducted by the finger or 
director, and carried directly upwards, so 
as to cut the middle of the upper part of the 
contracted portion. This incision, which is 
technically named the dilatation of the ring, 
should not be carried further than is abso- 
lutely necessary for leturning the parts. 
If the protruded parts are sound, and not 
adherent to each other, nor to the sac, they 
may be immediately replaced, the limb be- 
ing alway bent and rolled inwards in this 
part of the operation, to relax the opening 
as much as possible. Intestine, although 
very much discoloured, will recover when 
replaced in the cavity. If any adhesions 
exist, they must be destroyed by the knife, 
or finger if they are not strong. The omen- 
tum is often found in a state in wliich it 
would be improper to return it. This vis- 
ens becomes thickened and hardened in an 
old hernia, so that its return would require 
a very free incision of the ring ; and it is 
often discoloured by the inflammation con- 
sequent on the strangulation, In all such 
instances it should be cut away as far as it 
is affected, and the remainder returned into 
the abdomen, after any bleeding vessels 
have been secured by fine ligatures. The 
practice qf tying the omentum in a mass 
previoivsly to cutting it off is very pernici- 
ous, and has often been fatal. The wound 
should be closed by sticking plaister, assist- 
