BY HERNIOTOMY. 
291 
distinguished through the rectal wall. Should these attempts come to 
nothing, the operator must proceed to herniotomia interna, that is, 
incision of the processus vaginalis together with the abdominal ring. 
The seat of incarceration may generally be felt by introducing the 
finger, and division must be made at that point. The intestine generally 
lies in front of and above the testicle. 
According to Moller’s experience, in old stallions strangulation occurs about 
an inch below the internal abdominal ring. In geldings, on the other hand, he 
has generally found the annulus abdominalis the narrowest point. Possibly 
the heavy pull of the testicle on the spermatic cord, which becomes fan-shaped 
in the abdomen, exercises some influence on the funnel-shaped, or, as the 
French call it, the “hour-glass ” dilatation of the processus vaginalis, which 
is most noticeable towards the inner abdominal ring. The continuous pull can 
without doubt produce a dilating influence of that kind, which would explain 
the greater predisposition of old stallions to protrusion of the bowel at the point 
indicated. 
Girard constructed for this operation a pair of long hernia knives, one 
in the form of a greatly enlarged straight tenotome, and the other in that 
of a bent tenotome. The ordinary herniotome (fig. 129) may also be 
employed, or in case of need, a blunt-pointed bistoury. The abdominal 
ring must be incised near its anterior angle, and the cut be made in an 
outward direction. Towards the middle line, and in the neighbourhood 
of the posterior angle, are the vessels of the abdominal walls, which 
must be avoided, and any lengthening of the anterior angle is apt to be 
followed by tearing of the inner oblique abdominal muscle. Even when 
the point of incarceration has only been incised to the extent of a line or 
two, reposition becomes easy, and indeed usually results from the pull of 
the abdominal viscera themselves. Paty recommends pouring extract of 
opium and belladonna dissolved in oil into the processus vaginalis. This 
certainly lubricates the contents of the hernial sac and assists reposition; 
but plain oil sterilised by boiling would serve the same purpose. After 
reduction, treatment is the same as in non-strangulated rupture, that is, 
a pair of clams are adjusted as high up as possible over the spermatic 
cord and tunica vaginalis, which latter should be rotated once on its 
long axis. 1 
Where it is important to preserve the testicle, the subcutaneous 
operation, recommended by Bouley, can be carried out, though the 
strictest asepsis must be observed. The scrotum and tunica vaginalis 
are cautiously divided at the outer side, in the neighbourhood of the 
inguinal ring, so that a grooved director may be intioduced into the 
narrowest part of the processus vaginalis, which is then divided with the 
1 A full description of several cases of acute inguinal hernia treated by operation will be 
found on pp. 55 and 371 of Cadiot and Dollar’s “ Clinical Veterinary Medicine and Surgery.’’ 
For details of the u covered operation” of castration, see Dollars Opeiati\e technique, 
p. 217. 
u 2 
