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Show xx EXPLANATION duce a hernia, especially if there be reason to suppose that the last stage of strangulation is advancing. In this instance, as is too often done, one last pOWerful efi'ort was made to reduce the hernia, before the operation of the knife was resorted to. The gut was reduced ; but we see the conse. quences. A B, A portion of the intestine. C D, A portion of the abdominal muscles and peritoneum, to which the intestine still adheres. E, The part of the gut which was down in the hernia, torn by the force used in reduction. F, A quill introduced by the gut, and coming out by the torn part ofit‘, PLATE VII. M.) Vii. ‘s i \‘\g». ssh" ‘1 $3.: \ \%{\A \‘s‘«‘1‘\ In this plate I have given a view of the operation for hernia, descending into the labium of the woman. From being an inguinal hernia, the intestine had descended to become a hernia, resembling the scrotal hernia of the \t‘5VF" 5 male, only that it is contained in the lahium. A B, The extent of the herniary tumour. C, From this to B, is the course of the first incision, which cuts throng}: the skin and cellular membrane, and exposes the fascra. D, The fascia which covers the proper sac of the hernia. After dissecting of? some lamina from it, it is pinched up by the forceps, and the knife | fiag+:-€:én¢h¢5-‘w n being carried horizontally on the surface of the tumour, this layer is out through: then the directory is pushed under it. E, The directory pushed under the fascia, to ascertain its nature. Along this the knife is run, laying open the proper peritoneal sac. F, The peritoneal sac, smooth ; with distinct vessels running in it, and so transparent that the intestine gives it a darker hue. PLATE VIII. In this plate we have a View of the second stage of the same operation. The peritoneal sac has been cut up, and now the intestine appears. A, A portion of the small intestine, which seems to have been the original contents ofthe herniary sac, and which had here Sufi'ered less by the incaraeration. B, A portion of the great intestine, which had descended more lately, and had been the cause of strangulation. It is known to be a portion of the great intestine, from the greater size, the cellular form, and the fatty appendages which hang from it. The manner in which these portions of the intestines rise and cover the ring, may give the surgeon an idea of the difficulty which sometim es Occurs :a Cutting the stricture. i ‘/ i , 1' 2': ‘ . U WM" |