Location.—­The great majority of cases of rupture are groin or inguinal rupture.

Symptoms.—­A fullness or a swelling is first noticed in the groin, which is made worse in standing, coughing and lifting.  This disappears on lying down and reappears on rising in many cases, even at first; coughing makes the lump or swelling harder.  It may come on both sides, when it is called double rupture or hernia.

Mothers’ remedies.—­Rupture, Poultice for.—­“Take equal parts of lobelia and stramonium leaves; make a poultice and apply to the parts.  Renew as often as necessary.  This combination makes a very effective poultice and is sure to give relief.”

Physicians’ treatment.—­A person should wear a truss (support) that fits perfectly, and this should not cause any pain or discomfort.  The truss should be worn all day, taken off at night after going to bed and put on before rising, when still lying down.  If it is put on after rising a little of the gut may be in the canal and pressed down by the support.  There are many kinds of supports.

Operations now performed for rupture are very successful if the patient takes good care for months afterwards until the parts are thoroughly healed.  The operation simply closes a too large opening.  The testicles descending through the groin canal from the abdominal cavity before birth and in congenital rupture, left too big an opening.  In acquired rupture, these natural openings were enlarged by lifting, falls, etc.  The round ligament of the womb goes down through this canal and sometimes there is too large an opening left or acquired by accident.

Irreducible Rupture.—­This is when the rupture cannot be returned into the abdominal cavity, and it is without any symptoms of strangulation.  They are of long standing and of a large size.  This condition is often due to carelessness of a patient in not keeping in a reducible rupture with a proper support.  Adhesions form, holding the rupture.  Even if it is small, it gives rise to much discomfort and the patient is always in danger of strangulation of the rupture.

Operation for radical cure is generally a success.

[124 Mothers’ remedies]

Strangulation Hernia or Rupture.—­This means the rupture is so tightly constricted that it cannot be returned into the abdominal cavity, and its circulation is interfered with; then there is not only obstruction to the passage of the feces, but also an arrest of circulation in the protruded portion of bowel which, if not relieved, results in gangrene and death.  This occurs more often in old than in recent ruptures and more often in congenital than in acquired rupture.

Symptoms.—­Sudden and complete constipation with persistent vomiting.  The lump may be tense, hard and irreducible.  Then there is faintness, collapse; severe abdominal pain, complete constipation, with no gas passing, then vomiting, at first of food, then of the bile-stained fluid and finally of fluid with a bowel odor.  All these symptoms increase and the patient gradually sinks from exhaustion in eight or nine days, though in very acute cases the patient may die within forty-eight hours.