HERNIA. 73 



tight clothes, parturition, straining at stool, &c. Hernia is divided 

 according to the site of the protrusion, into inguinal^ ventro-ingui- 

 nal, umbilical^ ventral^ phrenic, perineal, vaginal, pudendal, thy- 

 roideal, and ischiatic. The condition of hernia is also a ground of 

 division mio reducible, irreducible, and strangulated ; and if the con- 

 tents of the sac be intestine, it is called enterocele, if it contains 

 omentum, it is called epiplocele. The sac is formed of peritoneum, 

 and the different parts are called mouth, neck, and fundus. 



Reducible Hernia. — Symptoms. — A painful swelling suddenly 

 forms at some part of the abdominal parietes, which is compressible 

 and soft ; can be made to disappear by pressure in the proper direc- 

 tion, and which often disappears spontaneously. An enterocele is 

 smooth, elastic, and globular, retires suddenly, and with a gurgling 

 noise. An epiplocele is more irregular in its form, has a doughy 

 feel, and retires slowly without noise. 



Treatment. — The treatment consists of reduction and retention. 

 Bcduction is effected by a manipulation termed taxis, the patient 

 being placed in a recumbent position, and the muscles of the abdomen 

 relaxed ; gentle and steady pressure is made by the hand in the 

 direction of the descent. Retention is effected by continued and 

 suitable pressure over the site of the protrusion, by means of a truss. 

 The points of a good truss are, a well made elastic spring and a 

 pad, that can be accurately fitted. The spring is to be applied two 

 inches below the crista of the ilium, and not above it, as is fre- 

 quently done. Care must be taken to prevent excoriation, and also 

 that every portion of intestine or omentum is removed from the sac 

 previous to its application. By constant and careful use of a truss, 

 a radical cure may be effected in a child, but rarely, if ever, in an 

 adult. 



Irreducible Hernia. — When the contents of the sac cannot be 

 restored to the abdomen, the hernia is called irreducible. It may 

 arise from adhesions between the sac and the intestine contained, or 

 from membranous bands stretching across the sac ; from great en- 

 largement of the omentum or intestine, or contraction of the cavity 

 of the abdomen. The patient usually suffers from flatulence, indi- 

 gestion, and constipation, owing to the peristaltic movements of the 

 bowels being partially interrupted. 



The treatme7it consists in carefully regulating the bowels, avoid- 

 ing any great exertions, and the wearing of a bag truss to support 

 the tumour, and prevent further protrusion. 



Strangulated Hernia. — This is an incarceration of the con- 

 tents of the sac with inflammation, and an interruption to the passage 

 of fseces, and the circulation in the part. The inflammation is 

 caused by the constriction, which may be the result of spasm, or 

 sudden enlargement of the intestine by fteces or gas. 



The symptmns are flatulence, constipation, pain in the part and 

 abdomen, nausea and vomiting ; sometimes the matter is stercora- 



