HERNIA. 393 



atively easy to recognize, and can be reduced to two principal 

 points, to wit— the discovery of a tumor, and appearance of an 

 opening coexisting in the abdominal walls. These tumors and 

 openings offer many varieties of form and character. The tumor 

 located opposite to a natural opening, or under a breach or sepa^ 

 ration ia the structure of the abdominal walls, or under a cicatrix, 

 forms a mass, indolent, elastic, remittent, of varying size, but di- 

 minishing or increasing under peculiar conditions, such as rest or 

 pressure, and the standing, or the lateral or recumbent position, 

 etc., and having different forms, being located ia various places. 



It has also, in many instances, the quality of being reducible, 

 that is, it may be made to disappear by means of certaui manipu- 

 lations and appropriate treatment, and arrangements of position, 

 to return to their previous status when these agencies are sus- 

 pended; or again, they will become permanently irreducible under 

 special pathological changes already alluded to. The presence of 

 borborygmus is also an important item among the means of form- 

 ing a physical diagnosis of these tumors. This is detected more 

 or less readily when the displaced organ is a portion of the in- 

 testines. They are, however, missing when the hernia is formed 

 by other organs, as, for instance, in case of epiplocele. Other 

 points connected with this subject remain to be mentioned. 

 Among these are the final symptoms, and more or less remote re- 

 sults, which may follow the presence and working of the lesion 

 upon the general economy and the physiological functions at 

 large, when the acute action has passed away. 



The constitutional symptotna, or what may be so denominated, 

 wiQ vary, in their nature and their intensity, correspondingly with 

 the condition of the hernia and the complications which may ac- 

 company each case. Among these complications, four principal 

 ones may be mentioned as taHng precedence : 



1st. Irreducibility.—This. is more frequent m old cases than 

 m new, and is probably due to the mcrease in size of the dis- 

 placed organ to the degeneration of the tissues, or to old adhe- 

 sions between the organ and its covering, the sac. These cases, 

 which may be considered rather permanent than merely chronic, 

 maintain their status, either completely or partially, unchanged. 

 Yet they cannot, naturaUy or rationaUy, be held to be compatible 

 with a sound constitution or unimpaired stamina in the animals 

 so conditioned, and their Hability to contract indispositions easily 



