HERNIA. 411 



During the operation certain accidents may occur, including 

 eventr'ation, an extra vaginal hernia and injuries to the intesti7ies. 

 At the j)resent time, eventrations are rare, by reason of the fact 

 that the division of the superior ring itself is no longer per- 

 formed. Yet they may occur through an accidental slip of the 

 knife, or a tearing of the walls of the vaginal sheath during ma- 

 nipulation for the reduction, and the accident is usually a fatal one. 



Of extra vaginal hernia, Bouley says: "While making the in- 

 cision of the neck, sometimes the cremaster muscle is divided in 

 the direction of its length ; an accident possible, especially when 

 one uses the concealed herniotome, and when too much freedom 

 is allowed to its blade. It is then possible that the intestines may 

 become engaged through this incision, and appear outside of the 

 vaginal sac, above the inguinal ring. If at this moment, by mis- 

 aj)plied taxis, the intestines should fail to re-enter the cavity of 

 the sac, eventration may take place. But if, on the contrary, the 

 intestine is first carefully returned into the vaginal cavity, and 

 then into the peritoneum, the edges of the peritoneal opening of 

 the canal being intact, the intestines will then be prevented from 

 making another exit." 



Wounds of the intestines may take place either through a 

 misdu-ection of the bistoury during the struggles of the animal, 

 or possibly from the nails of the operator or his assistants, and 

 the fact of their possibility suggests a sufficient hint touching the 

 obvious means of obviating their occurrence. The gravity of 

 these injuries will be measured by their extent. 



Old Inguinal Hernia. 



Old, or chronic inguinal hernias, are those of which the charac- 

 teristic condition is that owing to the state of dilatation of the vag- 

 inal sheath, the intestine contained in it is enabled, without jeop- 

 ardy to the life of the patient, to continue its function in the same 

 manner as if it had remained in the open cavity of the abdomen. 

 The vaginal sac has in this case become a kind of large diverticu- 

 lum of such dimensions as to allow, without interference, the work 

 and motion of the intestinal tract, lodged within it, to go on in a 

 natural way. These hernias are divided into continued, or perma- 

 nent and i?iterniittent — a division elsewhere alluded to — but they 

 may also be distinguished as sinqyle and complicated. 



