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Treatment (Lose not a moment in sending)

Lose not a moment in sending for the best medical aid that may be within reach. In the mean time, having placed the patient as directed for reducible ruptures, apply both hands on the tumor with gentle pressure, or grasp the tumor gently but steadily with one hand, while with the fingers of the other you endeavor to knead or push up the parts nearest the ring in the groin, applying the pressure in the same course the parts have taken in their descent. If this fails, seize the tumor between the finger and thumb of the left hand, close to where it enters the belly, and carry them downwards, with a moderate pressure, so as to dislodge any excrement which may be there, while with the right you endeavor to push in the gut.

If you cannot succeed in two or three attempts, place the patient in a warm bath and try it again.

If still foiled (you have no time to waste in unavailing attempts) cover the tumor with pounded ice, snow, or any very cold application. Should this fail, bleed the patient until he nearly faints, regardless of the small thready pulse; if fainting actually occurs, seize that moment to return the parts, as before directed.

Should the rupture still remain irreducible, there are but two resources left, the tobacco clyster and an operation. One-half of the clyster should be injected; if it occasions sickness and a relaxation of the parts, endeavor to return them.

If the first half does not produce these effects, throw up the remainder of it, and when relaxation comes on endeavor, as before, to push up the gut. As regards the operation, no one should ever attempt it but a surgeon. Large doses of laudanum allay vomiting, and are otherwise beneficial; in all cases of this kind they should never be omitted.

Remarks. Ruptures are liable to be confounded with some other diseases, as dropsy of the bag, enlarged spermatic vein, etc. The modes of distinguishing them have already been pointed out, although it must be confessed that with respect to the latter considerable difficulty exists. If the disease is a rupture, by placing the patient on his back, returning the tumor, and holding the fingers firmly over the opening, and then desiring him to rise, the swelling will not appear. If, on the contrary, it is an enlarged spermatic vein, it will be found to be greater than ever. The latter has also a peculiar ropy feel, as if a bundle of cords were in the bag.

Aneurism.

Symptoms. At first a small tumor without pain or redness, attended by a peculiar throbbing; it disappears on pressure, and returns the moment it is removed. As the tumor increases in size, the throbbing or beating of the artery grows less perceptible. It is generally found in the ham, thigh, neck, groin, and arm. Distinguish it by the beating or throbbing, which is diminished by pressing on the artery above the tumor, and by the latter disappearing on pressure, and returning when it is removed.

Treatment. In the early stage apply a soft and elastic cushion to the tumor, and bind it tightly over it by a bandage. If the patient is of a full habit he should be bled and purged. This plan, steadily and vigorously pursued for a long time, has sometimes effected complete cures. There is nothing, however, but an operation that can be depended on; wherefore, as soon as any swelling of this nature is perceived, no time should be lost left to itself it will finally burst, and death be the inevitable consequence.

Fleshy Tumors.

Symptoms. Small warty projections, which, as they increase in size, drag down the skin from the neighboring parts, which forms a kind of stem or foot-stalk, on which the tumor hangs. They are hard, full of vessels, and are neither painful nor inflamed.

Treatment. When very small, they may be frequently touched with caustic, which will destroy them; if large, the ligature or knife must be employed, for which purpose have recourse to a surgeon. Steatomatous Tumors.

Symptoms. A small, fatty swelling, which gradually increases, and sometimes grows to an enormous size. It is soft and free from pain, the color of the skin remaining unaltered.

Treatment. These tumors, technically called steatomatous, are merely inconvenient from their bulk. They can only be removed by the ligature or knife, for which purpose apply to a surgeon.

Encysted Tumors.

Symptoms. A distinct, hard, circumscribed swelling, gradually growing larger until a slight inflammation comes on, when it becomes a little painful, soon after which a fluctuation is distinctly to be perceived. As it progresses the vessels become enlarged; it seldom exceeds the size of an egg.

Treatment. Apply to a surgeon.

Ganglion.

Symptoms. A small, movable, elastic swelling, with little or no pain, or alteration in the skin, situated under or between tendons or sinews, and generally near to a joint; it sometimes hinders the motions of the part.