File:Annals of surgery (1885) (14587328687).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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and lateralbranches of the twelfth thoracic, may divide fibres from one orthe other of these sources, and thus lead to a subsequent areaof anaesthesia to the inner or outer side of this upper angleof the incision. This is well illustrated by the accompanyingphotograph (Fig. 8) of a double herniotomy, in which the inci-sions were made at different distances from the median line.This bordering anaesthesia, on one side or other of the skin LOCAL ANMSTHESIA IN RADICAL CURE OF HERNIA. 25 incision, may occasionally represent the entire area of post-operative cutaneous anaesthesia, even when the ilio-inguinaland genital branch of the genito-crural have been divided orcocainized, as is shown in photograph (Fig. 9). Presumablyin such instances the crural branch of the genito-crural suppliesthe area on the inner side of the thigh, usually accredited tothe former two nerves. Such an arrangement occurs occasion-ally in Dr. Bardeens diagrams. Deeper Nerves met in the Operation.—The ilio-inguinal
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Fig. 9.—Showing small post-operative area of anaesthesia to the inner side ot theincision, consequent to the division of lateral cutaneous branches of thetv^elfth dorsal. In this case the ilio-inguinal and genital branch of thegenito-crural had been divided with loss of cremasteric reflex, but withoutproducing any cutaneous anaesthesia. nerve emerges from the external ring, and near by, or alsothrough the ring, the genital branch of the genito-crural ap-pears. In the canal they usually are found anastomosed as onetrunk, the early cocainization of which at the deeper part of thecanal, after splitting the aponeurosis beyond the internal ring,is perhaps the most important step of the operation. As hasbeen stated above, this may result in no additional cutaneousanaesthesia. The usual anaesthetic sequel, however, is repre-sented by a complete loss of sensation of the entire scrotal 26 HARVEY CUSHINQ. contents, cord, hernial sac, and testicle, with the possible ex-ception of its lower vas

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