TREATMENT OP INCARCERATED INGUINAL HERNIA. 547 



by means of a narrow tape passed through it. The hernial sac, 

 which may be f inch in thickness in chronic cases, is then separated 

 as in the operation for scirrhous cord, and exposed for a considerable 

 extent in an upward direction. The clam or ligature is now applied 

 over the vaginal tunic and spermatic cord in the manner above 

 described, provided no intestine is present in the hernial sac ; but 

 as one must, in the gelding, always be prepared for adhesions, it 

 is best where the slightest doubt exists to open the sac, and by in- 

 troducing the finger to make sure of the absence of intestine or 

 omentum. To prevent injury, the intestine must be separated 

 with the greatest care. For this purpose the scissors are most useful ; 

 and if possible the border of the adherent bowel should be found, 

 and where this cannot be clearly made out, a portion of the wall of 

 the sac can be left adhering to the surface of the bowel and the two 

 replaced together. Pieces of omentum may be ligatured with 

 sterilised material and cut off, or they may be included in the clam 

 without danger. Strecker, in operating on a gelding, used a ligature 

 to close the tunica vaginalis. 



(B) TEEATMENT OF INCAECEEATED INGUINAL HEENIA. 



This must be carried out as early as possible, and in conformity 

 with the general precautions mentioned under " Treatment of 

 Strangulated Hernia?." 



The horse is carefully cast, chloroformed, and laid on its back, 

 the hind-quarters being higher than the fore, which Jessen effects 

 by laying the fore-part in a hollow ; the hind-legs are bent, and, if 

 possible, the leg of the affected side is drawn outwards and backwards, 

 One then endeavours, by pressing on the neck of the hernial sac, and 

 by drawing and turning as described (vide loc. cit.), to effect taxis, 

 the testicle meanwhile being drawn forward. Reposition may be 

 effected by introducing the hand into the rectum and cautiously 

 pulling on the parts in the inguinal canal, but caution must be used 

 in manipulating the hernial sac, and the older the strangulation the 

 greater the care required. 



After complete reduction, the animal is allowed to roll on to the 

 sound side ; the hobbles are loosened, and if the animal remain 

 quiet, it may be allowed to lie for a quarter to half an hour, though 

 it must not be forcibly prevented from rising. 



If, after trying for half an hour, reduction cannot be effected, 

 herniotomy is usually the only resource. For this purpose anaes- 

 thesia should be continued or reinduced ; the hoofs of the hind-legs 



