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Show 186 or rm: REDUCTION or INGUINAL urinals. 187 When the surgeon in his operation has slit up duction made impossible, however great the force may be this, he still finds another membrane, which I should say was which is used. This will be the eli‘ect of pushing the tumour towards the anterior and superior process of the ilium, the tumour. the expanded web of the cremaster muscle, if I had not ob served it so particularly strong in the hernia of the labium in women. Finally, under this there is still the sac, the pro- longation of the peritoneum. OF THE REDUCTION OF THE INGL'INAL IILRFIA BY THE HANDE THE TAXIS is the reduction of the contents of the herniary sac, by position of the patient, and pressure of the hand. To accomplish this reduction, the patient is made to rest on his head and shoulders, his hips and thighs are raised and supported, and of consequence the spine curved, and the muscles of the belly relaxed. The thighs must at the same time be supported, and brought near together, that by relaxing the fascia the ring may in some measure be relaxed. One arm of the surgeon being now passed betwixt the thighs, both hands are applied to the tumour, the first effort bein gently and uniformly to compress it. By this it is intended to press the fluid contents of the intestine, which is within the sac, into that part of the canai which is still within the belly ; for unless the distension of the incarcerated gut be diminished, how can we expect the gut to be returned through the narrow ring 9 Having succeeded in diminishing the tu- mour, we then endeavour to accumulate the sac towards the lower part, and at the same time to direct the upper part of the tumour towards the centre of the ring ; or we embrace the whole tumour with the palm of the hand, and make the ends of the fingers knead and direct the neck of the sac, while the , w .u‘. -. ....._ .L-‘Mu -.-- or Inn REDUCTION or INGUINAL manna. fingers of the other hand keep occasional pressure on the rine‘e guarding from falling down what is reduced. If this fail, we try a variety of positions, the hanging of the patient by the thighs, &c. I know of no error more common in reducing hernia, than the pushing of the tumour in a direction toward the side of the ring, by which the neck of the we wtid is twisted, and the re as advised by Mr. Cooper. When the hernia consists in part or entirely of omentum, the reduction is often difficult, from its being a solid and in» compressible mass, which must be reduced every inch by the pushing of the fingers, and the kneading of it, as it were, into the ring. The exertion of the surgeon in reducing hernia, should ra- ther be persevering than violent. The parts when uniformly supported by the sac, do in general bear a great deal; and certainly often at er twenty minutes exertion, we succeed. But every one must see early in practice, high inflammation, accellerated by the violence of this operation, and (though more rarely) the actual rupture of the bowel. When the strangulation is advanced, or complete, our efw forts must be more guarded, and less persevering. Failing by mere mechanical cunning to reduce the hernia, we must excite the bowels ; and I have already said, that the laxative medicines given by the mouth ought not to be of a drastic nature, and that we should trust to clysters chiefly. These must not consist of a little fluid to excite the rectum, as in acommon case ; but the whole of the great intestines must be distended by the syringe. This failing, we give the infusion of tobacco (a pint of water to two drachms of the tobacco) ; and during the delay of the operation of these we apply cold cloths to the tumour. We have also the warm bath prepared, and bleeding and the warm bath may produce a languor and faintness favourable «‘0 reduction 7, and now we attempt the operation again. |
