File:Annals of surgery (1885) (14587172718).jpg

Identifier: annalsofsurgery31philuoft (find matches)
Title: Annals of surgery
Year: 1885 (1880s)
Authors:
Subjects: Surgery
Publisher: Philadelphia Lippincott
Contributing Library: Gerstein - University of Toronto
Digitizing Sponsor: University of Toronto

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ircumstances, no further need of the anaesthetic, as we areworking in an area freed from all sensation. The combinedilio-inguinal and genital branch, which has been cocainized atthe outer limit of its exposure, is now reflected to one side orthe other, care being taken not to divide it, since this leadsapparently to a more or less permanent paralysis of the cre-master, which is to be avoided. I believe the accidental divi-sion of this nerve leads to the great relaxation of the scrotumso often seen after hernia and varicocele operations. In thelatter operation, especially, it would be detrimental to the bestinterests of a successful result to interfere with the cremasteric 32 HABVEY CUSHINO. function in any way. The remainder of the operation, theexposure of the sac and cord after a longitudinal division ofthe infundibuliform fascia, the amputation of the sac at itsneck, and closure of the peritoneal opening, the excision ofthe fundus of the sac, division of the cord and castration, if
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Fig. 12.—Sketch showing usual situation of nerves as exposed after reflection ofthe divided aponeurosis. deemed advisable, may now be done practically without pain.Occasionally, however, some stray fibres of the genito-cruralmay be encountered about the neck of the sac, and also duringcastration I have found that ligation of the veins at the lowerpole of the testicle may be painful, though division of the cord LOCAL ANJESTHESIA IN RADICAL CURE OF HERNIA. 33 above is not. Possibly the superficial perineal branches whichhave been unanaesthetized furnish nerves to this lower blood-supply. The closure of the parietes by any of the more commonlyemployed methods may now be painlessly accomplished. Notinfrequently in these cases, in old people with large herniasof long standing, the two rings have become concentric, andthe falciform expansion of the conjoined tendon is no longerpresent. It is in such cases that Bloodgood has advocatedtransplantation of the rectus fibres after opening of th

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