388 DISEASES or the intestines. 



opening the sac, to guard against wounding the gut, and especially when 

 the parts are much distended. The best mode of proceeding is, first, with 

 the middle of the blade, to scrape through some of the exterior fibres, 

 and afterwards, with the forceps, to dissect up, layer by layer, until we 

 arrive at the innermost serous layer, that immediately enveloping the 

 gut. Into this a hole is to be made, only large enough at first to admit 

 the director, by the aid of which, either with the bistoury or the scissors, 

 the aperture is to be sufficiently dilated. The incarcerated intestine, 

 evolving under the knife, is now to be drawn out of the sac, and main- 

 tained extended by the pressure of a linen cloth moistened with some 

 simple mucilaginous liquid, in order to facilitate getting at the stricture. 

 The operator is then to pass one or two fingers into the hernial sac, and 

 carry them onward to the seat of stricture ; against which he must keep 

 them steadily maintained, so that they may serve as a director to the probe- 

 pointed bistoury, which is to be passed flatwise along them, with its edge 

 turned outwards, and thus insinuated within the stricture. Being certain 

 that the bistoury has passed the neck of the hernia, he has nothing fur- 

 ther to do than to turn its edge forwards, still keeping it inclined out- 

 wards; and immediately he finds the stricture divided, the liberated gut 

 will slip back into the belly, either all at once or by degrees. Some cases 

 will be found to require an extension of the incision, or some further di- 

 vision of the stricture : much discretion, however, is requisite in these 

 secondary cuts, inasmuch as the return of the hernia is always to be less 

 apprehended after small incisions. Should the gut not spontaneously 

 recede, a little dextrous manipulation may accomplish its return ; in any 

 case it will never be required to pass the hand into the rectum. 



M. Renault mentions two cases which occurred to him in 

 1836^ in illustration of this operation. 



In the first he practised herniotomy, as described and recommended by 

 Girard. He cut through and turned up the scrotum and dartos, and then 

 penetrated with caution into the hernial sac, in which he found nearly two 

 feet of intestine. He unravelled it, and gave it to an assistant to hold 

 while he divided the ring ; which done, with great difficulty he returned 

 the whole into the abdomen. A clam was then applied upon the cremaster, 

 and M. Renault was congratulating himself on the fortunate termination 

 of the operation, when, the animal making a sudden plunge, the intestine 

 again escaped through the ring, separated or lacerated the fibres of the 

 cremaster above the clam, and protruded again quite as much as before. 

 The intestine was once more returned, and the lips of the scrotal 

 opening now held together by the continued suture : but all hope had 

 fled ; the animal died a few days afterwards. 



A novel Operation. — As the above accident might often occur — it not 



