408 



OPERATIONS ON THE DIGESTIVE APPARATUS. 



efforts must not be persevered in too long. If not successful al- 

 most immediately, it is better to have recourse at once to the in- 

 cision of the neck of the sac than to expose the intestine to the 

 subsequent effect of pressures or tractions of which the termina- 

 tion may be a fatal gangrene. The following steps are recom- 

 mended by Bouley in making this iucision. Says this author : "One 

 assistant takes hold, with both hands, of the edges of the incision 

 made through the vaginal sac, stretching them into a funnel shape ; 

 another draws the testicle outward and backward, to stretch the 

 cord. Then the operator having explored with his finger the con- 

 dition of the neck, introduces the blunt bistoury or the herniotome 

 (Fig. 386) as far as the neck of the sac, taking for his guide the 

 index finger of his right hand (Fig. 388), introduced 

 into the neck or canulated director, and holding the 

 instrument in such a manner that its 

 back rests against the pulj) of the fin- 

 ger which supports it, and its sharj) 

 edge turned outward, corresponds to 

 the stiffened band of the neck, to- 

 wards the internal face of the thigh. 

 This band will thus become stretched 

 over the knife in such a manner that 

 it divides itself upon the sharp edge 

 of the instrument, with the aid per- 

 haps of the slightest pressure made 

 by the finger which supports it. The 

 important point is to make a very hm- 

 ited incision, dividing only the thick- 

 ness of the vaginal sac and its fibrous 

 covering, and avoiding the wounding 

 of the cremaster, that being one of the 

 conditions of the closing of the sheath. 

 The division once made, the degree of 

 dilatation of the neck is readily made 

 out, and if the finger can be easily in- 

 troduced into it, the reduction of the 

 hernia becomes then an easy task. 



The modus o2)erancU by the use of 

 the herniotome differs but little from 

 the preceding. Allien this instrument 



