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Symptoms (Small swelling free from pain)

A small swelling, free from pain, and generally soft, the color of the skin over it remaining unaltered. While standing up the swelling increases, on lying down it decreases, the patient being able to return the parts himself, while in that position. The swelling is also increased by coughing, sneezing, or straining as if at stool. If he is flatulent, a rumbling sensation may be felt in it.

Treatment. The patient should place himself on his back, with his head and shoulders a little elevated. Draw up his knees to his belly, and (if in this position the parts do not return of themselves) endeavor to push or knead them gently up into the belly, through the opening at which they come out, and which, if the tumor be in the groin or bag, is an oval ring or slit in the groin, at the precise spot where the swelling first appeared.

When this is effected, he should remain quiet until a truss can be procured, the spring of which must be passed round his body, the pad be applied directly over the spot just mentioned, and held there with one hand, while the other passes the strap into the buckle and draws it sufficiently tight.

Having done this, he should get up and walk about. If the swelling no longer appears, the truss is properly applied; if otherwise, take it off, return the parts as before, and apply it again; when, if, on rising, walking about, slightly coughing, etc., the parts are found to be well kept up, he may resume his ordinary business. The truss should be worn night and day, as long as he lives.

Irreducible Ruptures.

Symptoms. A rupture in which there is no pain, yet that cannot be returned into the belly, caused by an increased bulk of the parts, or their having formed adhesions, or grown fast to adjoining parts.

Treatment. A rupture thus situated must be simply supported by a bag or bandage, and left to itself. The patient should be extremely cautious in his diet, and in avoiding costiveness, by the use of clysters, or, if necessary, laxative medicines. He should also be very careful to protect the tumor from blows, always recollecting that it is in danger of strangulation.

Strangulated Ruptures.

Symptoms. The first mark of a rupture being strangulated, or of pressure being made on it, is costiveness. The tumor, which before was insensible, becomes painful, the pain being most severe at the spot where the strangulation or stricture exists, and extending from thence across the belly, which becomes swollen and hard. The pain resembles that which the patient would suppose to arise if a cord was drawn tightly across it. The pain continues to increase, and is augmented by pressure; sneezing, coughing, nausea, and vomiting, first of the contents of the stomach, and af- By the word tumor is meant a swelling of any terwards of the intestines, ensue; great anxiety,