HYMIOCELE OF THE CORD.—In the young there is a condition to which atten tion has been seldom called, and that not infrequently in the hands of the general practitioner causes a mistaken diagnosis of strangulation. This condition is hy drocele of the cord. In this disorder the swelling is more tense and cystic to the touch; it is more freely movable, more globular in outline, and has a more sharply-defined upper border, which, upon careful examination, shows that it does not enter the abdominal cavity. In a very few cases it may be difficult to differentiate between the two conditions from physical signs alone, but invariably the clinical history of the swelling will render the diagnosis easy. If hydrocele of the cord, there will be absolutely no general symptoms, and, if the statements of the parents be of any value, it will he found that the swelling has existed for several days or weeks, which shows the impossibility of its being a hernia.
[I have operated upon seven eases of strangulated hernia in infants, and in every case the general symptoms have been so well marked that mistaken diagnosis would have been impossible. WILLIAM B. CoLEY.] Treatment of Strangulated Hernia.— TAXIS.—Taxis and operation comprise the only methods of treatment to be con sidered. Taxis judiciously applied should always be used before operation is ad vised. Various positions of the patient are supposed to be of advantage in per forming taxis. In inguinal hernia the pelvis should be elevated and the thighs flexed; in femoral hernia the thighs should be flexed and slightly rotated in ward; in umbilical hernia both thighs should be flexed in order to relax the abdominal muscles. Traction on the tumor, followed by pressure, will often aid in reduction.
[Some, notably Hem, advocate with drawing the fluid from the hernial sac by means of a fine hypodermic syringe prior to taxis. Out of 33 cases thus treated reduction was accomplished in 29. He advises this method only in cases of recent strangulation and which refuse operation. It certainly should not be ad
vocated as a routine treatment. WILL TANI B. COLE].] Ether irrigations advocated as an ex cellent means for reduction of strangu lated hernia. A teaspoonful of ether is poured over the hernial tumor every quarter or half hour, keeping it covered with compresses during the interval. As a rule, after 3 or 4 tablespoonfuls, the intestinal loop slips into the abdominal cavity. In incarcerated scrotal hernia it is advisable to irrigate with a mixture of ether (20 parts) and hyoscyanuts-oil (4 parts). Drakin (Proceedings Krakow Med. Soc., No. 10. 'SS).
In 63 cases of strangulated hernia 53 were reduced by local etherization. The patient is laid on the back, pelvis slightly elevated, and thighs bent, the parts around being protected by abundant smearing with olive-oil ; every ten min utes or so a tablespoonful of sulphuric ether is poured on the hernial ring and tumor, until the latter loses its tightness and diminishes somewhat in size, when it returns spontaneously, or with slight help. ()mental hernitv will not yield to this treatment. Finkelstein ( Berliner kiln. Woch., No. 19, '91).
For the performance of taxis it is better to place the patient on a table so slanted as to raise the hips; to crowd the abdominal contents toward the chest; to apply one hand to the neck of the tumor and the other to its body, and to draw it down so as to lengthen it out, at the same time compressing it. The utmost gentleness is essential. De Garmo (The Post-graduate, Sept., '92).
In strangulated hernia the patient should be placed in a hot pack, with ice over the hernia, grain of morphine being given by suppository. If, after three hours, a gentle attempt at taxis fails, herniotomy should be resorted to. Morison (Birm. Med. Review, Sept., '92).
General amesthcsia should, as a rule, be avoided in cases of strangulated her nia in old and exhausted subjects. Keet ley (N. Y. Med. Jour., Nov. IS, '93).