INGUINAL HERNIA. 387 



The Clams ought to be applied immediately after the reduction of the 

 hernia. In putting them on, care must be taken to draw out that part 

 of the scrotum to which the sheath of the vaginal canal is adherent, and 

 to push them up as close as possible to the belly prior to shutting and 

 confining them by ligature. 



In the case of irreducible hernia, we must lay open the hernial sac, and 

 by the introduction of the finger to ascertain the nature and situation of 

 the stricture, proceed to release the contained portion of intestine ac- 

 cording to the rules laid down for strangulated hernia. After the return 

 of the gut, the clams are to be applied upon the cord, with the additional 

 precaution that the opening made in the sac be included. 



OPERATION FOR STRANGULATED HERNIA.— 

 The intention of this operation is twofold : — first, to remove 

 the obstruction or impediment to the return of the stran- 

 gulated viscus into the belly ; secondly, to set up an ob- 

 struction to its descent again into the scrotum, or escape 

 elsewhere. Towards the accomplishment of these objects it 

 becomes necessary — first, to lay open the hernial sac; 

 secondly, to ascertain the seat and nature of the stricture ; 

 thirdly, to divide or otherwise remove the stricture; fourthly, 

 to return the hernia; fifthly, if required, to finish by cas- 

 tration. The instruments, &c., required are — scalpels, 

 straight and curved bistouries and directors, dissecting 

 forceps, curved scissors, clams, ligatures, clam-pincers, 

 sponge, and a pailful of warm water. 



Supposing the case to be iNGiJiNAii heknia, the animal being cast 

 upon his back, many advantages will be found to accrue to the operator 

 should the situation afford a beam or a ring or anything over or through 

 which he can manage to pass the hobble-rope coming from the hind leg of 

 the hernial side, whereby he may obtain the power of extending it at 

 pleasure, and abducting it from the opposite limb. Everything ready, 

 and the assistants properly posted, the operator retaining the most handy 

 of them in attendance on him, will extend an incision, begun about 

 opposite to the external ring, down along the middle of the anterior sur- 

 face of the cord, for the space of two or three inches ; at the same time, 

 provided there be no intestine actually within the scrotum, the testicle 

 may be drawn out. The skin being thus divided, the operator will next 

 carefully cut through the dartos, by which he will expose the vaginal 

 tunic, now become the hernial sac, which is recognised at once by its 

 compact albugineous texture. The most scrupulous nicety is required in 



