(From Bubonocele 1529 the groin, and a tumour). It is also called hernia inguina/is, or rupture of the groin, when the intestines are forced through the ring of the external oblique muscle of the belly. When through the cavity in the thigh, between the musculus pectineus and sartorius, it is called hernia femoralis, or cruralis.

The cause may be great distention of the bowels from wind, violent exercise, as leaping, or lifting burdens. A relaxation of the ring of the muscle is not an uncommon cause, and on this account the disease is sometimes hereditary. In lean persons the ring is also frequently relaxed, and in fat people"the weight of the parts will occasionally bring them down.

The signs are, a tumour in the groin, or upper part of the scrotum, beginning at the ring of the abdominal muscle, and extending more or less downward, towards or into the scrotum in men, and the labia pudendi in women. This tumour appears different to the touch, according to its contents. If a portion of the ilium forms the tumour, its surface is smooth and elastic, but much more so if the patient coughs and sneezes. If only a piece of the omentum hath slipped down, the tumour is more flabby when felt, its surface is more unequal, and it makes less resistance to the finger. If both the intestine and omentum have descended, the diagnostics will be less distinct, and it requires generally some experience to assist in judging of what can hardly be learnt by description.

The distinction of bubonocele is of considerable importance, and the greatest injury has been done by mistaking it for bubo, for hernia humoralis, for cancer of the testicle, and hydrocele. Of the symptoms distinguishing it from bubo we have just spoken. Hernia humoralis, or a swelled testicle from venereal irritation, is distinguished by the symptoms of its attack; for the latter is preceded by a hardness of the epididymis, followed by a hardness and acute pain of the body of the testicle itself, while the hernia is not equally painful, till external inflammation, and other symptoms of affections of the bowels, sufficiently point out its nature. It could scarcely be supposed that a cancerous tumour of the testicle could be mistaken for hernia, had we not seen the error committed. The slow progress of the swelling, the scirrhous feel, and the undisturbed state of the bowels, sufficiently discriminate the two diseases. The dropsy of the tunica vaginalis testis is most often mistaken for hernia. This, however, feels more smooth and equable; a fluctuation can be perceived, a transparency, when a candle is placed on the opposite side, is obvious: and if we can observe its progress, we shall find that it begins at the bottom of the scrotum, gradually rising upwards, and the spermatic cord is generally free; while in hernia, the enlargement is felt from above downwards. The increase of the tumour on coughing or sneezing, and the obstructed state of the bowels; above all, its receding or lying back; are fully sufficient, even for the less experienced practitioner, to discriminate the two diseases.

One other complaint should be noticed as sometimes confounded with bubonocele, viz. the varicocele, particularly the varices of the spermatic cord. These are forced down in coughing, and disappear in a recumbent posture. The distinction is not difficult. When emptied from a recumbent posture, if a finger is placed on the ring, and the patient raised, the tumour will reappear should it be from varices, but not if it is a hernia.

The ring of the muscle so often mentioned, is an aperture in the tendon of the external oblique, formed by the splitting of its fibres. Through this passage the testicles in the foetus, or soon after birth, descend; and the spermatic cord is, by the testicle, drawn down through it. No process, except the occasional accumulation of fat, contributes to close it, and through this aperture the intestines descend. Though authors speak of the ring, yet there are two; for another aperture is formed by the tendons of the internal oblique and transverse muscle behind, and a little on the outside of the other ring. Though we have said nature has not closed the aperture, yet the ring is drawn close by the action of the external oblique; and this action, while it often prevents rupture when it has occurred, occasions what is called strangulation. The term is perhaps improper, as the tendon is not capable of contracting. In reality, the distention of the bowels occasions the contraction of the external oblique, which draws the fibres of the tendon closer; while the distention of the portion of intestine filled with air, contributes to fill more completely the contracted aperture. The internal ring is more muscular, and may be spasmodically contracted.

The symptoms of all intestinal herniae are those of ilius; and in every case of violent colic, the practitioner should always examine whether some hernial tumour can be discovered. The pain is generally most violent at the pit of the stomach, as the omentum, which accompanies the intestine in the sac, is dragged down with it. The pain goes on increasing, incessant vomiting comes on, and what is discharged is at first watery, then bilious, and lastly, feculent; stools are obstinately retained, and mortification closes the scene. Vomiting and hiccough frequently occur in herniae; and the cause will be obvious when the connection of the omentum with the stomach is considered. The pulse is at first hard, but when mortification and cold sweats come on, it is softer and more regular, but soon becomes small, frequent, and tremulous.

When a hernia comes down, if the patient is strong and plethoric, some blood may be taken, and a clyster injected; the reduction is next attempted.

To reduce the hernia merely by the hand, without cutting or eroding the part, is called taxis; and when it is thus reduced by the hand, if the rupture consisted of a portion of the intestine only, it generally slips up at once. The posture of the patient,if laidon his back, with his heels brought near to his buttocks, assists the return of the protruded parts: if a piece of the omentum is the contents, its return is not so speedy; if there are both omentum and intestine, the latter ascends first, and the former feels flabby, but soon after follows also. Sometimes after the intestine is returned, a soft knotty substance remains unreduced, and resists all the efforts to reduction, until the patient's vessels are emptied by bleeding, repeated purges, and a low diet; the varicous feel which this substance hath, seems as if it was the mesentery with its vessels distended.