HEENIA. 407 



guides the bistoury, with which the hernial sac is now freely 

 opened, in front and behind. This free cutting aUows the escape 

 of all the serous or sero-sanguineous fluid contained in the sac, 

 varjing in quantity according to the duration of the hernia. 



The contents of the hernial sac are now exposed. They consist 

 of the testicle, pushed outward, agarast the commissure of the 

 ring ; the loop of the intestine, placed on the inner side of the 

 spermatic cord, rarely extending as far down as the testicle, but 

 usually reaching to the level of epididymis, and again, not un- 

 commonly remaining in the condition of a huhonoale. But what- 

 ever may be the dimensions of the protruding loop, the intestine 

 is always easUy recognized by the roundness of its form, the smooth- 

 ness of its surface and its color, which may range from various 

 shades of red to bluish black. It is also recogTiized by the changes 

 which have taken place in its consistency, resulting from the bloody 

 and serous infiltration which has taken place in its structure. The 

 intestine should now be carefully wiped off with a soft, fine sponge, 

 or washed with lukewarm water, in order to free it from any de- 

 posits or adhesions of serous or bloody matter that may be present. 



The opening of the hernial sac should be immediately followed 

 by the exploration of the neck with the index finger, vnth a view 

 to the determination of the exact point where the strangulation 

 exists, and to judge of its degree of tightness. This will not be 

 found upon the superior opening of the inguinal canal, as thought 

 by Girard, D'Arboval, Hertwig, Hering, Lafosse, Rey, Verrier and 

 others, but should be looked for two or three centimetres below that 

 opening, as demonstrated by Bouley ; that is, where the neck of 

 the vaginal sac is situated. This point made out, if the hernia is 

 very recent, and the intestine has not yet become the seat of thick- 

 ening, a few tactical manipulations can be appHed, the internal 

 face of the vaginal sac having first been lubricated with sweet oil, 

 or some mucUaginous substance, or even oil of belladonna ; and 

 even cool irrigation has been of service. In the performance of 

 this taxis the first step is committed to the assistant, who stretches 

 both borders of the sheath in order to separate them in the form 

 of a funnel, the testicle being drawn outward, in order to stretch 

 the cord also. The operator then appUes both hands upon the loop 

 of the intestine, and with moderate and gradual pressure endeavors 

 to push it through the neck of the vaginal sac. Rectal taxis applied 

 at the same moment may also be of great assistance. But these 



