564 HERNIA 



The consistency of the hernia will depend upon the con- 

 tents. Perineal hernias are usually soft, easily reduced and 

 the hernial ring readily palpated. Holding the patient up by 

 the hind limbs often effects reduction. Should the bladder 

 be in the hernial sac the patient will show dysuria and the 

 enlargement feel cystic. A positive diagnosis can be made by 

 puncturing the swelling with a trocar and' obtaining some of 

 the contents. A differential diagnosis is necessary between 

 the hernia and enlargement of the anal pouches. A careful 

 examination will reveal the difference between them. 



Treatment.— A careful consideration of the symptoms 

 should be taken into account in order to determine definitely 

 the conditions so that proper treatment can be applied. If 

 the bladder is in the hernial sac replacement should be 

 brought about as soon as possible. This may be done by 

 carefully manipulating the parts, or if this fails open the 

 hernial sac, empty the bladder with a fine trocar and push it 

 back into the abdominal cavity. Insert the sutures rather 

 deep in the tissues in order to effect deep adhesions. 



In the female, if the uterus is in the hernial sac, ventro- 

 fixation is recommended. Many cases, when of ordinary 

 size and no particular disturbance present, should not be 

 treated. Castration is recommended when enlarged pros- 

 tates are present. In some cases it may be necessary to 

 remove the glands. 



Other hernias have been observed but they are so rare that 

 no attempt will be made to describe them. 



