Whatever be the cause, bleeding, according to the strength of the patient, is necessary; and an active purgative must follow. Goulard's saturnine water should be applied cold by means of rags folded several times, and repeated as often as they grow warm; a mixture of vinegar and brandy, or any other discutient lotion, will be nearly as effectual. (See Lotio.) If these remedies do not succeed in a few days in removing the violent pain, or diminishing the tumour, leeches must be applied to the part; and in every stage opiates, in large doses, alternated with laxatives, given.
The patient should lie on his back, in a large room, with little external covering; and even in this state the swollen testicle should be supported. Mercury may be employed if any induration remain, but the tumour itself is wholly inflammatory, and does not require this remedy.
Thus, if the part is suspended properly, and if the patient can conform to lie much on his back, this tumour will be removed in a short time, without the usual violent pain, or the hardness remaining afterwards, which is almost the constant effect of emollients. If, notwithstanding all our care, a suppuration come on, an emollient cataplasm must be applied warm, and continued until the matter is discharged. The knife is usually preferred for opening the abscess, but great caution is necessary that the testicle be not wounded: the dressing may be the same as directed for abscesses in general. On abscess in the testicles, see Kirkland's Medical Surgery, vol. ii. p. 256.
Dr. Swediaur proposes in cases of virulent gonorrhoea to prevent this disease, that the patient avoid exposing himself to cold, violent exercise, or venery, and that he keeps the scrotum duly suspended. If hernia humoralis occurs, he attempts, first, to allay the irritation, and then to recall the poison to its former original seat.
If the pulse be quick, full, and strong, he advises bleeding immediately. If costive, a clyster should be administered, and the patient sit half an hour in a warm bath, or on a perforated chair over the steam of hot water, previously suspending his testicles. He must then go to bed; a warm dry bag truss should be immediately put on; a warm bread poultice applied to the penis; and a full dose of opium given by the mouth, or in a clyster with lintseed oil. The opiate must be repeated every twenty-four hours, and the parts exposed two or three times a day to the steam of hoi water. The design of the poultice to the penis, and the hot steams, is to reproduce the discharge; but though this be useful, it is not essentially necessary, for the disease is evidently not a translation of the poison, but of inflammation only. See Dr. Swediaur's Observations on Venereal Complaints. Aikin's Observations on the Preparations of Lead. London Medical Observations and Inquiries, vol. iii. P. 152.
Hernia incakcerata. It is styled an incarcerated or confined hernia when the protruded intestine cannot be returned; from its adhesion, or from the bulk of its contents. The symptoms of the disease are, a swelling in the groin, and upper part of the scrotum, very painful to the touch, and resisting the pressure of the fingers; the pain is increased by coughing, sneezing, or standing upright; frequent vomiting; and a fever, with obstinate costiveness, presently comes on, which is soon fatal.
Very copious or repeated bleeding, and a proper posture, are the principal helps; the patient should be laid with his hips much higher than his shoulders, and thus by gently raising the scrotum, and a light pressure on the tumour, the intestine may return. The tobacco clyster is highly beneficial; made by infusing two drachms of dried tobacco in one pint of boiling water, for the space of ten minutes. It acts by producing nausea, and diminishing irritability. See Bubonocele. London Medical Journal, vi. p. 118, 259. Edinburgh Medical Commentaries, v. 270.
Hernia inguinalis. See Bubonocele. Hernia intestinalis. See Hernia scrota -lis.
Hernia lachrymalis. When the tears pass through the puncta lachrymalia, but stagnate in the sacculus lachrymalis,the tumour is styled hernia lachry-malis, with little propriety or precision. It is with equal impropriety called by Anel, a dropss of the lachrymal sac. If the inner angle of the eye is pressed, and an aqueous humour flows out, the disease is the Fistula la-chrymalis, q. v. Kirkland's Medical Surgery, vol. ii. p. 135.
