380 DISEASES OF THE INTESTINES. 



The circumstance of stricture following, 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 hernia 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 enterocele from 

 other swellings of the genitals, and particularly when the-hernia is com- 

 plicated with sarcocele or varicocele, or thickening of the cord, or a com- 

 bination of these affections. The tumour of an enterocele does not 

 preserve a general uniformity ; it is commonly most bulky nearest to 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 com- 

 pressed. If it be raised up with the hand, it sensibly diminishes in 

 volume, from part of its contents being withdrawn into the abdomen : 

 the retraction sometimes being attended with a gurgling noise. Should 

 it be deemed advisable to examine into the state of the inguinal canal, its 

 openings will be found to be more or less dilated and encumbered ; and 

 this is an infallible proof of the existence of hernia. 



One Diagnostic more I would add, which seems to have 

 escaped the observation of our learned author ; and that is, 

 the self-expansion of the swelling under the effort of 

 coughing. Grasp the tumour with one or both hands, softly 

 but closely, and then let another person cough the horse, 

 and the swelling will be found suddenly to expand under 

 the efiPort, and as quickly to recede again. Might not this 

 criterion supersede the troublesome business of exploration 

 per rectum et vaginam penis ? 



Morbid Consequences. — In almost all chronic hernise we 

 meet with serous effusion, either into the cavity of the tunica 

 vaginalis, or into the cellular tissue uniting the hernial 

 coverings. Morbid thickening of the tunics is a much 

 rarer occurrence, and one of which M. Girard has seen but 

 few examples. The comparative rarity of cases of adhesion 



