HERNIAL RUPTURE. 323 



The clinical symptoms of strangulated hernia are very marked 

 in most cases. The hernia can no longer be reduced or pushed 

 back into the cavity, or a swelling suddenly appears after any trau- 

 matism, or after great abdominal pressure, and cannot be reduced 

 even with careful manipulation. The hernia is distended, harder 

 and fuller than usual, becoming very sensitive to pressure, and 

 especially so as the inflammation becomes more intense. The skin 

 covering the hernia is normal in the beginning, but later becomes 

 red, swollen, and warm to the touch. Another symptom which is 

 generally present is vomiting. This may be so constant and vio- 

 lent toward the later stages that the animal will vomit feces. At 

 that period symptoms of severe intestinal obstruction present them- 

 selves. The hernial swelling becomes cold, insensible to pressure, 

 and symptoms of collapse appear, and death occurs frpm twenty- 

 four to forty-eight hours after strangulation first appears. The 

 temperature can hardly be said to have any diagnostic value, as 

 we very often find it normal or even subnormal up to the time of 

 death. 



In rare instances we have the formation of a fecal abscess; this 

 is caused by the sloughing of a certain portion of the intestine, 

 allowing the contents of the intestine to escape into the sac ; this is 

 due to the circulation being cut off and subsequent mortification of 

 the part; this is quickly followed by purulent inflammation of the 

 hernial covering. If an incision is made in the hernial swelling, 

 fecal matter and pus flow off externally without being followed by 

 any grave symptoms, except that it may subsequently form a false 

 anus in the cavity. 



Fecal fistule, intestinal fistule, or preternatural rectum is seen 

 in very rare instances. The expression " fecal fistule " or " intes- 

 tinal fistule" is used where there is an external intestinal orifice, 

 but the greater mass of fecal matter is passed through the rectum. 

 The term " preternatural rectum " (anus praeternaturalis) is used 

 when all the fecal matter passes through this opening. Such an 

 opening may also be produced by penetrating wounds or the 

 entrance of foreign bodies. 



In strangulation of the omentum the symptoms are less marked, 

 but there is great pain on pressure. We frequently find adhesions 

 between the omentum and the orifice of the hernia. This inflam- 

 mation produces a complete immobility of the hernia and gan- 



