528 TREATMENT OF STRANGULATED HERNIA. 



Attempts are then made to diminish or return the contents lying 

 immediately over it, and by gradually applied pressure, to get rid 

 of the obstruction. Cold applications often have a favourable in- 

 fluence, and greatly assist in effecting taxis. In Paris, where stallions 

 are extensively employed and strangulated herniae correspondingly 

 common, the attendants have instructions in such cases to keep 

 a jet of cold water turned on the parts until the arrival of the 

 veterinary surgeon. It is said that when so treated the majority of 

 cases can be reduced by taxis. 



Where the bowel is thought to be twisted on the abdominal side 

 of the ring, the sac should be moved sideways, so as to lift the twist 

 and set free the bowel contents. This must be done slowly but 

 continuously and in different directions, because it is impossible 

 to tell exactly where the obstacle lies. A gurgling sound may then 

 sometimes be heard, indicating the evacuation of the imprisoned 

 intestine. Diminution of the swelling under the fingers is a still 

 more favourable sign. Reduction may sometimes be effected by 

 a hand in the rectum exercising very cautious traction on the 

 incarcerated portion of bowel. The greatest care is, however, 

 required. 



Failing reduction by this method within half an hour, an incision 

 (herniotomy) must be made, or, under certain circumstances, may 

 be resorted to at first. Should it be clear that the displaced intestine 

 is already semi-necrotic or is ruptured in the hernial sac, one dare 

 not proceed to reposition on account of setting up peritonitis. The 

 longer, therefore, strangulation has continued, the more careful 

 should the operator be in attempting reduction. Inflammation of 

 the hernial sac and emphysema of the skin clearly point to rupture 

 of the bowel having taken place, a condition which is usually fatal 

 in animals. 



Incision (herniotomy) is resorted to, to remove strangulation, 

 and may be carried out in various ways. In human surgery a 

 distinction is made between hernial incision without opening the 

 peritoneal cavity, and a similar operation with division of the 

 peritoneum. The first or external herniotomy offers great difficulties, 

 but was formerly more often practised than at present ; nowadays 

 the second method, or internal herniotomy, is more frequently resorted 

 to as the use of antiseptics has greatly diminished danger from 

 peritonitis. The same is true in animals. The procedure in per- 

 forming the external operation is as follows : — The seat of operation 

 is carefully disinfected, the animal anaesthetised and placed in a 

 suitable position, and an incision, which must extend the entire 



