416 



OPEEATIONS ON THE DIGESTIVE APPAEATUS. 



To this we may add, with Bouley, that the operation is also 

 indicated when the hernia is exclusively vaginal and of sufficient 

 proportion to interfere with the locomotion of the patient. It is 

 also indicated as a means of preventing its further development. 

 The operation for chronic inguinal hernia identifies itself with 

 that of castration with the use of the clamp, and by the process 

 known as covered testicles, as it is by this alone that the accom- 

 plishment of the ultimate purpose in the reduction of the hernia 

 and release of the strangulation can be obtained. The instru- 

 ments required are those needed in castration. The clamp, how- 

 ever, requires to be of increased length and dimensions, and 



Fig. 389.— Straight and Curved Clamp. 



curved, in order to adapt itself to the parts. A broad cloth, such 

 as a bed sheet, may prove useful to receive and protect the intes- 

 tines in case they shoiild protrude too extensively. 



The animal is place(J in the decubital position on his back, 

 with the leg of the affected side maintained in abduction. Anes- 

 thetics are generally used, especially when there are fears of com- 

 plications, while, in fact, they ought never to be omitted. The 

 operator then, with the convex bistoury, makes carefully, on the 

 inferior border of the hernial sac, an antero-posterior incision, 

 parallel to the median raphe of the scrotal region, cutting through 

 the sMn, the dartos and the first layer of the cellular tissue under- 

 neath. He then with his hands tears the adhesions which exist 

 between the dartos and the tunica erythroidea, in order to enucle- 

 ate the hernial tumor in its entirety. This step is easily effected 

 when the cellular tissue, which covers the fibrous coat, is not in- 

 durated, but if that should be the case when adhesions exist, the 



