INGUINAJ. JIKKNIA. 289 



If we ai'e still unsuccessful, or if tlie advanced stage (say, after 

 the sixth hour) of the strangulation precludes any attempt at 

 forcible manipulation, we should lose no more valuable time; but 

 should at once proceed to ease off the constriction, which we may 

 do with a specially-made knife (a herniotome) or probe-pointed 

 bistoury. To facilitate matters, while keeping the patient on his 

 back and under the influence of chloroform, we should, as advised 

 by H. Bouley, attach a rope to the pastern of the hind leg of the 

 affected side, and di'aw that limb well away from the body and 

 bring it forward as much as possible, so as to save the operator 

 from being incommoded by the struggles which the animal will 

 make, even when under chloroform, and to produce muscular re- 

 laxation of the part. To further secure the limb, we may attach 

 the end of the rope to some fixed point, such as a ring in a wall, 

 post, or heavy cart. The best position for us to occupy, is on our 

 knees, behind the animal. The operation of cutting the structure 



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Hfe 



Fig. 113. — Ecraseur. 



which causes the strangulation, is greatly simplified by knowledge 

 of the fact discovered by H. Bouley, that the constriction is not, 

 as we might have thought, at the superior inguinal ring; but 

 about an inch below it. By making an incision at that spot, we 

 avoid the great danger there would be to a recurrence of the 

 hernia by our having increased the size of the superior inguinal 

 ring. The form of herniotome recommended by H. Bouley is a 

 straight probe-pointed knife, the cutting edge of which is only of 

 small extent and situated near the point. We should bear in mind 

 that the loop of bowel will be on the internal side of the cord of 

 the testicle. Having first carefully found out with the index 

 finger the exact position of the constricted spot in the inguinal 

 canal, and having the edges of the wound held open by an 

 assistant, we should place the flat of the cutting surface of the 

 herniotome or bistoury on the pad (the side opposite to the nail) 

 of the index finger of the left hand, if the hernia be on the left 

 side, and vice versa, with the edge turned backwards and the entire 

 end of the blade overlapped by the skin of the finger, so as to 

 prevent it inflicting any accidental injury on the tissues. The 

 other fingers of the hand should grasp the handle of the instru- 

 ment, and the thumb should keep the flat of the blade pressed 



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