HERNIA OR RUPTURE 



Where strangulation is known to have existed for some time this should 

 be resorted to at once without delay. 



Under such circumstances the intestine will be inflamed, swollen, and 

 soft, and may be easily torn or fatally damaged in any attempt to relieve it 

 by taxis. 



The operation referred to (herniotomy) consists in enlarging the 

 internal abdominal ring in order to remove 

 the constriction and allow the gut to pass 

 back into the belly. 



For this purpose the patient must be 

 kept under the influence of chloroform and 

 strict antiseptic methods observed. The skin 

 and underlying membrane (dartos) are cut 

 through and carefully dissected from the 

 peritoneal sac (tunica reflexa) in which the 

 gut is contained. A small opening is now 

 made into the sac, and the finger passed 

 along it in the direction of the internal ring- 

 in search of the constricted spot. When this 

 has been found the herniotome is passed into 

 the opening, and, following the finger, is 

 brought to the seat of strangulation ; the 

 back of the instrument is then turned towards 

 the bowel, and the blade towards the outer 

 part of the ring. It is now brought into 

 action by opening the handles. A very slight 

 incision is sufficient to set free the strangu- 

 lated bowel, unless, as a result of inflamma- 

 tion, it has become adherent to the sac. 



Should this be found to be the case the adhesions must be carefully 

 broken down with the finger and the parts returned. 



Castration by the " covered operation " should follow liberation of the 

 gut. In this method the tunica vaginalis reflexa and the spermatic cord 

 are securely included between a pair of clamps, which must be adjusted as 

 high up above the testicles as possible. After the wound has been freely 

 dressed with some antiseptic dressing the patient is allowed to rise. 



Williams, in his Principles and Practice of Veterinary Surgery, in 

 referring to this operation, observes: "I consider this method a very 

 undesirable one, and calculated to be succeeded by very unsatisfactory 

 results; and even if it were always successful, I fail to see the advantage 

 of dissecting the skin and dartos muscle from the tunica vaginalis, and 



A A, Intestine. B, Interna] abdominal 

 ring. C, Inguinal canal. D, Knuckle of 

 intestine. K, Testicle, ami r its enclosing 



