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Show 110 OF IHE CAUSE OF STRANCULAIIOX. OF THE SAC OF HERNIA. And now no effort of the gut A, will withdraw the por~ tion B, from the neck of the sac C; because the incarcerated portion has been distended to the utmost, and now forms an angle so sudden and acute with the neck of the sac, that it CHAPTER II. cannot empty itself; and without being emptied, it cannot be withdrawn. Two things result from this view of the subject. It is necessary, in order to strangulate a piece of gut, not OF THE SAC OF A HERNIA MORE PARTICULARLY, AND OF THE merely that it has escaped from the belly, but that beyond the hole or noose, by which it has escaped, it has the liberty PART \VHICH FORMS THE STRICTURE IN STRANGULATED HERNIA. of dilatation ; for if it be not dilated, it will not be noosed, but be drawn back again, as it was obtruded. Further, it ap~ pears from this, as well as from facts ascertained during operav iion or dissection, that the strangulated intestine must be a dilated intestine. That the stiinulatiinr the superior portion of the gut within the belly, in order to procure the retraction of the incarcerated portion, is dangerous, since it is as likely to distend it more as to retract it, and so by pulling on the hernia to confirm it! To the stimulating of the lower portion of the gut, there cannot. be the same force of objections. Let me further observe, that this reasoning on the original cause of the incarceration, does not materially affect the question of the propriety of an early operation ; for whether the stricture he the primary and the sole cause, or a mere consequence of the distension, the operation with the knife at an early period. or" the incarceration and before strangulation has taken place, equally to be desired. "" Often Where an incarcerated hernia gr"‘«""cnes, hursts, and discharges 2‘ s contents, the feces pass freely from the wound, proving that the hernia 1‘ mld have received matter by the upper portion of the canal, ifit 01ml" "M e rczzn'ned it into the abdomen by the lower portion. THE term rupture we have understood to be impro- per, since it was adopted from an idea that it was the bursting of the peritoneum which produced the hernia. The peritone- um descends before the viscera, and forms what is called the sac. In a recent hernia, the sac retains much of its original character of peritoneum; but in old hernia, it is dense, thick, and Opaque, more like the dura mater than the. peritonsum. " In the bubonocele, or that hernia which is conhned to the groin, the sac is most frequently thin, consequently more easily divided, and there is required greater attention in its division, that we may not perforate it unawares; in the oscheocele, or scrotal hernia, if the disease be recent, the sac is usually thin also; if of long standing, it is sometimes of considerable thickness." Pott, vol. i. page 84» 'We have already observed, that there is an incessant mus» cular pressure on the viscera within the belly, while nothing but the firmness of the cellular membrane resists the increase of the herniary tumour. The first stage of the progress of hernia is by dilatation or elongation of the peritoneum; but the succeeding increase is more of the nature of a growth than of dilatation; for this stretching of the sac by the con: a: Vr'fifiwn‘ .-. tents produces an excitement in the membrane or its vessels, which accumulate new matter, giving the membrane thick; ness and strength which it did not naturally possess. Even in the. most recent hernias, the sac is not merely the peritone» var. p Z |
