Recovery.—­The case terminates as a rule in death in three to six days, if aid is not given.

Treatment.—­Purgatives should not be given.  For the pain, hypodermics of morphine are needed.  Wash out the stomach for distressing vomiting.  This can be done three to four times a day.  Thorough washing out of the large bowel with injections should be practised, the warm water being allowed to flow in from a fountain syringe and the amount carefully estimated.  Hutchinson recommends that the patient be placed under an anesthetic, the abdomen kneaded, and a copious enema given with the hips placed high or patient in inverted position.  Then the patient should be thoroughly shaken, first with the abdomen held downward and subsequently in the inverted position.  If this and similar measures do not succeed by the third day surgical measures must be resorted to.

For bloating, turpentine cloths should be used, and other hot, moist applications.

Diet.—­Should be very light, if any, for a day or so.

Rupture (Hernia).—­Hernia means a protrusion of an organ from its natural cavity, through normal or artificial openings in the surrounding structures.  But by the term hernia, used alone, we mean the protrusion of a portion of the abdominal contents through the walls, and that is known by the popular term of “rupture.”

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The most common forms of rupture protrude through one of the natural openings or weak spots in the abdominal walls, as for instance, the inguinal (groin) and femoral canals.  The femoral canal is located at the upper and inner part of the thigh, and this place is a seat of rupture, especially in women.  Rupture may also occur at the navel, when it is called umbilical hernia or rupture.  The contents of a hernia are bowel and omentum (a covering of the bowel) separately or together.  The bowel involved in a rupture is usually the lower portion of the small bowel, but the large bowel is sometimes affected.  A sac covers the bowel or omentum in a rupture.  This sac consists of the protruded portion of peritoneum, which has been gradually pushed through one of the canals (inguinal or femoral) or of the process of peritoneum, which has been carried down by the testicle in its descent, and the connection of which with the peritoneum of the abdomen still continues, not having been obliterated, as it usually is before birth.  The former is called an acquired rupture sac; the latter is a congenital rupture sac, and it is found only in groin (inguinal rupture).

Causes.—­Rupture is more common in men than in women.  It may occur at any time of life.  The majority of cases occur before middle age, and the largest number during the first ten years of life, owing to the want of closure of the peritoneum which is carried down by the testicles before birth.  Rupture is most frequently strangulated between the ages of forty and fifty.