Reducible Hernia.
Diagnosis.—A reducible hernia usu ally presents the following signs: A soft tumor or swelling is found in one of the hernial openings; this swelling disap pears on lying down, or on moderate pressure. It gives a distinct impulse on coughing, and usually it is seen to in crease in size during the act of coughing or straining of the abdominal muscles. In most cases there is a history of grad ual' development with sensations of comfort in the region of the swelling, especially noted after long standing or walking. In the early period of develop ment nothing more than a slight full ness may be found; but as the hernia descends it becomes a well-defined tumor. The character of the swelling varies ac cording to the contents of the sac. If it contains bowel alone, it feels smooth and elastic: the impulse on coughing is well marked and reduction is often accom panied by a gurgling sound. Percussion yields a tympanitic note distinctly dif ferent from the flat sound produced in omental hernia. If the contents con sist of omentum alone, the tumor is more uneven in outline, gives a lobulated feel ing and is entirely without elasticity.
Both bowel and omentum may be pres ent, in which case there may be a com bination of the physical signs already de scribed. Not infrequently the bowel is perfectly reducible, while the omentum is adherent to the sac. The sensations of discomfort and the dragging pain, which may be very slight in a rupture of small size, may become very marked in a large hernia, especially if the latter be not controllable by truss.
Treatment of Reducible Hernia.—The various methods for the treatment of hernia may be classified as either pallia tive or operative. Palliative, or mechan ical, treatment includes all the various appliances by means of which an effort is made to restrain the contents of the abdomen within the hernial orifice. In the majority of cases mechanical treat ment does not aim to close the orifice, though in children and young adults such a result is often obtained, thus effecting a permanent cure.