. Abdominal hernia : its diagnosis and treatment. well as locating the relative position of thetumor. With the tip of the finger in the external ring it canusually be decided whether the protrusion is tc5 its inside,—-direct hernia.—or to its outer side and a little lower;—femoralhernia. Here the author would again caution the examineragainst passing the finger ?// the canal. Such method ofexamining the canal is reprehensible and may lead to herniawhere none exists. There is one small round tumor forming in the femoralspace that is easily reducible, that has the typical shape offemoral hernia,
. Abdominal hernia : its diagnosis and treatment. well as locating the relative position of thetumor. With the tip of the finger in the external ring it canusually be decided whether the protrusion is tc5 its inside,—-direct hernia.—or to its outer side and a little lower;—femoralhernia. Here the author would again caution the examineragainst passing the finger ?// the canal. Such method ofexamining the canal is reprehensible and may lead to herniawhere none exists. There is one small round tumor forming in the femoralspace that is easily reducible, that has the typical shape offemoral hernia, and that is frequently mistaken by the examiner,viz., a varicose condition of some of the vessels of this of some of the larger vessels of this region mayprove very perplexing to those of moderate experience (fig. 31:2 ABDOMINAL HERNIA. 172). The points of differential diagnosis are first, and mostimportant, great ease of reduction in varix; second, the tluidfeel of the contents and peculiar impulse upon coughing. Fig. A left varicose saphena vein. {EccUs.) Femoral hernia, as previousl} stated, is slow and ratherdifficult of reduction, and it is almost always a necessity thatthe patient should be recumbent before it can be accomplished.\arix, on the contrary, is soft and readily compressible withthe patient in the standing position. By pressure over it withthe hand it cpiickly disappears and as quickly returns when the FEMORAL HERNIA. 313 pressure is removed. Furthermore, there is a strong impulsein the varix when the patient coughs which does not exist infemoral hernia. The impulse gives the sensation of thrill rather than of expansion. It is the impulse of fluid, and hasthat characteristic feel under the fingers. A single varix ofthis type may exist without other vessels of the region, or on Fig. 173.
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