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Show t 2'): cause or DISAllI. CAUSE or DEATH. cd by a vain hope of amendment, to feel more acutely the fatal termination. 11.3 is a peculiar foetid odour. When the dissector turns away the violently distended and high coloured intestines, he will die cover others in a very different state, small, compressed, and S 'IanTOMS IN HERSIAe Winn: these symptoms are combined with a herniary tu. mour, there is a drawing down of the belly to the seat of the hernia; the tumour becomes quite tense and hard; by and bye, it becomes red and painful, even upon slight hands ling-vs. The redness will vanish on pressure, and the surface pit slightly by the resting of the fingers. OF THE CAUSE OF DEAllI. 0}: this subject, which is certainly of the highest import- Mann‘s. is remarkably white, and free from blood. Let us now combine these appearances with the symptoms; practice, I will take somewhat more latitude of enquiry than strictly belongs to the systematic form of this book ; because I roneeive it to be a subject very little understood, though I by no means mean to say that I am about to deliver any new tower portion of the canal. Let us further consider how inany survive, when only a portion of the canal is incarcerated, I trust the view which I shall give, has occurred to the observation of every man who has pursued the enquiry so that its contents can still pass ona‘s; and we shall be con- by dissection : yet it is not laid down in our books. When we lay open the abdomen of one who has died of ilius. from intus-susception, or internal strangulation, or from here nia, this is the state of the parts. A few turns of the intestine occupy the whole belly, as it were, and they have pushed vinced that death follows the high inflammation of the upper of a very high colour, and greatly inflamed in some places, The colour of these intestines is a . approaching to gangrene. portion of the canal, incessantly working and agitated by ineffectual etiorts to relieve itself of its contents; and that the strangulation is fatal as an obstruction, not as an inuuediate and direct source of inflammation and gangrene. The idea is entertained, that the inflammation extends into the abdomen, from the tumour of the hernia; and the pain upon pressure of the belly, is conceived to be the indication of the spreading of this inflammation to the peritoneum-f. ' ‘ The part that is actually noosed and strangu- lated, will be mortified: but below the strangulation, though the violent tormina and twisting of the upper portion of the bowels, until they are checked in the strangulation, or the mouth of the herniary sac, and the perfect quiescence of the back and hid the part of the canal that was below the ob. struction. These distended intestines are full of flatus; MB ' eased; darker in its colours, and in a state approaching to mortification. ance,‘ and which must be the foundation of all our rational doctrines. ....A~g.-s-s >" . -o "s M ---» .._-‘~L; . -- . tract towards the stricture or obstruction, more and more dis- .i‘or a little way as if affected by contact, the parts are black and mortified; yet there is no distension in the gut, no shew of turgid inflamed vessels; but, on the contrary, the intestine I .n‘a having no colour or mark of inflammation. When he begins to unravel the confusion which this unequal distension produces, he finds the upper portion of the canal as he follows its dark brown ; sometimes a dark purple, with spots of a more iurid lake colour, where the turgid vessels are more numerous. And this opinion that the incarceration of the hernia is the direct cause of in" That apart only of the diameter of the gut being fixed in hernia, will On the surface of these intestines, pus lies and flakes of coagu~ lable lymph. The peritoneum is dark and full of vessels, but often destroy the patient,I do not wish here to conceal; but I believe it not in an equal degree with the distended intestines. tion of a portion of the gut, without any mechanical obstruction, " :ll gri c There x duced, or at least accelerated, by the attempts to reduce the gu'~ does 50 b1" Preventing the natural action ot'the canal. rise to obstinate retention of the contents ol‘thc canal. t See Mr. Cowper, p. :26. The mere intiamma- |
