he external ring, T, in
the usual way. In this form of hernia--a compound of the oblique and
direct--while the parts remain still covered by the integuments, it must
be difficult to tell its nature, or to distinguish any mark by which to
diagnose the case from one of the external variety, H, Plate 36, which,
on entering the canal at the internal ring, protrudes at the external
ring. In both cases, the swelling produced in the groin must be exactly
of the same size and shape. The epigastric artery in the case where the
two herniae co-exist lies between them, holding in its usual position
with respect to each when occurring separately--that is, on the outer
side of the internal hernia, H, and on the inner side of the external
one, G; and the external hernia, G, not having descended the canal as
far as the external ring, T, allows the internal hernia, H, to assume
its usual position with respect to the cord, Q. [Footnote]

[Footnote: Cases of this double hernia (external and internal) have been
met with by Wilmer, Arnaud, Sandifort, Richter, and others. A plurality
of the same variety of hernia may also occur on the same side. A
complete and incomplete external inguinal hernia existing in the one
groin, is recorded by Mr. Aston Key in his edition of Sir Astley
Cooper's work on Hernia. Sir Astley Cooper states his having met with
three internal inguinal herniae in each inguinal region. (Ing. et
Congenit. Hernire.) ]

Returning, however, to the more frequent conditions of inguinal
hernia--viz., those in which either the direct or the oblique variety
occurs alone--it should be remembered that a hernia originally oblique,
H, Plates 35 and 37, may, when of long standing, and having attained a
large size, destroy, by its gravitation, the obliquity of the inguinal
canal to such a degree as to bring the internal, H, Plate 35, opposite
to the external ring, as at I, and thereby exhibit all the appearance of
a hernia originally direct, I, Plate 37. In such a case, the epigastric
artery, F, which lies on the outer side of the neck of a truly direct
hernia, I, Plate 37, will be found to course on the inner side, G, of
the neck of this false-seeming direct hernia, I, Plate 35.

In the trial made for replacing the protruded bowel by the taxis, two
circumstances should be remembered in order to facilitate this object:
1st, the abdominal parietes should be relaxed by supporting the trunk
forward, and at the same time flexing the thigh o