Hernia omentalis. See Epiplocele. Hernia scrotalis, hernia oschealis,.and hernia enteroschocele; also intestinatis, ecptoma, en-terocele; by Paracelsus, crepatio, or crepatura. When the omentum, the intestine, or both, descend into the scrotum, it has these appellations; when the omentum only, it is called epioscheocele. It is styled a perfect rupture, in contradistinction to a bubonocele, which is the same disorder; but the descent is not so great. The hernia scrotalis is distinguished into the true and false; in the former the omentum, or intestine, or both, fall into the scrotum; in the latter, an inflammation, or a fluid, causes a tumour in this part, as in hernia
5 C 2 humoralis, or hydrocele. Sometimes sebaceous matter is collected in the scrotum; and this hernia is called steatocele.
Hernia umbilicalis; epiploomphalon, omphalocele, exomphalos, omphalos; and when owing to flatulence, pneumatomphalos. In this disease the omentum, intestine, or both, protrude at the navel, and it can, in general, only be palliated. White's Surgery, p. 323.
Hernia uteri; hysterocele. Instances have occurred of the uterus being thrust through the rings of the muscles; but this is scarcely to be discovered, unless in a pregnant state, when the stragglings of a child would discover the nature of the disease. In that state, however, it could scarcely ever occur. It is the ecrexis of Hippocrates.
Hernia vaginalis. There is naturally a deep cavity between the rectum and the back part of the uterus, from the peritoneum descending pretty low, and forming a kind of sac, in which a portion of the small intestines in the unimpregnated state lies. The intestines, by pressing occasionally against the peritoneum at this depending part, deepen this cavity, and separate the back part of the vagina from the fore part of the rectum, thus forming the tumour in the vagina, called a hernia -vaginalis.
Hernia in vagina. See Colpocele. Hernia varicosa. See Cirsocele. Hernia ventosa. See Pneumatocele. Hernia ventralis, hypogastrocele. This may happen in almost any point of the fore part of the belly, but most frequently between the recti muscles, either above or below the navel; and is only to be relieved by returning the protruded parts, and preventing the recurrence of the hernia by a proper bandage. The tumour which requires this operation is seldom bigger than a walnut; so when there are the symptoms of a hernia, and yet no appearance of one in the groin, the belly should be examined. In obstinate cases of ileus, also, it is proper to examine every part of the abdomen, for the most violent symptoms may arise from a very small hernia of this kind. The stricture must be relieved by dilating the part, as in other cases; but after the operation a bandage must always be worn, as the cicatrix may be ruptured. White's Surgery, p. 324.
Hernia vesicalis, seu cystica. In this species, the urinary bladder is the part protruded, either in the groin or scrotum, through the opening in the external oblique muscle of the abdomen; in the fore part of the thigh under Poupart's ligament; or in the perinaeum. Through some of the muscular interstices of that part, the bladder has been pushed into the vagina, and formed hernial tumours of no inconsiderable magnitude. The common attendant symptoms are, a tumour with fluctuation, either in the groin, the fore part of the thigh, or perinaeum. The tumour subsides on pressure, and occasions either a desire to make water, or an involuntary discharge of urine. When the swelling is large, it is necessary that the tumour should be elevated as much as possible before the urine can be discharged; but when small, and no stricture occurs, water is generally made with great ease. When this complaint is simple, and no part of the intestine has fallen down, it commonly proceeds from a suppression of urine; so that every cause of suppression ought to be guarded against; and when no adhesions take place, if the protruded portion of the bladder can be reduced, a truss, properly fitted, should be worn for a considerable time. When the bladder cannot be reduced, while no symptoms occur to render the operation necessary, a suspensory bag to support the prolapsed parts, without producing severe pressure, is the only probable means of relief. When a portion of the bladder happens to protrude into the vagina, after reduction, future descents may be prevented by the use of a pessary; and the same means will be successful in preventing a falling down of part of the intestinal canal into the vagina: a species of rupture which now and then occurs. But should the protruded parts be attacked with pain and inflammation in consequence of stricture, so as to render the operation necessary, we must proceed, as in similar.cases, to divide the parts occasioning the stricture; but if the bladder adhere to the rupture of an intestine, great caution is required, should the operation become necessary, to avoid wounding the bladder. See Le Dran's Operations. Memoires de lacademie Royale de Chirurgie. Sharp's Operations. Sharp's Critical Enquiry. Arnaud on Ruptures. Pott on Ruptures. Gooch on Wounds, p. 427, Etc. Aikin's Observations on Preparations of Lead, p. 91, etc. Bell's Surgery, vol. i. p. 369 to 377.