33 
A TREATISE ON INGUINAL HERNIAS. 
From our method of castration, the appearance of an enterocele 
is a circumstance pregnant with difficulties and dangers; and the 
operator is all in a moment, and that an unexpected one, called 
on to take the most prompt and decisive measures. The first 
thing to be attended to is the reduction of the protruded intestine; 
and, having completely accomplished this, we should prefer the 
application 3 of the clams and the removal of the testicle (a la 
Francoise) to leaving the organ in and closing the scrotum by 
suture. The tunica vaginalis should, if practicable, be included 
within the clams; and the clams themselves pushed as high up 
as possible against the abdominal ring, using every precaution 
against the possibility of including within their gripe any knuckle 
of intestine. _ 
Should the operation have been practised with the clams in the 
first instance, the reduction may often be effected (in the recum¬ 
bent and proper position of the body) without removing them; 
the parts being, by way of security, afterwards brought together 
by suture. Should we, however, fail to accomplish the reduction 
in this simple manner, we must not hesitate to take off the dams, 
having first placed a ligature of silk or twine doubled around the 
chord above them. In our attempts at reduction, we may draw 
out the chord, or push it on one side, in order to facilitate an un¬ 
dertaking which becomes, on occasions, a very arduous one, in 
consequence of the violent abdominal efforts made against us, by 
which fresh portions of gut are successively driven out. 
“ In such grave and embarrassing circumstances, it is not without danger 
we resort to the expedient of introducing the hand into the rectum, to aid 
the reduction, which should always be actively prosecuted during the inter¬ 
vals of tranquillity. Should every varied manoeuvre prove unsuccessful, we 
must let blood as the animal lies: we may also employ emollient and muci¬ 
laginous fomentations. Should these different means not so far abate pain 
and induce relaxation of parts sufficient to enable us to succeed,—should 
they work no favourable change at all, the case may be regarded as a hope¬ 
less one. 
“In a case of strangulation, the stricture must, in course,be divided ; but 
this is a proceeding which does not always answer. When the contractions 
are strong and frequent, dilatation of the sheath serves only to facilitate 
the descent of intestine ; the herniae then forms a voluminous mass exter¬ 
nally, whose reduction becomes impracticable. 
“ As soon as we have succeeded in replacing the intestine within the 
belly, we must set about detaching the vaginal tunic, and clearing it from 
the dartos. This done, we draw forth the tunic, together with the chord, 
applied one against the other, and we fasten the clams upon them as wc 
would for castration (a testicule couvert). This second compression must be 
made higher, if possible, certainly not lower, upon the chord than the for¬ 
mer: when this cannot be accomplished, wc must employ, in place of the 
clams, a ligature of twine ; one advantage of which is, that we can put it on 
nearer to the ring. 
