326 HERNIA. 



a very narrow hernial opening. These conditions, however, are only dis- 

 tinguished during the course of the operation, and we are then forced to 

 change from the first to the second method of operation. In both methods 

 the skin of the operated region must be shaved and carefully disinfected. 

 We then lift up a fold of the skin corresponding with the axis and the 

 length of the hernia and split it open with a longitudinal incision. This 

 must be made very carefully until we reach the hernial pouch. This is 

 recognized by its irregular surface, which is of a grayish-yellow color ; also 

 by the fact that it is impossible to get an ordinary sound directly into the 

 abdominal cavity. 



Having opened the sac, taking care not to injure the contents, we follow 

 one of the two methods before spoken of— that is, not opening or opening the 

 hernial pouch. 



In the former case we introduce by means of the index-finger a probe- 

 pointed bistoury, or herniotome, between the neck of the hernia and its ori- 

 fice, turning the cutting edge of the knife toward the neck or restricted 

 portion, the dull side of the knife being toward the strangulated portion of 

 the intestine. By means of a small incision the tension becomes greatly 

 relaxed, and reduction is very easily accomplished. If the opening of the 

 hernial pouch is required, we hold up one of its folds with a hooked-shape 

 forceps and split it by means of a knife held flat or a pair of scissors. After 

 the discharge of the fluids in the hernial sac a notch is cut in the hernial 

 pouch by means of the herniotome. The exposed loop of intestines, which is 

 intensely red and inflamed, must be cleaned by means of warm boric-acid 

 water (4 per cent.) or creolin (2 per cent.), taking care not to allow the 

 cleansing fluid to get into the abdominal cavity. This exposed piece of 

 intestine is reduced by the method just described by cutting through the 

 constricted portion and working the intestine back in such a way that the 

 portion of the intestine which was prolasped last must be reduced first. 



If the intestine is much distended by gas, it may be emptied by means of a 

 puncture of a very fine trocar (or the canula of a large hypodermatic syringe). 

 Any degenerated portions of the epiploon must be amputated after being 

 ligated. If the intestine is intensely inflamed or gangrenous, we must either 

 resect it or make an artificial anus. Such operations, however, are ex- 

 tremely rare in the dog. We therefore will not enter into minute details 

 on the subject. 



After reducing the hernia we must close the hernial orifice. For that 

 purpose we place a tight catgut ligature around the entire hernial pouch, 

 which, if necessary, must be isolated, or, better still, we close the pouch and 

 orifice by means of a continuous stitch after having amputated the super- 

 fluous portions of the hernial sac. In cases where no hernial pouch is 

 presented or it has been shoved back into the abdominal cavity it is advis- 

 able to freshen the borders of the orifice by means of a blunt knife or curette ; 

 then stitch it up by a continuous suture of catgut. After thoroughly disin- 

 fecting it for the second time the external wound is to be stitched and cov- 

 ered with an antiseptic dressing, held in position by means of a bandage 

 (eight-tailed) around the body. 



