ore the intestines to the cavity of the abdomen
in consequence of the presence in them of large hard masses of fecal
matter, which no treatment proved adequate to remove, and which
finally occasioned the death of the patient. Rupture of the siphac is
most frequently the result of accident, jumping, straining in lifting
or carrying heavy weights, or in efforts at defecation, or of shouting
in boys or persons of advanced age, or even in excessive weeping,
etc. It is distinguished from hernia by the fact that in hernia pain
is felt in the testicle, radiating to the kidneys, while in rupture
of the siphac a swelling on one side of the pubes extends into the
scrotum, where it produces a tumor not involving the testicle. Rupture
of the siphac, he says, is a lesion of the organs of nutrition, hernia
a disease of the organs of generation. Accordingly, in the pathology
of Gilbert, the term hernia is applied to hydrocele, orchitis and
other diseases of the testicle, and not, as with us to protrusions of
the viscera through the walls of their cavities.

In young persons, he tells us, recent ruptures of the siphac may be
cured by appropriate treatment. The patient is to be laid upon his
back, the hips raised, the intestines restored to the abdominal cavity
and the opening of exit dressed with a plaster of exsiccative and
consolidating remedies, of which he furnishes a long and diversified
catalogue. He is also to avoid religiously all exercise or motion, all
anger, clamor, coughing, sneezing, equitation, cohabitation, etc.,
and to lie with his feet elevated for forty days, until the rupture
(_crepatura_) is consolidated. The bowels are to be kept soluble by
enemata or appropriate medicines, and the diet should be selected so
as to avoid constipation and flatulence. A bandage or truss (_bracale
vel colligar_) made of silk and well fitted to the patient is also
highly recommended. If the patient is a boy, cakes (_crispelle_?) of
_consolida major_ mixed with the yolk of eggs should be administered,
one each day for nine days before the wane of the moon. If, however,
the rupture is large in either a boy or an adult, and of long
standing, whether the intestine descends into the scrotum or not,
operation, either by incision or by the cautery offers the only hope
of relief. Singularly enough too, while Roger devotes to the operation
for the cure of hernia nearly half a page of his text, Gilbert
dismisses the whole subject in a single sent