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Show 66 VARICOSE SPERMATIC CORD. VARICOSE SPERMATIC CORD. guments, in general are often thickened. The operation is thus described by Mr. Home :~- The patient stands upright, and the inside of the knee being turned to the light, a fold of the skin is pinched up transversely to the course of the vein. A cut being made across this fold and the vein appears covered only with the aponeurosis. By making a little out in the membrane on each side of the vein, (not dissecting further on its coats) the common silver- this knot of veins from the spermatic vessels, and gives the upper portion to the assistant, to beheld very tightly, whilst he holds the lower part himself; he then makes a cut through the integuments, and exposes the varicose veins. But I must remark here, that if the surgeon or assistant lose hold, of that tissue of vessels which they know in the turgid state of the vessels to be those which form the tumour, they may find themselves at a loss in the middle of the operation, eyed probe, or a blunt silver aneurismal needle, may be thrust and unable to say, among the vessels of the cord, whether they under itse- The edges of the wound are brought together by sticking plaster. 0n the tenth or twelfth day, the ligature comes away. We are indebted to Mr. Home for the operation on the saphena vein, who has the further merit of instis tuting it from a previous careful investigation of the pathological principle. have got the right vessels again or not. Having exposed the varicose vessels, they are to be separated as much as possible. Then where they are attached by vessels above and below, a needle and common ligature is put when the skin is let go, a longitudinal incision is on the thigh, :r' .- "433M , ‘ ‘...1.:. 67 01" VARICOSE ENLARGEMENT OF THE VEINS OF THE SPERMATIC CORD. round, and tied betwixt these ligatures. The tumour is next to be dissected away. The wound is to be brought together with adhesive straps, dressed with a little lint; and the whole suspended. How this operation restores the more vigorous circulation of 1" y" ..93..\.va+:~we'-‘-Sn'- ~ ‘JUHQC‘ l‘ the testicle, I am at a loss to comprehend; unless it be much z" Tim spermatic veins stand very much in the same relation to the column of blood with the veins of the thigh and leg, and they are liable to the same disease. I do not say that they are precisely of the same nature. This state of the veins of the cord attends the relaxation of the scrotum, and occasions a diminution of the testicle, with pain and uneasiness. It is a disease frequent in warm climates. The treatment of slighter affections of this nature is evidently to suspend the testicle, and to bathe with cold astringent waters. But there are degrees of this disease in which an operation may be safely recommended. It is when there are distinct varicose knots ; and where they can be separated with the fingers from the main course of the vessels of the cord. I have assisted my brother to perform the operation in this manner: the operator feeling the cord and Vessels, separates " We are to recollect that the TC in is sometimes doubts, and that in this case both are to be tied. assisted by the stimulus of the knife, as an old surgeon and friend. of mine expresses himself: yet it certainly succeeds. I must, however, pointedly observe, that after an operation of this kind, on examining the extirpated part, I have seen a full inch of the spermatic artery in the centre of it. Here, where I thought the testicle would waste in consequence, the patient did well, and expressed himself highly satisfied and relieved. This is one in the circle of operations; but not, I conceive, to be lightly performed, or on common occasions. .Mmm w-vr . |
