n the trunk; 2nd, as
every complete hernial protrusion becomes distended more or less beyond
the seat of stricture--wherever this may happen to be--its reduction by
the taxis should be attempted, with gradual, gentle, equable pressure,
so that the sac may be first emptied of its fluid. That part of the
hernia which protruded last should be replaced first. The direction in
which the hernia protrudes must always determine the direction in which
it is to be reduced. If it be the external or oblique variety, the
viscus is to be pushed upwards, outwards, and backwards; if it be the
internal or direct variety, it is to be reduced by pressure, made
upwards and backwards. Pressure made in this latter direction will serve
for the reduction of that hernia which, from being originally external
and oblique, has assumed the usual position of the internal or direct
variety.

The seat of the stricture in an external inguinal hernia is found to be
situated either at the internal ring, corresponding to the neck of the
sac, or at the external ring. Between these two points, which "bound the
canal," and which are to be regarded merely as passive agents in causing
stricture of the protruding bowel, the lower parts of the transversalis
and internal oblique muscles embrace the herniary sac, and are known at
times to be the cause of its active strangulation or spasm.

The seat of stricture in an internal hernia may be either at the neck of
its sac, I, Plate 37, or at the external ring, T, Plate 38; and
according to the locality where this hernia enters the inguinal wall,
the nature of its stricture will vary. If the hernia pass through a
cleft in the conjoined tendon, f, Plate 38, this structure will
constrict its neck all around. If it pass on the outer margin of this
tendon, then the neck of the sac, bending inwards in order to gain the
external ring, will be constricted against the sharp resisting edge of
the tendon. Again, if the hernia enter the inguinal wall close to the
epigastric artery, it will find its way into the inguinal canal, become
invested by the structures forming this part, and here it may suffer
active constriction from the muscular fibres of the transverse and
internal oblique or their cremasteric parts. The external ring may be
considered as always causing some degree of pressure on the hernia which
passes through it.

In both kinds of inguinal herniae, the neck of the sac is described as
being occasionally the seat o