414 OPERATIONS ON THE DIGESTIVE APPARATUS. 



and sarcocele are present, the testicle is bosselated and hyper- 

 trophied, and the cord which supports it is surrounded by the 

 protruding intestines, which form on the outside an elongated 

 mass, of a consistency either puffy or perfectly elastic, according 

 to the period of digestion. Intelligent rectal exploration will 

 always reveal the presence of the intestine through the ring. 



When chronic inguinal hernia becomes complicated with acute 

 inflammation of the displaced organ, the scrotal tumor becomes 

 warm, painful, evenly tense and remittent, and assumes nearly all 

 the characters of a phlegmonous tumor, that a strong tempta- 

 tion is offered to open it with the bistoury. But, if this is con- 

 templated, it should be preceded by a rectal examination, carefully 

 made, as the only means of avoiding a possible error of diagnosis 

 whose consequences would be fatal. If the inflammation con- 

 tinues to be localized, the intestine contracts adhesions with the 

 walls of the sac, and the hernia becomes irreducible ; but if, on 

 the contrary, the phenomena of inflammation extend to the peri- 

 toneum, an acute peritonitis is established, and' the patient suc- 

 cumbs in a few days. 



The ohstniction or engorgement, which is a possible complica- 

 tion of chronic inguinal hernias, consists in the distension of the 

 intestinal loop by the lodgment of alimentary masses of varying 

 bulk which accumulate, and for the time being, occlude the intes- 

 tinal tract. This complication may be recognized by the in- 

 creased volume of the tumor, its greater weight, and the sensa^ 

 tion of a softish and pufify mass contained in it. It is often, how- 

 ever, but a temporary trouble, the colics which attend it yielding 

 easily to appropriate treatment, and the removal of faeces from 

 the rectum by back-raking being often sufficient in itself to afford 

 relief. But in exaeptional cases, treatment faUs ; the obstruction 

 becomes persistent ; the faeces accumulate in the protruding in- 

 testines ; the tumor is increased in bulk, and at length a period 

 arrives when such a disproportion between the volume of the dis- 

 tended intestine and the capacity of the opening through which 

 it has passed is estabHshed, that all the conditions necessary for 

 strangulation are fulfilled. This soon takes place and becomes 

 evident by the exhibition of symptoms akin to those pertaining 

 to its analogue of the recent or acute variety. There is, how- 

 ever, a difference between the two forms in respect to the impor- 

 tant matter of their comparative amenability to treatment, inas- 



