HEENIA. 405 



duction by direct traction with the hand thus introduced into the 

 abdoinen. 



The operation of herniotomy is that which consists in the 

 section of the neck of the vaginal cavity. It is the proper opera^ 

 tion toTC strangulated hernia. Bouley has said: "This operation 

 is not, as one may be inclined to think, a last resource, which is 

 not to be used except after the taxis, under its various forms, has 

 been appUed and failed. Far from it. We beheve, on the con- 

 trary, that in the horse, the taxis is a means of treatment which 

 is truly indicated only in the first five or six hours of the descent 

 of the intestine ; that even, ia this first period of time, one must 

 not use it too much nor too long, from fear of the compUcations 

 which might arise through the rectal manipulations, and that 

 after this limit of a few hours has elapsed, it is better to have re- 

 course immediately to the operation, without trusting to vaia 

 hopes from the use of the taxis." The operation is comparative- 

 ly a simple one, the dangers which were formerly apprehended 

 having been greatly reduced by a better knowledge of the seat of 

 the strangulation, and of the parts to be divided, and the ratio of 

 mortality is now so small — forty-two recoveries out of fifty-two 

 operations — that hesitation is no longer justifiable. 



The instruments required for this operation are straight and 

 curved bistouries, scissors, an ordinary director, a herniotonie 

 (Figs. 384a, 385), or blunt, straight bistoury, and a pair of ciu'ved 

 clamps with strong cords to secure their b]:anches. The hernio- 

 tonie is a bistoury-cache, which, however, since the use of general 

 anesthesia, has been replaced by the blunt, straight bistoury, en- 

 ables the operator to divide the neck of the vaginal sheatTi in the 

 right place with more certainty than heretofore, and to regulate 

 more accurately the dimensions necessary to relieve the strangu- 

 lation. The director which is best adapted for use in herniotomy 

 is one which has a flat, lanceolated, grooved surface at one end, 

 and which, while it guides the blade of the bistoury, contributes 

 hkewise to the protection of the intestine against the possibility 

 of injury by the sharp edges of the bistoury. 



The patient to be operated on is laid upon a soft bed, anes- 

 thised as completely as possible, and placed upon his back. The 

 hind leg corresponding to the side where the hernia is located is 

 freed from the hobble, secured with a rope, and carried outward 

 in abduction, with the rope made fast to a fixed point near by — 



