Hernias in women are treated as in men, but in them the disease is less common, as the aperture is much smaller, not requiring the passage of a body so large as the testicle, but only the round ligaments. Women, however, more frequently conceal the disease, and we must be more attentive to the cause of every kind of violent colic. One inconvenience arises from not distinguishing in them the inguinal and femoral hernia, since the tumour in each species is not very distant, and the mode of reduction is different. If the operator fee] P p 2 with his finger the course of Poupart's ligament, and find the neck of the tumour above its edge, the hernia is inguinal; if below, femoral: as, in the male, the intestine is sometimes not protruded beyond the external ring, and the disease may remain undiscovered.

After the operation, the patient must be laid in bed, with his body somewhat raised, and an opiate administered. A clyster should be soon given, and immediately after its operation, a mild but effectual laxative, as manna, castor oil, or the pulv. e senna c. administered. The wound, dressed in the common way, should be secured by a T bandage. The consequent bad symptoms are those chiefly of irritation from air admitted into the cavity of the abdomen, or mortification. Bark and opium are the chief remedies, and must be administered in proportion to the violence and nature of the complaint. The bowels must, however, be kept open with the greatest attention.

When a hernia has been of long continuance, adhesions between the gut and the sac, and between the contiguous portions of the gut, take place. Greater caution must be used in opening the sac when adhesions are suspected; and those between the gut and the sac must be carefully separated. If the disunion of the others be not easy, the intestine should be returned without its being effected. When the separation of the gut from the sac is found difficult, a part of the latter may be separated and returned with the gut.

The omentum often causes much uneasiness. If gangrenous, the diseased portion may be cut off. In general the vessels are small, and little haemorrhage occurs; but this is sometimes considerable, and it is necessary to tie a vessel, or even two. In this case the ends of the ligature should be brought beyond the wound, and they will soon separate. The method of separating the mortified portion of the omentum by a ligature, is often inconvenient from the irritation it induces, and no injury happens from dividing it.

When a portion of the intestine is mortified, it has been recommended to separate it, and unite the sound portions of the gut by ligatures, or, by placing them in contact, to leave the union to nature. This plan has been suggested by nature- occasionally separating a mortified part of some extent, while the canal was not interrupted. It is impossible in this place to enlarge on the minute details which such an operation requires; and the reader will find ample information in Mr. A. Cowper's most excellent work on hernia.

The portion of gut found in hernial swellings is very various, no part of the intestinal canal being entirely exempted from falling down. Hitherto the ileum has been commonly supposed to form the substance of the greatest proportion of such tumours: later and more accurate observation, however, renders it probable that the coecum, appendix vermiformis, and part of the colon, are more frequently contained in the hernial sacs than any other portion of the gut.

See Pott on Ruptures, Le Dran's Operations in Surgery, Sharp's Operations of Surgery. Lond. Med. Obs. et Inq. vol. iv. Bell's Surgery, vol. i. White's Surgery, 318. Cowper on Ruptures. Monro on Herniae.