722 S XJ R G 
however, extremely various. Sometimes a common tumour 
having formed, has burst and discharged for some time good 
matter, but afterwards the sides of the ulcer having become 
indurated, it has gradually acquired the appearance and the 
incurable nature of cancer. 
“ Diseases also, which strikingly resemble carcinoma in 
appearance, form in the following manner. An enlarged 
lymphatic gland shall gradually become soft, and contain a 
fluid. In this state it ulcerates or is opened; but instead of 
subsiding, it inflames; the surrounding parts become indu¬ 
rated ; the integuments acquire a dusky hue; the opening 
and cavity enlarge, and assume the appearance of a cyst, 
from the sides of which fungus arises, and turns over the 
averted edges of the opening. I have also seen, after the 
bursting of an encysted tumour the surrounding parts indu¬ 
rate, and throw out a fungus, forming a disease appearing 
like cancer, and which could not be cured.”— Abernethy on 
Tumours. 
Our cursory view of general diseases being now run 
through, it remains to enter into particular details. The ar¬ 
rangement we have adopted is a mere arbitrary division of 
the body into regions. But this is practically the best ar¬ 
rangement that can be adopted, because we have before us at 
once all the possible diseases of any one part, so that their 
discrepancies or similarities are at once apparent. This me¬ 
thod applies very well to medicine, and, indeed, has long 
ago formed the basis of some very fair systems of nosology. 
But with this we have not here to do. We shall confine 
ourselves to surgical diseases, and consider them in this 
order—The surgical diseases of the abdomen, of the pelvis 
and urinary organs, of the chest, of the throat and face, of 
the head, of the back, of the upper extremity, and of the 
lower extremity: we shall not, however, confine ourselves 
very strictly to the anatomical division of these parts. 
Of the Abdomen. 
Wounds of the abdomen differ as they are confined to the 
muscles, fascia, and integuments, or as they involve the peri¬ 
toneum. The former are only troublesome because they 
weaken the parietes of the abdomen, which are thus rendered 
liable to hernia ; an accident incidental also to severe con¬ 
tusions. The abscesses that form from these superficial 
wounds require free openings, because they are apt to bur¬ 
row between the fascia and peritoneum, but otherwise are 
not particularly dangerous. Wounds that pass through the 
peritoneum, are, however, very different. Active inflam¬ 
mation is set up, and the whole of the serous membrane may 
be shortly involved in disorganization. But if a wound be 
merely a puncture, it is often difficult to say whether the peri¬ 
toneum has been punctured or not; generally, such a wound 
produces great sickness, syncope, and fear, but these often 
attend fixed wounds. As, however, a puncture can scarcely 
be supposed to wound the peritoneum without also wounding 
some of the viscera, in these cases we shall have particular 
symptoms; as, for instance, bloody urine, when the kidneys 
and urinary bladder are injured; vomiting of blood, when 
the stomach is pierced; discharge of blood with the faeces, 
when the large intestines are wounded. Symptoms, like 
these, must of course throw considerable light on the nature 
of the accident. 
With regard to our not being always able to pronounce 
whether a wound penetrates the cavity of the belly or not, the 
want of precise information on this point is of little practical 
importance; for, if the case be not complicated with any 
urgent symptoms, the treatment should obviously resemble that 
of a simple wound, and if inflammation of the peritoneum 
evinced itself, it would then be met by depleting measures. 
“ When, in the case of a penetrating wound of the abdo¬ 
men, a portion of intestine, or omentum protrudes, the 
sooner it is returned, the more effectually will the irritation, 
arising from the exposure and constriction of the part, be 
prevented. The mesentery is always to be returned before 
the intestine; and the intestine before the omentum; but 
the last protruded portion of each of these parts ought to be 
the first reduced. 
E R Y. 
“ The two index fingers are the most convenient for re¬ 
ducing the parts; and it is a rule to keep the portion first 
returned from protruding again by one finger, until it has 
been followed by another portion, introduced by the other 
finger. The second piece is to be supported in the same 
way, by the finger used to return it, and so on, till all the 
displaced parts have, been put into their natural situation.” 
“ As soon as the reduction seems complete, the surgeon is 
to assure himself of it, by introducing his finger into the ca¬ 
vity of the abdomen, in order to feel that the parts are all 
freely reduced. When it is absolutely necessary to enlarge 
the wound, in order to get back the bowels, the dila¬ 
tation should be made in a direction parallel to the muscular 
fibres. 
“ The reduction of the viscera having been effected, the 
patient is to be laid upon his back, with the thighs bent upon 
the pelvis, and he must strictly avoid making any exertion, 
lest he bring on another protrusion. The wound is then to 
be closed with adhesive plaster, and the uniting bandage; 
but if the division be extensive, and these means ineffectual, 
it may be proper to have recourse to a suture.” 
If the bowel should be found injured as well as protruded, 
other measures are to be used. If the wound of the viscera 
be very small, a suture, or a ligature may be applied to it. 
If it is large, and transverse, or involves much of the cir¬ 
cumference of the bowel, it is best to retain it, dress the 
wound lightly, use very active antiphlogistic measures, and 
leave the case to nature. The wound will, for some time 
probably, serve as an artificial anus; adhesions will take 
place between the bowel and peritoneum, which adhesions 
gradually becoming a canal, the natural passage is re-estab¬ 
lished. It has been proposed, however, to sew the divided 
portions together. See Mr. Travers’ Inquiry into the Process 
of Nature, in repairing Injuries of the Intestines, 
Extravasations of various balls from guns, are of occasional 
occurrence in the cavity of the abdomen, but they cannot be 
removed with any certainty, or without doing much injury, 
and are therefore better suffered to remain. 
Of Hernia, or Rupture. —By this term is meant a tumour, 
which occurs from some of the viscera passing out through 
fissures or'openings in the abdominal muscles, and pressing 
out the elastic skin and cellular tissue, and forming a swell¬ 
ing. It is well known that in these muscles, there are some 
particular parts very incompletely closed; it is there that her¬ 
nia usually makes its appearance. Hernia has been applied, 
however, to any protrusion, as of the brain, &c.: here we 
speak of hernia covered by peritoneum. 
Our anatomists and earlier surgeons having been men 
who, for the most part, despised the harmonious and expressive 
language called English, set themselves to designate the 
varieties of hernia by the following harsh compounds of 
Greek and Latin. When the intestine only was contained 
in the hernia, they called the case an enterocele; when the 
omentum only, an epip/ocele; when both, an entero-epiplo- 
cele ; when the stomach came down, it was gastrocele ; the 
liver hepatocele; the protrusion of the bladder was cystoce/e. 
Then a hernia in the groin was bubonocele , and when this 
descended into the scrotum, oscheocele. A hernia that came 
through at the navel, was called exomphalos. 
The nature of hernia being stated, it follows that any 
violent or irregular action of the abdominal muscles, such 
as raising weights, or the like, must tend to produce it. And 
that heat, illness, or any cause tending to relax extraordinarily 
the muscular fibres, must favour its production. At the same 
time, it must be confessed that it is not always traceable 
to these causes, and that it often appears without any obvious 
reason. The general rule is, however, established. 
We shall now proceed to speak of various kinds of hernia. 
The Inguinal Hernia is known—“ 1. By a tumour arsing 
from a protrusion of some part of the bowel through that canal 
or opening which is commonly called the abdominal ring, 
and which in the male subject gives passage to the spermatic 
cord; and in the female, to the round ligament of the uterus. 
The swelling is not preceded by any symptoms of inflam¬ 
mation ; and though, according to the opinion of the most 
accurate 
