INTERNAL HERNIOTOMY. 
271 
made to again bring the animal into the position in which these symptoms 
have occurred, and to further diminish the size of the sac. 
Failing reduction by this method within half an hour, an incision 
must be made, or, under certain circumstances, may be resorted to at 
first. Should it be clear that the displaced intestine is already semi- 
necrotic or is ruptured in the hernial sac, one dare not proceed to 
reposition on account of setting up peritonitis. The longer, therefore, 
strangulation has continued, the more careful should we be in attempting 
it. Inflammation of the hernial sac and emphysema of the skin clearly 
point to rupture of the bowel having taken place, a condition which is 
usually fatal in animals. 
Incision (herniotomy) is resorted to, to remove strangulation, and 
may be carried out in various ways. In human surgery a distinction 
is made between hernial incision without opening the peritoneal cavity, 
so-called herniotomia externa, and a similar operation with division of 
the peritoneum (herniotomia interna). External herniotomy offers great 
difficulties, but was formerly more resorted to than at present, because 
now-a-days the use of antiseptics has greatly diminished danger from 
peritonitis. The same is true in animals. The procedure in performing 
the external operation is as follows:—The seat of operation is carefully 
disinfected, the animal anaesthetised and placed in a suitable position, 
and an incision, which must extend the entire length of the sac, carried 
through the skin covering the hernial swelling, in the longitudinal axis 
of the body. After dividing the panniculus to a similar extent, both 
skin and panniculus are thrust to one side, and an attempt made to 
attain the hernial ring. Large vessels are ligatured to keep the field of 
operation clear, firm portions of connective tissue divided with the 
scissors or knife. By introducing -the finger into the depths, one can 
discover the narrowest, that is, the strangulated, spot, which is then 
widened with a herniotome or tenotome without injuring the peritoneum. 
This effected, taxis becomes easy, and the wound is at once carefully 
cleansed and stitched up. 
Internal herniotomy requires similar preparations. The incision is 
made through the skin in the same way, and the hernial coats lying 
beneath divided with a knife as far as the peritoneum. A little fold of 
the latter, at the base of the hernial sac, is then raised with forceps, and 
cut through close below the forceps with a knife held horizontally, 
producing a small opening. By means of blunt-pointed scissors this 
opening is enlarged, the index finger pushed into the hernial sac, and the 
peritoneum incised with scissors as far as the neck of the sac, the finger 
meanwhile pressing back the hernial contents and protecting them from 
injury. The finger is now passed into the hernial opening, the liernio- 
tome introduced alongside it, and the ring or neck of the hernial sac 
