610 HERNIA, ETC. 



react upon an incarcerated hernia, raise it upwards, and ulti- 

 mately force it back again into the abdominal cavity and retain 

 it there. 



EPIPLOCELE 



Is a frequent companion of enterocele, without adding anything 

 to the importance of the case ; indeed, epiplocele of itself is so 

 far from being dangerous that it has occurred without symptoms 

 either of pain or disordered function. Protruded omentum, 

 without intestine, gives rise simply to a soft indolent tumour 

 in the groin, unvarying in volume, unless it receive additional 

 contents — a circumstance that serves at once to distinguish it 

 from enterocele. I think I may add to this cougliing, as a 

 corroborating diagnostic. M. Eoupp assured M. Girard that 

 in the course of the practice of castration on cart-horses, he 

 had on several occasions met with hernial omentum, and had 

 invariably amputated the protrusion without the slightest ill 

 consequences. 



Tliickening of the membranes will render the dissection of the 

 dartos from the sac both tedious and difficult; and this may 

 exist to such a degree — in one case they were found an inch in 

 thickness — that for the clams we shall be compelled to substitute 

 a strong waxed ligature for the compression of the cord, which 

 should be fastened by a running knot. 



In the case of sarcocele the operator must be guided by circum- 

 stances. Should the tumour consist of intestine principally, the 

 operation is to be conducted the same as for thickened mem- 

 branes. Sarcocele may render the tumour so firm and compact 

 as to deprive it of every sign or feeling of containing intestine; and 

 should the operator neglect to explore the ring, this concealment 

 may lead him into fatal error, in case he might determine on 

 the removal of the sarcocele. Whenever intestine is detected, 

 he must take care to make himself sure about its return before 

 he ventures to apply either clams or ligature to the sarcocelatous 

 swelling. 



Adhesions between the hernial gut and its sac are so rare 

 that M. Girard has seen but one instance of their occurrence ; 

 though it would appear, from what has been already stated, on 

 the authority of Mr. Charles Percivall, that between the testicle 

 and its vaginal covering they are by no means uncommon. 



