HERNIA. 445 



injury, it is in the form of a round, soft, elastic tumor, well- 

 defined in its outlines, and easily reducible. But if not examined 

 until after a season of delay, the definite configuration disappears, 

 and it is changed into an inflammatory swelHng, oedematous, warm 

 and painful to pressiire — in fact ha^dng the aspect of a warm ab- 

 scess. In the recent cases, the edges of the torn abdominal walls 

 may be identified through the thickness of the skin, but the sur- 

 geon will vainly try to make out this condition if the inflamma- 

 tory process following the lesion has become established, and the 

 serosity and the blood have become sufficiently infiltrated into the 

 cellular tissue to make the change described. After a few days, 

 if the hernia is not situated too low in the abdomen, the swelling 

 moves downward toward a more dependent spot, and gradually 

 abating disappears in about two weeks. Upon reaching this 

 point, the hernial tumor is once more recognized, constituting, as 

 it does, the exclusive manifestation of the displacement of the in- 

 testinal mass, and its presence outside of its natural cavity. It is 

 recognized by its changing conditions — elastic when the intestine 

 is empty ; soft and pufiy during digestion ; by its state of tension, 

 increasing with effort, and by being painless, depressible and re- 

 ducible. "When reduced, the edges of the opening are easily 

 made out, but it is not uncommonly found, upon the subsidence 

 of the inflammatory process, that, during the continuance of that 

 state, adhesions of the protruding organ with the walls of the 

 sac have formed, and the hernia has become irreducible. In their 

 dimensions, ventral hernias vary considerably. They may measure 

 from the size of a large nut to that of a man's head, or even exceed 

 that. Zundel reports a case where the rumen had penetrated into 

 the sac, which hung almost to the ground, and had produced a dis- 

 placement of the mammse, crowding them in a mass toward the 

 right side of the abdomen. 



Although the diagnosis of ventral hernia is not difficult, it is 

 still not impossible to mistake a recent case for certain other affec- 

 tions of the abdominal walls, such as tumors of bacterian anthrax, 

 or those of a bloody nature, or with phlegmonous or oedematous 

 growths. The reducibility and elasticity of the tumor, the bor- 

 borygmus, and the presence of the opening through the abdomi- 

 nal walls, are intelhgible signs by which to recognize the ventral 

 hernia. Aspiration of the tumor may sometimes be performed, 

 and rectal examination will also be of great assistance provided 



