This is to be repeated when the mat ter has accumulated again, and thus the contraction of the cyst will be promot ed; a third and fourth puncture may be necessary. Electricity and emetics of the metallic salts may be combined with this plan, to favour the absorption of matter ; and a blister kept open by the savine aerate will be an useful auxiliary means. Disease of the bone requires blisters, or issues in the loins.
Paracentesia abdeminis is an operation performed for the discharge of dropsical fluid, and consisting merely in penetrat ing the parietes of the cavity by means of a trochar. The instrument is to be introduced three inches below the navel, in a perpendicular line drawn from that spot : and it should not be pushed more deeply, when it meets with no further resistance. Pressure by a belt or the bands of assistants should be kept up during the evacuation, as faintness is fre quently produced by the sudden removal of the support from the abdominal vis cera.
ItiaN1• Is a tumour formed by the passage of any of the abdominal viscera from the cavity in which they are naturally contained, into a preternatural bag, form ed by the protrusion of the peritone um. The protruded portion of perito. neum is called the hernial sac. This peritoneal sac is covered by another in vestment, of various (tepees of thickness, consisting probably, in great part, of the surrounding cellular substance, con densed into a membrane-like appear ance, by the pressure of the hernia ; in the same way as tumours acquire their investing cyst. In the inguinal her nia, this external coat of the sac pos sesses some tendinous fibres in its struc ture, derived from the aponeurosis of the external oblique, where it forms the ring. The chremaster muscle is also expanded on its surface ; it consists usually of several layers, the division of which, in the operation, often leads the surgeon to suppose that he has opened the hernial sac. Scrotal ruptures often de scend to various distances on the thigh, sometimes indeed even to the knee, yet the whole inner surface of the bag, in which all the loose viscera of the ab domen may be contained, is lined by a continuation of peritoneum ; indeed, the hernial sac, taken altogether, is gene rally thicker and stronger in proportion to the size of the tumour, and to the duration of the complaint. The exterior covering is every where closely connected by cellular substance to the proper peritoneal sac. Hence the latter part is not returned into the ab domen when the contents of the swelling are replaced, but remains behind, ready to receive any future protrusion. When
the parts have descended through the abdominal ring, the case is called a bu bonocele, or inguinal hernia ; if they are in contact with the testis, it is termed congenital. The crural or fe moral is that which takes place under Poupart's ligament ; and the exomphalos or umbilical rupture, occurs at the navel. The names of enterocele, epiplocele, and entero-epiplocele, are applied ac cording as the swelling contains intes tine, omentum, or both together. These are by far the most frequent forms of the complaint ; yet there are several others, as ventral hernia, which takes place be tween the fibres of the abdominal mus cles; hernia of the foramen ovate, ischia tic notch, &c. While the viscera de scend and return freely, the complaint is said to be in a reducible state ; but when,from increase of bulk, preternatural adhesions, or other causes, they are in capable of being returned, it is termed ir reducible. An incapacity of reduction, arising from stricture in the opening through which the viscera have descend. ed, brings it into the. incarcerated or strangulated state. The causes of her nia are of two kinds ; the occasional, or exciting, which consist of all those, by which the pressure of the abdominal vis cera against the sides of the cavity is increased, as in straining, and all forcible actions of the respiratory muscles ; and the predisposing, which favour the oc currence of rupture in particular indi , viduals, as an unusually large state of the openings or lax condition of the margins of those apertures.
A reducible hernia is an indolent tu mour, smaller in the recumbent position, larger in the erect posture ; diminishing, or entirely disappearing, by means of pressure; large and tense after a meal, er when the patient is troubled with wind; soft and small in the morning, before he has taken any food ; attended occasion ally with a rumbling sensation, particu larly on his return ; and rendered tense when the patient coughs, so• as to com municate an impulse to the hand of the examiner. Various visceral derange. ment, as colic, constipation and vomiting, are occasionally attendant. Uniformity and elasticity of the tumour, together with the rumbling noise, and the feeling of impulse on coughing, show that the case is an enterocele ; but if the swelling be compressible, flabby, and uneven, free from tension on coughing, and slow in re turning, the contents are omentum.