SCROTAL HERNIA. 607 



place as renders the tumour, from its weight, incapable of 

 yielding to the retraction of the surrounding parts; in this 

 condition its augmentation goes on, until the matters accumu- 

 lated within the gut produce obstruction, and that becomes 

 followed by strangulation. These changes, so far from being- 

 sudden, proceed rather slowly ; and accumulation and obstruc- 

 tion always precede strangulation. While the accumulation is 

 going on, we may observe loathing of food, dulness, indisposition 

 to move ; also, as the engorgement proceeds, loss of appetite^, 

 constipation, borborygma, colic. Strangulation adds virulence 

 to these symptoms, occasioning, as in recent hernia, the greatest 

 distress, until gangrene takes place, and then all pain suddenly 

 ceases, and cold sweats ; shiverings and convulsions close the 

 scene. 



" Strangulation. — Practical observations show us that old herniae 

 become strangulated from engorgement, and not from stricture 

 around the neck of the sac at the ring ; that can be considered 

 but as a secondary cause. The circumstance of stricture fol- 

 lowing, however, accounts for the symptoms of strangulation 

 being in these and the afore-mentioned cases essentially alike ; 

 being found to vary only in their succession and rapidity of 

 progress. It may be observed, however, that many horses having 

 scrotal hernise not only escape strangulation, but continue to do 

 their work with a large tumour swinging between their thighs ; 

 Gibson mentions a case in which " the gut extended the scrotum 

 down to the hock," apparently without any inconvenience from 

 it, beyond what may arise from its bulk and weight. This is a 

 fact which argues most strongly against meddling with such 

 tumours unless we be peremptorily called on to interfere. 



" Diagnosis. — It is not always easy to distinguish scrotal enter- 

 ocele from other swellings of the genitals, and particularly when 

 the hernia is complicated with sarcocele or variocele, or thickening 

 of the cord, or a combination of these affections. The tumour 

 of an enterocele does not preserve a general uniformity ; it is 

 commonly most bulky next the abdomen, increasing from below 

 upwards ; indeed there are cases in which its volume below 

 little, if any, exceeds that of the scrotum. The swelling yields 

 to pressure, and returns to its form after being compressed. If it 

 be raised up with the hand, it sensibly diminishes in volume, 

 from part of its contents being withdrawn into the abdomen ; 



