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Show 100 or CUTTING "HIE CORD. We ought besides to observe well any distended cells on the cord, and dissect them ; and run the probe to the bottom of them before we cut the cord across. "To must also be careful not to cut through a confused mass of condensed cellular membrane ; for it may prove to be a herniary sac, and this. has actually happened. or CUTTING THE com. 101 ed, so as also to require a ligature ; or whether any other ar‘ teries bleed. Having secured all the arteries, the cord is to be entirely cut through. The incision being made in the whole length of the scrotum, and the cord cut through, the severe part of the operation is done ; and now we have only to pull down the cord, and with a free dissection turn out the testicle. If the testicle has been large, or the common inflammation active, the septum scrotiwill have adhered to the diseased testicle, and we shall have to cut a great part of it away with the testicle. This, of course, leaves the other testicle free, be- ing connected only by its cellular substance, so that it must be held aside by the assistant, or it will fall from its share of the scrotum. A considerable artery will sometimes bleed from the loose texture of the septum, and require a ligature. OBJECTIONS have been made to the cutting of the cord before the testicle has been dissected. In one case of extirpation of the testicle, " after the operation was completed, and the wound dressed, the patient being seized with a fit of coughing, to the astonishment and dismay of the surgeon, the dressings were forced off by a protrusion of several convolu- tions of small intestines ; from this it was proved that the patient had had a hernia: but the diseased enlargement of the testicle had acted as a truss, and prevented the rupture from coming down." This surgeon must have been remiss in ascertaining the his- Now taking the dissected part of the cord betwixt the fin. ger and thumb, cut it across, as is here represented, but not atonee. Cut into it, and as the vessels bleed, take them up with the forceps or tenaculum, on the surface A. 3011 command the bleeding with your finger and thumb ; and, holding up the cut. surface of the cord, you pick out tilt: extremity of the artery with the tenaculum‘ or forceps ; and the assistant ties a neat small ligature around the artery alone. 'lhen giving freedom to the blood, without letting go the cord, you examine whether the artery of the ma defers/IS b8 €111111‘S‘ tory of the diseaseas. He must have cut the cord directly through, without examination. If he could not recognise the * I venture to say, that there is nothing so truly despicable as the desire {a very common one) of giving a decided opinion off hand, without examin- ing the symptoms and history. The words Pox, Cancer, Sac. delivered on the first view of a case, ought never to impose on the young mind, as an indication of superior and almost intuitive knowledge. Had the young sur: geon the opportunity of observing the deliberate manner of investigation practised by the present Dr. Munro, a man the best entitled of any I know to give a decided and prompt opinion, he would never be ashamed of the seri= Gus investigation of a case, though apparently the most simple. VOL. 1. x, |