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Show 01' THE TRUSS. OPERATION FOR BUBONOCELE AND scnomL HERNIA. 18%) from the crest of the pubis, as not to press the cord against the os pubis. When the pad of the truss is applied, as in the place of the circle D, it may prevent the oblique descent of the hernia; and yet as it does not press against the bone, no pain, swelling, or varicose state of the cord follows. But most generally the passage is so direct, that the pad must be placed as on the circle C, in which case the only resource is, so to tease out and knead the hair of the pad, so as to be of the form of the dotted line E, that a kind of channel be left for the lodgment of the cords. A hard pad and strong spring wastes the substance about the ring, leaving only the tendons and skin. By perse~ verance in the use of a proper truss, the neck of the sac may be made to adhere ; but in the adhesion of such membranes, unsupported by a change in the tendinous ring, I have no faith as a support against the recurrence of hernia. l' A, the cord. B, the ring (we shall suppose). C, i/lc pad? :1 Iplz'ed lzcre m'll chafe and compress the cord. Applied at D, wmrnml "in" _ , 4.- ..).-..~c.-..-.-«-t-‘ A» ltlttltltlll‘ WEE .arrowA FOR BUBOWOCELE "D an "ROTH; "an." ' - i' a _ l:.-\_ i . 1/ it will oflen 712772 more ease, and as (fier'tztally, support the rz/_/J= ‘_ , p lure. 01" THE TEL-SS, WHEN the hernia is reduced, we still feel the empty sac; and now the surgeon must be particularly careful that no pore tion of the gut or of the omentum remains in the neck of the sac, when he is about to apply his compress or truss; forhigh inflammation, or all the effects of strangulation may result from this. Still keeping the patient supine, with the muscles of the belly relaxed, we examine well where the finger sinks into the ring, and if possible distinguish the course of the cord. We then try whether pressure towards the outer side of the ring does not effectually support the hernia. This it will do, if the passage of the neck of the sac be at all oblique through the abdominal tendons. If this be the case, then the pad of the tr us: is to he applied to the side of the ring, yet so far removed THE first incision is carried through the common integriments only, beginning about an inch and a halt above the base of the tumour, and reaching very near the bottom of the sero- tum. If the knife be carried lower, the tunica vaginalis testis may be cut. The blood escapes from the external pudic ar~ tery, but seldom requires the tenaculum. The fingers being spread upon each side of the incision, or the tumour grasped by the hand on the back part, the small transverse slips of cellular membrane which may remain are touched lightly with the edge of the knife. Then the thin aponeurotic membranes are scratched by the knife, when the grooved directory is thrust under them, layer after layer, and the edge of the knife run along it, until the thin, or at least the bare lamina of the peritoneum appears. ' Baked hair is the proper substance for the pad; and often the patient will himself give a form that sits with perfect case, when that given by the maker chafes and irritates ' . ' |
