288 HEKNI.E. 



than six hours (to adopt H. Boule/s judicious limit), we should seek, 

 by manipulating the hernia, to reduce its size and to push it back 

 into the abdomen, while gently pulling it down (the animal being 

 on its back) from the inside with the other hand, or while having 

 this done for us by a capable assistant. Colonel Nunn, who has 

 had much experience of this accident in India, points out to me 

 that the return of the loop is greatly facilitated at this stage, by 

 removing its contained gas and fluid by means of an aspirator (p. 

 79) or hypodermic syringe under antiseptic precautions. By doing 

 this, he has had but little trouble in returning the escaped portion 

 of the intestine, without having to resort to the somewhat hazardous 

 operation of opening the scrotum ; although subsequently there is 

 generally some difficulty in keeping it in the abdomen. There is 

 little or no danger in using an aspirator in this manner. If our 

 efforts prove unsuccessful, we should open the scrotum and its 

 lining membranes, by an incision, from front to rear, over the 

 tumour, taking great care not to wound the bowel. If our chief 

 object is to save the life of our patient, we should remove the 

 testicle (supposing that the animal is an entire), which we ca-n do by 

 torsion (p. 654) or by the ecraseur (Fig. 113) The removal of the 

 testicle of the affected side not only facilitates the returning of 

 the imprisoned parts ; but also greatly diminishes the danger of a 

 recurrence of the hernia. If, however, the horse is useful only 

 for his procreative powers, we may leave the testicle intact, with 

 the knowledge that a good recovery is very doubtful, owing to the 

 great difficulty of preserving the integrity of the testicle after 

 having exposed it. Even if we are successful in this, the animal 

 will in future be specially liable to this form of hernia. With the 

 escaped parts exposed to view and touch, we shall be in a more 

 favourable position than we occupied before opening the scrotum, 

 to decrease the volume of the tumour by carefully applied massage, 

 and by drawing off as much of the watery and gaseous contents 

 of the tumour, as we can conveniently do with an aspirator. 

 Having got the tumour as small as possible, we may again try to 

 reduce it by pulling from within and pushing from without. When 

 we are endeavouring, from the inside, to draw the contents of a 

 strangulated hernia through the inguinal canal, we should take 

 hold of both ends of the loop of intestine; for we cannot free the 

 loop by pulling at only one of its ends. In manipulating the 

 bowel, we should be most careful not to injure it by using undue 

 force, and should remember that the longer it has been strangu- 

 lated, the easier it can be torn. The progress of the destructive 

 changes in the loop of intestine, will be marked by the red of 

 early congestion passing into the purple of inflammation, and 

 ending in the blackness of mortification. 



