DIA GNOS S.—When a femoral hernia is not strangulated, an impulse may be felt when the patient coughs. The tumor is generally tense, small. and round, and can be pushed to the outside of the spine of the pubes.
Inguinal llernia.—From this variety the distinction is sometimes difficult, especially in women; but the neck of a femoral hernia is always below the spine of the pubes and to the outer side.
Enlarged Lymphatic Glands.—These possess no neck, and several glands more or less enlarged can often be felt. Gurg ling cannot be detected; fluctuation through the presence of pus sometimes renders the diagnosis difficult.
Psoas-abscess.—Gurgling is also ab sent, but cough also causes an impulse, and the abscess often disappears as in hernia when the recumbent position is assumed. Spinal symptoms usually com plicate such cases, however. If a psoas abscess, deep pressure in the iliac fossa will detect the tumor after apparent re duction.
Varix of the femoral vein is sometimes misleading, but pressure over it from below upward, sliding the finger over the vein until the femoral ring is reached, causes it to become emptied, but it may be seen to quickly refill from below,— the differential feature.
Cysts arc reducible, but coughing pro duces no impulse.
Lipomata are bosselated, have no im pulse on coughing, and are more doughy to the touch.
Ilydrocele and a thickened empty sac are difficult to differentiate, and sometimes require an exploratory incision.
Treatment of Femoral Hernia.—RE DUCIBLE.—An appropriate truss involv ing the principles as to pressure, etc., already outlined, should be employed. A truss is not curative in the case of fem oral hernia, however, and is often held in place with considerable difficulty. It should press diagonally upward toward the spine. Compression of the femoral vein, which lies externally to the hernia, must be avoided.