288 
TREATMENT OF NON-STRANGULATED INGUINAL HERNIA. 
of Bassi and others, and for this reason this method cannot be recommended; 
that above described is certainly to be preferred. 
Sorensen (Stockfleth) and others apply a ligature above the clams 
for a similar purpose. The clams are removed next day, but the ligature 
is left in position until it falls off. Tetanus is, however, said to be a 
common sequel. 
(c) The method of ligaturing the tunica vaginalis, together with the 
spermatic cord, has not found many supporters; though a few recommend 
it. It certainly cannot produce such perfect occlusion as the clams, 
though, if aseptic materials like silk be employed it may render it 
possible to close the processus still higher in the inguinal canal. 
(cl) Bouissy’s plan of multiple ligation of the scrotum is inadvisable, 
because of the danger of including a portion of bowel, and to prevent 
this (even when using the clams over the processus vaginalis), it has 
been suggested to first incise the processus, and, by introducing the 
finger, to make sure that no intestine is present. This may be useful 
in doubtful cases, but an external examination generally suffices. 
(8) Closure of the abdominal or inguinal ring. Many operators 
describe having sutured the inner abdominal ring, but as the modus 
operandi is never sufficiently well described to convince one of the 
correctness of the assertion, the point must remain doubtful. In old 
stallions the narrowest portion of the inguinal canal lies f to 1J inches 
below the abdominal ring, and presents an almost insuperable difficulty. 
If the inner abdominal ring has ever been sutured, an abnormal condition 
of the parts has clearly existed, to begin with. On the other hand, the 
position of the inguinal ring (i.e., the outer ring) would easily allow of its 
being sutured, but the rigid character of the edges (tendinous head of 
the external oblique muscle) effectually prevents union. Certainly the 
same success could not be obtained as by the above described methods, 
and this probably explains its slight popularity. 
In the gelding, operative measures must be somewhat modified. Here 
the processus vaginalis must first be found, which is most easily effected 
in the following way :—The horse is cast, chloroformed, and laid on its 
back ; the castration cicatrix discovered, and an elliptical incision made 
through the skin around it, so that the skin which is adherent to the 
base of the processus or to the end of the spermatic cord can be lifted, 
together with the sublying tissues, by means of a narrow tape passed 
through it. The processus vaginalis is then separated as in the operation 
for scirrhous cord, and exposed for a considerable extent in an upward 
direction. The clams are now applied over the processus and spermatic 
cord in the manner above described, provided no intestine is present in 
the processus; but as one must, in the gelding, always be prepared for 
adhesions, it is best where the slightest doubt exists to open the processus 
