OCR Text |
Show 183 Drsrrncuoxs or ALUIL' AND cnnoxrc IXERIVIEL. or IIERNIA THROUGH THE ABDOMINAL mm. ferable to the part, and a drawing down of the belly to the ring. The tumour, without the internal evidence of symptoms, would often be insufficient to announce with suflicient accuracy, that the disease was a hernia, and to warrant operation. I have operated where the inguinal glands clustered closely embraced, and the progress from incarceration to total obstruction of the circulation of the part, and strangulation is rapid. The terms acute and chronic are better adapted to signify the natural type and tendency of a diseased action. The dis~ tinctions in the progress of hernia depend on a mechanical effect. about the sac, so as to obscure its natural character; and I 183 assisted Mr. Lynn in an operation on a lady, where two hydatid tumours attached to the sac gave it a very great obscurity. In general, however, by a continued pressure in the examination of the neck of the tumour with the fingers, we shall be enabled to ascertain that the tumour does actually proceed from the enlarged opening of the tendons. Hernire have been classed into the acute and chronic. This 0F HERNIA DESCENDING THROUGH THE RING OF THE ABDOMI- NAL MUSCLES. THE chUINAL ncumn we have found to be that which descends through the ring of the external oblique muscle of the belly. SenoriL unrmu is the increase and further descent 0f the same tumour. appears to me very trifling; and seriously considered, the subject does not admit of such a classification. To produce hernia, there must be predisposition, and there must be an immediate cause. The latter is uniform, viz. The testicle partially descending at a period of life later the compression of the abdominal viscera by the muscular walls. The former consists in an unnatural laxity, and than usual, may be mistaken for inguinal hernia: often atruss widcnes‘s of the openings through the tendons of the mus- cles. This laxity can differ only in degree; and the degree of width in the ring, or under the ligament of the thigh, makes all the distinction. When there is great laxity, the tumour forms slowly; the bowel gradually descends; it is protruded with every slight effort of the muscles of the belly; it is not apt to be strangulated, because the opening is wide. The hernia often appears in infancy or early youth, and remains long without dangerous consequences resulting from it. This they may call a chronic case ; but it is liable to be- come as quickly fatal as any other, by the descent of a new portion of gut, or omentum, or by unusual congestion in the _ ' ‘U .. ..-.._ ..V»‘a_;;.--.-~ - VIVIIii "Wi‘ ‘L‘T DISEASES IT MAY BE CONFOUNDED» contents of the hernia. When there is less predisposition to the disease, a more pow- erful exertion is necessary to produce the hernia. has been applied in this case. I have seen the operation for bubonocele performed for the tumour of the testicle! The scrotum being empty of the testicle, should put us suili~ cicntly on our guard. A sac of fluid formed upon the cord, or the cellular hydrocele of the cord, may be mistaken for this kind of hernia. Pcrhaps if large the tumour may be known from its transparency ; it is uniform and elastic ; it does not receive the impulse from coughing as the hernia doesse. Varicocele may be mistaken for this kind of hernia. But it has a woolly, or sometimes a stringy feeling. Further, the blood being pressed from the vessels of the cord, if we press with the finger on the ring and upper part of the cord, the tumour will return by an uniform enlargement (and not a de- scent from above), in consequence of the filling of the veins with blood, through the arteries of the cord and testicle. The OPCH' ing through which it comes down is small, the gut is more ' Sometimes, however, it does receive the impulse, when the dropsy 'i' the cellular membrane ofthc mrd extends much into ‘llfi abdomen |