e, be pushed away from the point of protrusion. Sometimes the
contraction of the muscular fibres at a point where the hernia makes its
exit is so great that the tumor cannot be replaced. In this case the
system should be relaxed with lobelia (not given in doses to produce
vomiting), and as soon as the patient is thoroughly under its influence,
the manipulations may be resumed. When there is any difficulty
experienced in putting back the "breach," or rupture, professional
assistance should be promptly summoned. After the reduction of the
rupture, a truss should be properly adapted, applied, and constantly
worn, to prevent the protrusion of the intestine.

[Illustration: Fig. 4.
The above cut fairly illustrates a case of Double
Inguinal Hernia, complicated with Hydrocele,
cured at the Invalids' Hotel
and Surgical Institute.]

Of the latter instruments there are several hundred varieties for sale
throughout the country. With the exception of about one-half dozen
forms, which embody the true principles of a proper truss, they are,
without exception, harmful. Unless proper support be given to the walls
of the abdomen, and that without constant pressure, a truss does harm;
then, too, the shape of the pad must be such as to avoid pressure where
it is not required; otherwise, as in the case where a small ring is worn
upon a finger, there is a gradual loss of strength and a depression
formed in the healthy tissue, which can be plainly seen and felt. In
this way trusses do harm, and such evil consequences may follow the
_improper_ application of a _good_ truss.

SURGICAL TREATMENT. When the hernia has become strangulated and cannot
be returned by manipulation, a surgical operation is necessary. Whenever
the necessity for such a procedure is apparent, it should be performed
_immediately_, for the greater the delay the greater the liability to
fatal results. The operation consists in cutting down upon the
strangulated bowel, thus relieving it of its constriction and
facilitating its replacement. It is a delicate operation, and must be
skillfully performed. After the operation, the patient requires
appropriate hygienic treatment.

[Illustration: Fig. 5.

This figure illustrates a Double Inguinal
Hernia, of large size, which was permanently
cured by our improved method of
treatment. The left side (_b_) shows the _direct_
descent of the bowel into (_c_) the scrotum,
while on the right side (_a_) the rupture
is indirect, the