In infants the reduction is generally easy, and as they acquire strength they are less subject to a relapse. In the vigour of life the return is generally more difficult, and the neglect or bad management more dangerous.

It often happens that raising the buttocks while the body is depending, will alone succeed. Should this not be the case, the surgeon should grasp the tumour with one hand, press it steadily upwards and outwards, while with the fingers he begins to reduce the last protruded portion. Should he succeed in part, the rest soon follows, and the patient is relieved. If he fail, different plans have been advised.

Of the remedies, copious bleeding is the first, and often an indispensable one. When the patient faints, the tumour often spontaneously recedes. Purgatives have been next employed, and absurdly given by the mouth; we say absurdly, because, by increasing the peristaltic motion above the tumour, it rather adds to the disease. It has been usual to join the purgatives with opium to relax the stricture, while the purgative contributed to conquer the constipation. In such cases, however, the purgatives are so often retarded by the opium, as to lose their effect; and should this combination succeed, it must be attributed to the opium only. Purgatives injected as clysters are not liable to the same inconvenience; for the increase of the peristaltic motion below the tumour, has a tendency to draw back the intestine. Soap, particularly the black soap, is highly useful in this way; and purgatives of the most active nature, and of every kind, have been employed. The most ready and advantageous one, however, is the infusion of tobacco in clyster. From half a drachm to two scruples of tobacco may be infused in ten or twelve ounces 'of boiling water for ten minutes, and injected as a clyster. It is not only useful as a laxative, but produces so much languor and fainting, as often to occasion the gut to recede without other assistance. The digitalis also seems chiefly useful, by producing syncope.

It has been usual to apply warmth in every form to the hernial sac, with a view probably of relaxing the ring; but it was not considered that even if this effect was certain, that the flatulent contents of the sac would be enlarged in a greater proportion, and even the substance of the intestine itself. We believe it has seldom succeeded; and when useful, the faintness induced by its continuance has been the chief cause of the relief. The warm bath for the same reasons has sometimes succeeded, but much oftener failed; and we think that, in many cases, it has accelerated mortification. The contrary method is now more advantageously adopted; ice and snow have been applied with success to the hernial sac. When these cannot be procured, the coldest water, often renewed, has been of service; and water cooled artificially has been used. The most ready way of cooling water is to suspend it in a wet bladder to a current of air, and the effect will be increased if the outside of the bladder be moistened with aether, carefully purified from the acid. A solution of nitre with sal ammoniac will be equally effectual, in the proportion of eight parts to five; and with management, by further cooling water first artificially cooled, all the effects of ice may be procured even in summer. The constant application of cold has thus often succeeded, and it is one of the most valuable improvements of modern practice.

All will in many cases fail, and the operation, though dreadful, and often fatal, must be attempted. Yet there is one further step to avoid it, viz. to dilate or divide the ring, to prevent strangulation, and suffer the tumour to remain. This is the advice of Dr. Monro, and we think it merits more attention than it has received. This operation is not formidable, is not perhaps highly dangerous; and should it be performed hastily and unadvisedly, does not prevent reducing the rupture at a subsequent period. The danger and the severity of the operation have occasioned its being too long delayed; but though it succeeds in some apparently desperate cases, it fails in others where the prospects were more favourable. The external appearances of mortification are undoubtedly among the symptoms which would render it unsuccessful, since mortification takes place in the intestine before it is communicated to the integuments, and is, of course, more violent in degree in the former than the latter part. Feculent or putrid vomitings have been considered as highly unfavourable to success; yet even in such instances the patient's life has been saved. Mr. Cooper thinks that a general soreness in the abdomen is the chief symptom which should prevent the attempt.

In Mr. Home's opinions, the symptoms are influenced by the state of the gut. If no inflammation has taken place in it, the consequences of obstruction only are observable. When inflammation takes place, there is a general soreness, with constant vomiting, that does not relieve, and considerable depression of spirits. When the stricture produces mortification, all the unfavourable symptoms are observed, and a general coldness comes on. The last symptom is decisive against attempting the operation.

To proceed in the operation, the pubes and groin should be shaved; and, in order to have as much empty space as possible for the return of the protruded parts, the patient should be advised to empty his bladder entirely. The patient being then laid on his back, on a table of a convenient height, with his legs hanging easy over the end of it, with a straight dissecting knife an incision must be made through the skin and membrana adiposa, beginning just above the ring of the abdominal muscle, and continuing quite down to the inferior part of the scrotum. Upon the division of the membrana adiposa, some small tendinous bands appear distinct from each other, lying close upon the hernial sac, which is next to be divided with the utmost caution, as the sac is thinner in some parts than in others: even the external incision of the teguments ought to be made with great care; for although, in by much the greatest proportion of hernial swellings, the spermatic vessels lie behind the protruded parts, yet on some occasions they have been found on the anterior part of the tumour; so that, in order to avoid the risk of wounding them, so soon as the skin is divided, the remainder of the operation must be done in the most cautious manner, care being taken to avoid every large blood vessel that makes its appearance. The incision in the sac is best made about an inch and a half, or two inches, below the stricture, and need be no more than such an aperture as will just admit the extremity of the probe. If the probe will pass freely up and down, enlarge the opening with a probe pointed bistoury, sufficient to introduce your finger to divide the whole, remembering to divide it first downwards, which gives more room, and lessens the hazard of the intestines being wounded by the knife, which might easily happen in dividing it in the opposite direction. The fore finger is the best of all directors, and upon that finger a narrow bladed curved knife, with a bold probe point, will be the only instrument necessary to finish the operation. With this knife on the finger the sac should be divided, first downward to the bottom of the scrotum, then upward to the ring. Upon the first division of the hernial sac a fluid is discharged, differing in quantity and colour in different patients. The sac being fairly divided up to the ring, the intestine pushes out, and seems to be more in quantity than it did while in confinement. At this juncture, if the quantity of the protruded intestine is not very great, try to reduce it by first pulling down a little more, for thus, its bulk being lessened, it perhaps may pass without dividing the ring; if this does not succeed, the probe pointed knife, conducted on the fore finger, will immediately divide the upper part of it, and set all free. The sac and ring divided, the contained parts come into view, and, according to their different states, will be variously managed. If sound, immediately reduce them, remembering that the parts last protruded should be first returned. Slight adhesions may be separated with the finger, or snipped with the scissors. If the parts are so adherent as not to be capable of being returned, remove the stricture by dividing the sac and ring, and leave the prolapsed parts in the scrotum as you find them; but this case seldom happens. If the contained parts are mortified, death will be the issue; but if the mortification is not very extensive, return them, and trust to the efforts of nature, and the effects of medicine. If the intestine is mortified, make a ligature and fix it to the wound; thus the faeces will pass out at the aperture, and the patient may live many years after.