[Reprinted from The Medical News, May 4, 1895.] 
A CASE OF INCARCERATED HERNIA AND ITS 
REDUCTION BY MEANS OF RECTAL TAXIS. 
By GEORGE S. BROWN,. M.D., 
OF BIRMINGHAM,- ALA. 
On February 21st I was called to see a white child, 
C. M., two months old, who, while crying and straining 
at stool, suffered a right inguinal rupture. I saw him 
thirty minutes after the accident occurred and discovered 
a cylindrical-shaped tumor, three inches long and of a 
nearly uniform diameter of about one inch, distending 
the right scrotum and extending uprto the internal ring. 
The end of the tumor occupying the bottom of the 
scrotum was easily made out to be a portion of bowel 
distended with gas. This composed about one-third of 
the total length of the tumor. The remaining two-thirds, 
or two inches, was a solid non-compressible mass. It 
was traced to and found to be firmly wedged in the in- 
guinal ring. Under profound anesthesia from chloro- 
form and with the child held vertically by the feet to 
secure the additional aid of gravity I began an attempt to 
reduce it by taxis. It was a surprise to me to find how 
very tightly this solid portion of the hernia was wedged 
into the inguinal opening. It conveyed a sensation to 
the hand similar to that of a corn-cob stopper in a jug 
(to use a readily understood simile), one that had been 
forced into the jug with an effort and time allowed for 
the inner end to absorb fluid and swell to the size of the 
large end outside. Upon introducing my finger into 
the rectum, after half-an-hour of futile effort at taxis in 2 
the ordinary way, I was even more forcibly struck with 
the exactness of the foregoing comparison. The tumor 
could be moved about between my finger in the rectum 
and my external hand in any direction except vertically 
through the ring. Just here it seemed to me that I 
had discovered something valuable, as I found I had 
absolute knowledge and control of the entire hernial 
mass. By making steady pressure on the mass from 
without, while with the finger in the bowel I pushed 
from side to side in every direction the portion of the 
mass presenting through the abdominal opening of the 
inguinal canal, I was finally rewarded by feeling the mass 
move back through the opening slowly and tightly all the 
way, and at last drop back into the abdomen. This 
portion, clearly omentum, had followed the loop of 
bowel through the ring and caused immediate and com- 
plete strangulation. The loop of bowel, now that the 
wedging epiplocele was put out of the way, retreated 
rapidly under gentle taxis and disappeared with the 
characteristic flop. The process of reduction is exactly 
illustrated by inverting a bottle of champagne which is 
a little stale. The force of the contained carbonic acid 
will represent the steady pressure maintained by my 
outside hand, while the to-and-fro motion of the thumb 
on the cork, to aid its expulsion, will represent the action 
of my finger in the rectum on the interior portion of the 
tumor. This finger in the rectum gave exact knowledge 
of when and how much, first the epiplocele and, then, 
the bowel moved, and just when they successively 
passed back through the internal ring. The tip of the 
finger could then be introduced into the internal open- 
ing. Another useful aid it gave was that on lessening 
the pressure from without I could push it up alongside 
the tumor and dilate the internal ring. 
On a somewhat superficial search I can find no men- 
tion of this method of rectal taxis in the reduction of 
hernia. If it has before been employed, I would be 3 
grateful for information on the subject. At any rate, I 
wish to emphasize my conviction as to the value of it. 
Taxis in this case in the ordinary way, with the child 
inverted and profoundly anesthetized, had completely 
failed. The finger in the rectum, introduced for examin- 
ing purposes, rendered the reduction possible and saved 
a cutting operation, which was then being prepared for. 
I would suggest finally that a recently incarcerated 
inguinal hernia in an adult might be reduced in a similar 
manner. A surgeon with a small hand might introduce 
it entire into the rectum and give material aid to the 
efforts at taxis without, by traction with finger and 
thumb on that part of the tumor just within the internal 
ring. I say this might be possible, and when such a 
case presents itself I shall certainly try it. 
I would add that the child had no further symptom of 
any injury, being apparently as well as ever the next 
morning.