TREATMENT OF STRANGULATED HERNIA. 527 



sutures. Healing is often completed without pus formation. But 

 in large animals, and especially in herbivora, suturing the hernial 

 ring often presents insurmountable obstacles, because the abdominal 

 walls are too firm and resistant to allow of approximation and union. 

 Where the aperture is slit-like, further trouble is often caused by 

 the hernial contents having become adherent to the abdominal walls, 

 and dissection is both difficult and very dangerous. After freeing 

 the bowel, or cutting off the omentum, or, if necessary, ligaturing 

 it, the hernial contents are returned to the abdomen and the ring 

 sutured. To assist union of the cicatrised edges of the hernial ring, 

 they can be pared with the knife or scissors, or numerous superficial 

 incisions made. In inserting sutures, the left hand holds back the 

 viscera to protect them from the needle. The edges are brought 

 together with strong, carefully sterilised silk, the hernial ring being 

 as far as possible closed. Where tension is great, quilled sutures 

 are useful. The skin is afterwards brought together with strong 

 material, a deep hold being taken. 



It is scarcely necessary to add that the strictest antisepsis must 

 be observed, without which there is always danger of peritonitis, 

 and closure occurs far less rapidly and certainly. Finally, a radical 

 cure may be effected by applying a clam to the neck of the hernial 

 sac, a method generally employed in umbilical hernia, and described 

 under that head. 



Treatment of strangulated herniae. It has already been stated that 

 incarceration is always dangerous, and that treatment should at 

 once be resorted to. The latter consists primarily in attempting 

 reduction. For this purpose the animal should be placed so that 

 the hernia is as elevated as possible, as the contents then tend to 

 return to the abdominal cavity by their own weight. The rest- 

 lessness of horses, and the tendency they have when cast to contract 

 the abdominal muscles, often cause difficulty in reposition. To 

 avoid this, anaesthesia should be produced, without which reposition 

 cannot be satisfactorily effected in large animals. In horses, 

 chloroform, in cattle, chloral or chloroform, and in dogs, morphine 

 is usually employed. In oxen it is often preferable to slaughter 

 the animal, because the use of chloroform may make the flesh unfit 

 for food. 



It should be remembered that the obstruction always lies near 

 the hernial ring, and therefore that any attempts at reduction must 

 be directed to this point, pressure at the base of the hernial sac being 

 mere waste of time. In extensive hernia, the sac is grasped with 

 both hands, the points of the fingers lying near the hernial opening. 



