Surgery; its theory and practice (1896) (14591293097)

Identifier: surgeryitstheory00wals (find matches)

Title: Surgery; its theory and practice

Year: 1896 (1890s)

Authors: Walsham, William Johnson, 1847-1903 Spencer, Walter George, 1858-1940

Subjects: Surgery

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Contributing Library: Columbia University Libraries

Digitizing Sponsor: Open Knowledge Commons

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infants, however,a hernia may be translucent, and in a hydrocele of the congenitalvariety, the fluid can be pressed back into the abdomen, but itdoes not return with the gurgle or slip characteristic of a hernia.6. In varicocele the dilated veins feel like a bag of worms in thescrotum, and the impulse on cough has a thrill-like character. A 646 DISEASES OF REGIONS. varicocele, like a hernia, is reduced on the patient lying down,but if the finger is placed firmly over the ring, the veins, on thepatient rising, refill notwithstanding the pressure of the finger,whereas a hernia would remain reduced. The indirect herniacannot practically be distinguished from the direct, as the ringsget dragged opposite one another. The indirect is more commonin the young, the direct in the old. Treatment.—What has already been said on this subject withregard to hernia generally is applicable here, and it need only beadded that if an operation is necessary the incision (Figs. 310 and Fig. 310. Fig. 311.

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Oblique inguinal hernia, with line of incision. Direct inguinal hernia, with line of incision. 311) should be made downwards and inwards, over the long axisof the hernia, beginning just above the external abdominal ring;that the stricture, whether the hernia be direct or indirect,should be divided directly up7vards, so as to avoid the epigastricartery; and that when combined with retained testicle a trusswith a -^-shaped pad should be worn, if practicable, above thetesticle. If the truss causes the testicle to become frequentlyinflamed, the testicle had better be removed (see retained testis).A FEMORAL HERNIA is onc that cscapcs into the femoral sheath,and nearly always internal to the femoral vessels, though in veryexceptional cases it has been found external to them. As a rule,it leaves the abdomen at the femoral ring, and after passingdownwards through the femoral canal, emerges at the saphenousopening, and then turning upwards and outwards over the ftilci-form process of the fasci

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1896

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