HEENIA. 403 



manipulations the surgeon may succeed in removing the difficulty, 

 if by that time the testicular sheath continues to be free from con- 

 gestion. But if this ah'eady exists, and the coUcs are increasing 

 in severity, the taxis in the standing position becomes impossible 

 and it will be necessary to throw the animal. This done, he must 

 be placed in the dorsal position, with his hind legs kept apart and 

 his haunches raised as much as possible by bunches of straw. 



In this position, the operator must j)roceed to practice what 

 must be described as an exceedingly delicate massage or taxis 

 ujDon the scrotal sac, both hands being used, in such a manner as 

 to crowd or press the intestinal mass toward the superior opening 

 of the canal. The design of this is to stimulate the cii'culation 

 thi'ough the capillaries, and also to free the cavity of the intestine 

 from the semi-fluid and gaseous contents which may be present, 

 by this means diminishing its volume and facilitating its reduction. 



That this must be done with the utmost caution and patience, 

 needs hardly to be urged. And it should be persevered in for at 

 least a period of thirty seconds before advancing to the other 

 stei3, which consists in gradually pushing the intestine toward 

 the opening. If the protruding loop is not too long, and the 

 massage has succeeded in its design, and the bulk of the tumor 

 has been sufficiently diminished, and, above aU, if the hernia has 

 had but a short existence, it may be within the probabilities that 

 this external taxis alone will be sufficient to reduce it. But such a 

 result cannot be counted on with any degree of certainty, and it 

 is then the simple dictate of wisdom to make assurance sure, if 

 possible, by having recourse to double taxis, and attacking the 

 danger at both its internal and external accessible points. 



For a single operator to undertake the performance of both 

 branches of this compound manipulation can hardly be advised. 

 Few men possess the necessary powers of endurance, and an acci- 

 dent might easily compi'omise the very life of both surgeon and 

 patient. At the least, it involves quite an unnecessary amount of 

 effort and fatigue. All the reasons are in favor of a division of 

 the work, by which a competent assistant will be put in charge 

 of the rectal taxis portion of the labor, while the practitioner in 

 chief will direct and execute all the other steps of the treatment. 



The successful result of the operation will be known at once 

 by the diminution of the tumor, the disappearance of its puffy 

 and tense condition, by the sudden sensation of yielding, felt by 



