STRANGULATED INGUINAL HERNIA. 
381 
needle and (per rectum) punctured the distended bowels, giv¬ 
ing rise to the escape of gases and bloody serum, thereby dimin¬ 
ishing the volume of the intestines to a considerable degree. 
The discharge of bloody serum through the tube indicated a far 
advanced gangrenous state of tiie bowels, and I then practiced 
taxis with the left, and with the right hand endeavored to extract 
the pinched knuckle of intestine, hut to no purpose. The ani¬ 
mal apparently approaching death rapidly, I desisted from any 
further attempts to reduce the hernia and made a fatal prognosis. 
Death ensued about fifteen minutes later in my presence. I 
immediately made an autopsy, which verified my diagnosis. 
Opening the left testicular coverings, a flow of serum followed of 
a reddish color hut containing no intestines. Exposing the right 
testicle also caused a discharge of bloody serum. Enlarging my 
incision upward toward the inguinal canal, I discovered a coil of 
intestine about four inches long protruding from the abdomen. 
This portion of intestinal tube was of a mahogany color, greatly 
congested and thickened, but nowhere was it found to be in a 
sphacelated condition. The line of constriction was sharply 
defined. Small intestines contained a large quantity of bloody 
serum throughout their whole extent. 
There is of course nothing of any interest in the occurrence 
of strangulated hernia, but there is in the operation for its relief, 
which I, to my regret, have not as yet had an opportunity to per¬ 
form. 
The greatest importance is attached in diagnosing the case 
before the strangulation has caused irreparable damage; that is, 
the impairment of the vitality of the protruded bowel that it 
could not recover itself. It is my belief that in the vast major¬ 
ity of cases, if seen immediately after the occurrence of strangu¬ 
lation, reduction can be effected by manipulation without much 
trouble, but as time elapses it becomes more and more difficult of 
accomplishment, simply because the parts are becoming more 
engorged every moment. If failure attends this method after 
reasonable trials, herniotomy ought to be resorted to at once. I 
am thoroughly satisfied that long-continued and violent attempts 
to effect reduction by manipulation often destroys the only 
chance remaining, and to wait for a spontaneous reduction is haz- 
