424 OPERATIONS ON THE DIGESTIVE APPARATUS. 



the opening, and the cord thus separated from its adhesions. 

 After a while, the pressure, which was quite firm at first, dimin- 

 ishes, and the intestine gradually returns to its position. This 

 mode is slow in its steps, but it is successful in its results, even 

 in cases of obstruction and of strangulation. When it fails, it is 

 because of the strength of the adhesions between the cord and 

 the abdominal walls, or the inguinal canal. 



(c) Division of the Stricture through the JRectum. — To per- 

 form this operation, invented by Schmidt, a trocar about sixty- 

 five centimeters (some thirty-five inches) long is necessary. This 

 trocar has its point attached with a screw, in order to permit its 

 removal and the substitution of a blunt bistoury. With the left 

 hand in the rectum, a fold of that intestine is secured a little be- 

 hind the point of stricture, and the trocar pushed through it. 

 The stylet of the instrument being then withdrawn, leaving the 

 cauula in place, the point of the trocar for the bistoury is then 

 inserted, whiLe the hand, stiU in the rectum, leaves the rectal fold 

 loose, feels for the spermatic cord, raises it and guides the bis- 

 toury against it, which with comparative ease completes the di- 

 vision of the stricture. 



{d) Division of the Stricture after Incision of ttie Flank. — 

 Through an incision made in the middle of the right flank, the 

 hand is introduced and grasps the spermatic cord, which is then 

 divided with a bistoury cache, or, which is better, with the inside 

 edge of a hook kept sharp, similar to the hook used in some cases 



Fig. 390.— Sharp Hook for the Section of the Testicular Cord. 



of distokia. The hernia being reduced, and the wound in the 

 flank brought together with sutures, a circular bandage is appUed 

 around the abdomen. With the reduction of the hernia, what- 

 ever may have been the means of accomplishing it, the symptoms 

 subside, and the treatment is completed by the administration 

 of laxatives or sedatives, rectal injections, etc., as tke indications 

 may require. 



