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Show 180 or imzsncunuron AND STRANGULAI‘ION. the hand, without operation by the knife. Am I not war" ranted in concluding that the gut, after lying some time in- carcsmted by the pressure of the neck of the sac, is incapable of bearing such a force of distension as will extend the neck of the sac ? The last point I shall touch upon in this introductory chap ter, is that of SPASMODIC srmcrnnn. Mr. Cowper, in speaking of inguinal hernia, observes, that many surgeons have entertained an opinion in favour of the spasmodic nature of the stricture in hernia. This naturally CHARACTER or IIERNIARY renown. 181 other. Incarceration consists in the obstruction to the passage, of the contents of the intestines, with the ineffectual effort of the portion of the intestine within to withdraw the part included in the hernia. But the strangulation of the intes- tine in a hernia implies that the source of its life and circular tion is cut off ; the vessels are compressed so that it quickly mortifies. A hernia may be incarcerated, and the motion of the bowels obstructed for many days; but when there is brings out his, in other respects, very valuable observation, that the cause of strangulation is in the lower edge, or semi~ circular border of the transversalis, in illustration of this ef= strangulation added to this, then the fate of the patient must be quickly decided; fora few hours will destroy the life of the gut. Before the life of the strangulated gut be destroyed, its power of action is destroyed ; and often when a strangulated feet. This idea he conceives to be confirmed by the acknowu led ged fact, that the ring of the abdominal muscle, being of gut is reduced, by enlarging the stricture it will be Within the abdomen, and still refuse its office. a tendinous nature, cannot partake of spasmodic stricture; ' fl. ti " - ww- .unmuwpflwvw "mi j ' ' ' but i know not what the peculiar symptoms of the bubono- cele are, nhich warrant the conclusion that an explanation of the origin of muscular and spasmodic contraction in this spe- cies of hernia, can be held to put the question to rest in re» gard to all the others ; for I assert that they are all subject to the same subsiding and rising of the pain, the same succes~ sion of alternate drawing towards the stricture and relief, the same feeling of binding and strangulation at the seat of the stricture, which has given rise to the idea of the stricture be: ing spasmodic. In short, with all the confidence which 8. man may have in so diliicult and important a subject, and in opposition to a man so deservedly high in the estimation of the profession, I say that these symptoms of spasmodic strictu re are referable to the action of the gut, not to the neck of the sac, or membranous bands. OF THE DIFFERENCE BETXVEL‘N INCAKC ERA'IION ARI) STEAL? GULATION. CHARACTER OF THE HERNIARY TUMOUR. . View Ma "1"", Henna: are to be distinguished from other tumours by these circumstances f--1. The situation; as when the tumour covers the abdomt nal ring, or lies on the top of the thigh, or on the umbilicus. 2. By the impulse communicated to the tumour when be patient is made to cough. 3. By its being returnable into the belly at night, or when the patient is thrown into a recumbent posture. Although this be not the case w en you examine, yet enquire if it was not once so. 4:. "'hen the hernia contains intestine, it is elastic; if the intestine is returnable, the tumour is compressible, and am eompanied with a gurgling noise-«if strangulated, tense as a ball, yet distinguishable from a solid body. W'hen the tun mour contains omentum, it is more irregular. 5. If the tumour diminishes on pressure, still the openings in the tendons are obscured, and the sac is felt empty. THE incarcerated hernia is different from the irreducible her nia, on the one hand, and from the strangulated hernia, on thn 6. When the intestine is incarcerated, and the symp‘LOIns of intestinal obstruction succeed. there is pain rem |