OCR Text |
Show 202 DISQUISXI‘ION ON THE sac or run Enema. orlnron THAT THE STRIC'IURE was IN 'rnr: cosrnsrs. an inguinal hernia : the intestine being freed from the sac, rose in a remarkable degree, so that it could not be held down to expose the line. Upon cutting the ring, however, pretty frec- ly, so that the finger was introduced with case, still the inter tine was much distended, and could not be reduced. Upon introducing my finger about an inch within the outer ring, I felt a narrower ring than that without, which formerly beu girt the intestine. I carried my finger up to it, and cut it a little with the point of the probe-pointed history, and enlarged it with my finger. Here I am sure, if I had thought it right to dissect on the outside of the neck of the sac, Icould not have done it, If it were asked, why do I suppose that 20-3 larges, and pushes lower, the tendon of the external oblique muscle is stretched, and expanded over the neck of the sac ; and at the same time, the general expansion of condensed cel- lular membrane r. hich covers the abdominal muscles, acquires more strength and thickness, and further covers the inequality which might otherwise enable us to distinguisn between the neck of the sac and the abdominal tendon. Even in the buboa nocele of women, as represented in the plate, we see that these uniting lamina of apeneurosis covering the sac, are very strong. Many before the time of Pott imagined that the strangw this internal stricture was from the sac; 1 should say, that it lation of hernia was in the contents, and that the stricture was an accident arising from the inflammation and distenv sion of the gut; or, in other words, that the intestine was was perfectly circular, and like a firm ring ;. not as if the first inflamed, and, by means of the alteration produced by membrane was merely bound down by a slip of tendon pass» ing over it, or the edge of the inner muscles of the belly. And further, in dissection in similar cases of bubonocele, l such ii'illammation, it became too large for the 'tendinous have found the stricture at this place still resist the finger, at ter all the fibres of the surrounding muscle were dissected oil. The appearance of this stricture in the peritoneum is repre sented as I have found it on dissection. perhaps the obstruction, being too frequently continued afte * the Operation. This led them to a very dangerous conclusion, that freeing the intestine from the stricture was not removing the disease. aperture, which therefore made a stricture upon its. This is an opinion which has arisen from the inflammation, and u M, urn-mu tantrum '. 1 And now as to the outside of the neck of the sac, there is somC= Indeed, when we consider that the tendons or ligaments thing necessary to be observed. The term Abdominal King has been taken not from the natural appearance of the parts on dissection, but the appearance, or rather the feeling, during operation. For the frequency of the disease, and the occasion are never more contracted than natural, but on the contra‘ of operating, gave opportunity to observe the state of the parts in disease, before dissection was practised, when the opera: tors knew not the natural anatomy. and certainly of any of the parts concerned in hernia-we see a good reason why surgeons should reject the idea that the tendon is the active cause of strangulation. We must In recent hernia, and before the condensation of the sur- take it as a settled point, I conceive, that the muscles and. tendons of the abdomen are merely passive in the change rounding cellular membrane has confounded the parts, we can easily distinguish betwixt the tendons of the ring, or POUPZITVS ligament ; but when the inguinalhernia particularly is large, and of long standing, a firmer circle or ring may be felt, "hm the finger is introduced into the mouth of the sac: but on ry, aluays more stretched, and forming wider openings than natural even in strangulatcd hernia-when we find that they are parts the least capable of change of any in the body, producing strangulation in hernia. the columns of the tendon, in whatever part of the belly the rupture may have taken place, will be drawn tight on the outer surface tit-"re is no such (lifiinetion betwixt the 5:10 .115. the twin of the abdominal 1111""7‘" ; for as the hernia en. ... :L A" \thn a small hernia bursts through the split tendon of the abdominal muscle, ‘ See Pott, p. 9]. |