ACUTE INGUINAL HERNIA. 37 



existence of acute inguinal hernia. You will remember that on the 

 first examination I was able to enlighten you on this point. Whilst 

 the left cord was relaxed and free, and its different parts could readily 

 be distinguished with the fingers, the right was retracted, enlarged, 

 and felt as though inflated ; the two principal parts, the vascular cord 

 and the vas deferens, could no longer be distinguished. At the first 

 touch one could feel that the distended vaginal sheath contained, in 

 addition to the spermatic cord, a loop of intestine swollen by strangu- 

 lation. The clinical characters were such as to leave no doubt regard- 

 ing the condition. 



The horse was cast on the left side, chloroformed, the off hind 

 leg abducted and fixed with lengths of webbing by the usual method. 

 Some attempts at taxis having failed, I was obliged, after preparing 

 the parts, to perform the operation for strangulated inguinal hernia — 

 kelotomy. 



You will recall the stages — free incision of the scrotum and 

 dartos in the long axis of the hernial swelling ; isolation of the mass 

 formed of deeper seated tissues, the vaginal sheath and its contents, 

 by breaking down the subdartoid connective tissue, this isolation being 

 prolonged upwards as far as possible ; puncture of the vaginal sheath 

 at its posterior part, where its parietal la}-er is in contact with the 

 testicle ; laying open the base of the vaginal sheath parallel to the 

 long axis of the testicle for a distance corresponding to the entire 

 length of the latter ; seizing the edges of the sheath by means of broad- 

 jawed forceps ; incision of the outer edge of the hernial ring with a 

 button-pointed bistoury ; washing of the extravasated intestine with 

 boiled water ; reduction commencing with the upper parts of the loop; 

 re-application of the vaginal sheath over the cord ; torsion of these 

 parts ; application of curved clams ; finally, removal of the testicle by 

 dividing the cord half an inch below the clams. 



In this horse the loop of herniated intestine, situated as usual in 

 front of and inside the cord, measured about ten inches in length ; it 

 was severely congested and distended ; its walls were infiltrated with 

 fluid, but were firm, resistent, and not abraded, and there was there- 

 fore no fear of their tearing through under cautious manipulation. 

 The first incision not having given sufficient space, I reintroduced the 

 left index finger into the vaginal sheath as high as the hernial ring, 

 and increased it. xAlthough the opening was sufficiently enlarged, the 

 intestine returned with difficulty. 1 therefore had the horse placed on 

 its back, and whilst one of you exercised traction on the upper part of 

 the herniated loop through the rectum, I recommenced taxis. Re- 

 duction was complete in a few minutes. 



