286 HERNIA. 



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 the 

 efforts prove unsuccessful, open the scrotiun. and its lining mem- 

 branes, by an incision, from front to rear, over the tumoui-, 

 taking great care not to wound the bowel. If the chief object 

 is to save the life of the patient, remove the testicle (supposing 

 that the animal is an entire), which can be done by torsion (p. 

 664) or by the eoraseur (Fig. 113). The removal of the testicle 

 of thfe 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, leave the testicle intact, with the know- 

 ledge 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 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 that 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 can be conveniently done with an aspirator. Having 

 got the tumour as small as possible, again try to reduce it by 

 pulling from within and pushing from without. When en- 

 deavouring, from the inside, to draw the contents of a strangu- 

 lated hernia through the inguinal canal, take hold of both ends 

 of the loop of intestine ; for the loop cannot be freed by pulling at 

 only one of its ends. In manipulating the bowel, be most careful 

 not to injure it by using undue force, and remember that the 

 longer it has been strangulated, 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. 



If still unsuccessful, or if the advanced stage (say, after the sixth 

 hour) of the strangulation precludes any attempt at forcible 

 manipulation, lose no more valuable time; but at once proceed 

 to ease off the constriction, which may be done with a specially- 



