OCR Text |
Show OF IIIE LIGAIURE OF THE CORD. or THE mantras OF THE cone. sac of a hernia, lying before the cord, would he have done it better by dissecting the testicle free in the first place, and af» or not succeeding in that, we can tie this ligature so as to in. elude the portion of the cord in two distinct knots. But the manner I have described is still a better method b3 which the testicle itself is made to answer the purpose of this ligature; for instead of cutting the cord through at once, we leave one third of it (not the body of the cord, or chief fas~ eiculus)--and havmg thus cut the main artery, the weight of the testicle keeps it drawn down until that artery or its branch" terwards cutting the cord P But putting aside this objection of the possibility of a hernial sac being in the way, are there not other more cogent objections against this operation ? For example, the thickening and disease of the tunica vaginalis, in hydroeclc, may have de~ ceived us, and we shall only discover this when we have in effect castrated the man. But is this not equally apt to 1121p pen when we dissect the testicle out in the first place .9 For unless, like Pott, we push a trocar into the substance of the testicle, as a first step of the operation, we shall be no better able to ascertain the disease when the scrotum is dissected oil", than by feeling the testicle through the integumcnts. In regard to the manner which I have recommended of ty-v ing the cord, it will be said, that the cord is apt to slip up into the belly. Mr. Benjamin Bell says, that he has seen this twice in his practice, and that the patients died of hamorrv hagy in consequence of it. It must have been a shameful bu~ siness ; and all that can be said is, that it is to be regretted there was no person present capable of giving a good advice. This retraction of the cord is a consequence of letting the weight of the diseased testicle hang upon the cord, so as to pull it down before it is cut. 165 cs are secured. But if this should not be done, and the cord by any aeei» dent retract within the ring, death from heemorrhagy is, l trust, still not inevitable. We may follow the cord \\ ith all safety, even to the origin of that muscle, the cremaster, which pulls it up, if we know the course which the cord takes obliquely onward, along the grooves of the lower pillar of the ring. ‘ It will be said that it is difficult to take up the artery sepa~ rately. I have only to reply, that I have done it, and seen others do it who in other matters had little dexterity. It is with more truth said, that often it will happen that if you take up the individual artery, you will find that there are meny mouths. Mr. Home says, " I have known a surgeon take up the spers "'hen by cutting off the testi» rnatic artery alone, then five or six vessels one by one; and cle, this weight is taken away, the cord retracts ; we have to after having kept the time necessary for this purpose, find him- take care then (if the cord be then loose, and the testicle hang self obliged to include the whole cord in a strong ligature, ing) to support the testicle, and allow the cord to retract as so many other vessels continqu to bleed." faras it will before. it is cut. We shall not then see the cord (jerk up into the belly on the incision being made. proves that in some cases the arteries are numerous, and that If, however, we find the cord diseased in such a way that we should be tempted to cut it very near the ring, it is necessary to separate it into two fasciculi, and put the needle, With a double ligature, through betwixt them, before cutting" 1110 cord across, lest we should afterwards have difficulty from the retraction of the cord within the ring. This ligature may draw down the cord, whilst we secure the months of the vessels ? T0 me this only after dividing the cord, and seeing many vessels throw out their blood, we shall be obliged to include the whole cord, or to tie it in two fascieuli. That we can thus do it, after having attempted a milder method, is an additional motive for preferring the ligature of the individual artery. 0n the other hand, when we wish to take every possible source of irritation from the extremity of the cord, we, after having divided it, tie a ligature either on the whole cord, or in two divisions. The cord is at this time enlarged and thin} |