INGUINAL HERNIA. 291 



uccasioned by the outer skin and soft parts lying below it, I 

 select a short but carefully-disinfected pair of clams, and make an 

 incision through the skin, large enough to allow the clams to be 

 pushed to the bottom of the wound, and to be just under the 

 inguinal ring. The skin is then brought over them and sutured, 

 thus retaining them in the wound. If neither fever, swelling, nor 

 other disturbance is marked during the next few days, I allow 

 the clams to remain in position for a week. On removal, healthy 

 granulations will be found, unaccompanied by pus formation, and 

 the wound heals in a short time'^ (Dollars translation of MoUer's 

 " Veterinary Surgery''"). These precautions will prevent the bowel 

 or its connecting membrane from becoming exposed, in the event 

 of its again descending through the canal. Removing the testicle 

 or cutting down on the constriction, will, however, so far obviate 

 the risk of a recurrence of the hernia, that we may dispense with 

 the use of a clam, the presence of which will be apt to give rise to 

 blood poisoning, on account of its unavoidable interference with 

 the drainage of the part. A clam cannot, of com'se, be used, when 

 we are trying to preserve the testicle. The action of the clam is 

 to cause strangulation of the part imprisoned between its branches, 

 with subsequent inflammation and union by granulation. To 

 accomplish this, the pressure of the clam should be regulated, so as 

 to effect adhesion without causing such rapid mortification that 

 the clam would drop off before the opposing surfaces had united, 

 in which case, the action of the clam would be nullified. 



When deciding the question whether it was the disease or the 

 treatment which had killed the patient in case of death after hernia 

 has been reduced by taxis, we should remember that there have 

 been many instances of recovery after the intestine had become 

 almost black. If, before treatment, inflammation had advanced 

 to such an extent as to suggest the probability that its action had 

 weakened the strength of the tissues, the operation of freeing the 

 constriction by means of a knife should be at once performed in 

 preference to more hazardous efforts at reducing the rupture solely 

 by manipulation. 



Chronic Inguinal Hernia. 



We may apply this term to inguinal hernia which is not 

 necessarily followed by strangnlation, and which consequently 

 can exist for a lono- time without «2:ivino: rise to acute svmptoms. 

 It is made manifest by a soft and generally painless swelling in 

 the scrotum, which, if we, as advised by Percivall,^ grasp with one 

 or both hands, softly but closely, and then let another person 

 *' cough " the horse, will be found to suddenly expand under 



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