INGUINAL HERNIA. 391 



circumstances be determined on ; and there is danger not 

 only at tlie time of the operation, but after it is finished. 

 In a prediscovered or even suspected case of this kind, it is far 

 better that we should abandon our own and betake ourselves 

 to the French method of performing castration — to that 

 which by them is called a testicule convert. The hernia 

 being reduced, the wooden clams are to be appUed upon the 

 vaginal covering of the spermatic cord, and secured as 

 close as possible against the belly ; special care being taken 

 that no knuckle of intestine is left included within their 

 gripe. 



Even in a case where the vaginal tunic has been opened 

 before any discovery of the hernia has happened to be made, 

 after having effected the return of the gut, instead of pro- 

 secuting the operation according to the English fashion, it is 

 advisable to have recourse to the French plan, and to en- 

 deaveur to finish the operation still a cordon convert, by 

 detaching the vaginal tunic from its connexion with the 

 scrotum, and extending it afterwards upon the cord, so that 

 it may become included, together with the cord, within the 

 clams. Cases do unfortunately occur, however, in which, 

 owing to the impetuous and slippery descent of the hernial 

 gut from the moment it becomes liberated from its confine- 

 ment within the vaginal tunic, all our eff*orts to return, or 

 even restrain the protruding bowel, prove unavailing, coun- 

 teracted as they continually are by the struggles of the 

 animal and the contractions of the abdomen. 



In such perilous and embarrassing circumstances, it is not without 

 danger we resort to the expedient of introducing the hand into the 

 rectum to aid the reduction, which should always be most actively pro- 

 secuted during the interval the animal remains most quiet. Should 

 every varied effort at reduction prove unsuccessful, the patient ought to 

 be bled as he lies ; after which we may try the effect of emollient muci- 

 laginous fomentations to the bowel. It would also be well worth our 

 while to make trial of the tobacco enema. All these means failing, 

 either to abate suffering or sufficiently relax parts to render our renewed 

 efforts more successful, the case may be regarded as hopeless. 



In a case of strmigulation, the stricture, of course, must be divided ; 

 though even this is a proceeding which does not always answer. When 



