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Show 190 OPERATION ron BUBoxoanI: AND scnonn Remus. OPERATION FOR BUBONOCELE AND SCROTAL HERNIA- 191 Let it be recollected that though rarely, yet it sometimes happens that the spermatic vessels (and particularly the vas dilate what remains. But let not the finger be bored forcibly into the mouth of the sac. deferens), are spread on the fore part of the sac of the bubo- nocele, So that the patient may be castrated by a stroke of the knife, even before the sac is opened! "With the forceps, the proper sac is now pinched up, and cut by carrying the knife horizontally. The probe or directory being introduced, the opening is enlarged, when the finger maybe put into the sac, and the whole length of the sac slit up. In doing this, there is no apology for haste; and even if any stight doubt arises whether or not this is the sac which we have exposed, then we run in the directory under the membrane. ' If this be only a layer of cellular membrane, the directory passes with diificulty; if we have penetrated the sac, the point passes easily. Again, we are not always to expect the dark-coloured gut; but the fatty, cellular sub- 13‘MLFTTUKQ. _.-A ,_ mum‘s: ,o stance of the omentum may present; my that fat may be adhering to the sac, which may still more perplex the young surgeon. Fluctuation in the sac I conceive to be a very rare occurrence ; nor are we to value highly the prognostic from the colour of the fluid which escapes, since we have the parts themselves under our inspection. The surgeon now introduces his finger into the neck of the sac, and feels the place and degree of the stricture. If he can easily introduce the point of his finger into the belly, he may try to reduce the gut without further cutting. But this is not likely ; and to endeavour to dilate the narrow neck of the sac by the finger, is as full of danger as the attempt to compress the gut is, and forcibly to reduce it. I have introduced a plate, in which we see the effects of violence in this part of the operation. If the tip of the finger be admitted into the mouth of the sac, then the ring and the mouth of the sac being raised on the point of the finger, the transverse bridling fibres are to be scratched with the point of the knife; when the finger may The point of the finger is put into the neck of the sac, so as to lift up the edge of the tendon; the knife is then carrir ed forward on the finger, and what is felt firmly constricting, is cut fibre after fibre with the point of the knife. When the finger enters easily, the stricture is sutliciently taken ofl‘. If the neck of the sac does not admit the finger (the assistant holding down the distended intestine), the surgeon insinuates the directory into it, and with the probe-pointed his; tory he cuts the mouth of the sac and the ring. |