INGUINAL HEENIA. 287 



made knife (a hemiotome) or probe-pointed bistoury. To 

 facilitate matters, while keeping the patient on his back and 

 under the iniluence of chloroform, attach a rope to the "pastern of 

 the hind leg of the affected side, draw 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 relaxation of the part. To further secure the limb, 

 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 kiiees, behind the animal. The operation of cutting the 

 stricture which causes the strangulation, is greatly simplified by 

 knowledge of the fact discovered by H. Bouley, that the constric- 

 tion 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 in a recurrence of 

 the hernia by having increased the size of the superior inguinal 



Fig. 113. — Ecraseur. 



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. Bear in mind that 

 the loop of the 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 hemiotome 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 instrument, and the 

 thumb should keep the flat of the blade pressed against the pad 

 of the index, which should then be passed into the scrotum and up 

 to the constricted point in such a manner that the flat of the 

 knife will be next to the outer side of the inguinal canal, the 

 intestine next to the inner side, and the index finger between the 

 two. The knife should now be made to revolve on its back, so 

 as to bring its blade at right angles to the flat of the index finger. 



