When a rupture happens, and is unattended with any signs of stricture, or other violent symptoms, a bandage or a truss will be the most eligible means of relief. The modes of operation when the knife is necessary will be afterwards explained.

Hernia aquosa. See Hydrocele.

Hernia bronchialis. See Bronchocele.

Hernia carnosa. See Sarcocele.

Hernia cerebri. A rupture of the brain; a protrusion of the cerebrum, or cerebellum, through an opening of the bones of the cranium not perfectly ossified, discoverable by a protuberance, differing with respect to magnitude, figure, and place of the cranium which it occupies, covered with the common integuments, preserving their natural colour, unless a gangrene has supervened. The protuberance is soft and indolent, resisting the touch, and painful only when inflamed, usually fluctuating, surrounded at the circumference of its basis by a bony circle, which may be traced by the fingers, and discovering a defect of ossification: it is peculiar to infants, attended, at least, in the beginning, with no violent symptoms, if the tumour is small, and situated in the vertex, or sides of the head; but palsy, stupor, and convulsions come on if it be large, or if in the occiput. The disease must be carefully distinguished from a spurious aneurism, which often in infants arises from a blow, or violent pulling of the hairy scalp. Trew, and Le Dran, cured this complaint by placing thick compresses, moistened with spirit of wine, or aqua vitae, upon the part affected, for several weeks, renewing them every twenty-four hours. See Sauvages' Nosologia, vol. i. p. 217. Warner's Observations Chirurgics, xi. 59.

Hernia congenita, is a rupture where the intestine and testicle are in contact. The testes are originally situated in the abdomen, just below the kidneys, and gradually descend near the time of birth through the sheath of the spermatic chord into the scrotum, each carrying along with it an external coat, which in each is the tunica vaginalis. This discovery was made by Dr. Hunter, in the year 1755, and demonstrated in his public lectures that year.

Soon after the birth of the child, the communication between the tunica vaginalis and the abdomen is obliterated by a stricture of the parts, and an accumulation of fat; but if the intestine falls very soon, these defences are not formed.

In the treatment of congenital ruptures, the management is nearly the same as in the bubonocele. See Bell's Surgery, vol. i. p. 340.

Dr. Wrisberg observes, that, in his dissections, he several times found a part of the omentum or intestines adhering to the testicle in the abdomen of the foetus, and in such cases a hernia congenita must take place. The same, he adds, will occur, when the peritonaeum, in its course over the seminal vessels to the mesentery, sends off a minute process to the ilium or coecum, and by means of it draws down the intestines on the right side, which is the common seat of the hernia congenita. See the London Medical Journal, vol. i. p. 376. White's Surgery, p. 332.

Hernia cruralis. See Hernia femoralis.

Hernia cystica. See Hernia vesicalis.

Hernia femoralis, cruralis femorocele. This species of rupture is the same in both sexes, and formed by the falling of the omentum or intestines, or both, into the inside of the thigh, through the arch made by the os pubis and ligamentum Fallopii, where the iliac vessels and tendons of the psoas and iliacus in-ternus muscles pass from the abdomen. (See Bubonocele.) The methods proposed for ruptures in general will often succeed; and if the operation is necessary, it is the same as for the bubonocele, with the difference of dilating the ligament instead of the rings of the muscles: the dilatation must be made obliquely outwards, instead of perpendicularly upwards, to avoid dividing the spermatic vessels in the male, or the round ligaments in the female; but the pressure must be made directly upwards. Authors, however, are by no means clear respecting the means of avoiding the division of the spermatic vessels and round ligaments. Indeed it seems very difficult, and almost impossible.

The directions of Mr. Borret in the Medical and Physical Journal are the most clear and precise. When the fascia and sac are laid bare, he observes, that Pou-part's ligament is seen binding down the sac, which must be divided; but to avoid injuring the parts mentioned, he advises making a small incision between the fibres of the external oblique about half an inch above the ligament, and to pass a director under the ligament, and over the artery, on which the operator may safely cut. The stricture must then be divided inwards to the pubes, inclining Pott's knife rather obliquely downwards. See White's Surgery, p. 324.

Hernia flatulenta. See Pneumatocele.

Hernia foraminis magni ischii. In this hernia the intestines or omentum fall through the great hole of the ischium into the internal part of the thigh, between and under the two anterior heads of the triceps muscle. It is owing to a great laxity of the ligament, and the intestine must lie behind the pectincus; so that no pressure can be employed, and no operation can be successful, because the orifice cannot be dilated, on account of the vicinity of the vessels.

Hernia gutturis. See Bronchocele.

Hernia humoralis; inflammatio testium; though often an inflammation of the tunica vaginalis only. Dr. Swediaur thinks that the testicle itself is never swelled, or in the least affected, in the beginning of this complaint, and that the only affected part is the epididymis. He adds, if the testicle ever swells, it is from the inflammation extending in consequence of bad treatment. It usually is owing to a venereal inflammation, though it may also happen from irritation, or external injuries; and is subject to the usual termination of inflammation.

This disease is often induced by a stoppage of the venereal gonorrhoea, not from the poison itself, but from the inflammation extending to the mouth of the excretory ducts of the seminal vesicles; in which case, brisk purgatives, if they produce a return of the discharge, are useful, for this is the quickest method of relieving the complaint. Vomits, when the constitution can bear them, are useful while the tumour is in the inflammatory state; but are best given when the inflammation begins to yield. The ipecacuanha would be as useful as the hydrargyrus vitriolatus, if its activity were equal.