File:Annals of surgery (1885) (14587325967).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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FiG. 4.—Case XXI. Before operation. Showing the large descended leftinguinal and undescended right direct inguinal hernia. tion, was immediate, and perhaps is one of the greatest gains in com-fort following such large herniotomies in old people. The accompanying anjesthesia chart of a plotted five-minute LOCAL ANESTHESIA IN RADICAL CURE OF HERNIA. 15 pulse-rate shows how little effect the operation had upon the cardiacaction. (Fig. 3.) Case XXI.—Large, completely descended left inguinal hernia.Large, undescended right direct inguinal hernia. (Fig. 4.) Mentionis made of this case on account of the large size of the hernia, whichhung half-way to the patients knees, and measured fifty-one centi-metres in circumference, and on account of the painlessness of theoperation. As will be pointed out later, there is great variation in
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Fig. 5.—After operation on left inguinal hernia, showing area of subsequent anaesthesia. the distribution of the nerves supplying the inguino-scrotal region,and the anastomoses may be sufficiently free to embarrass the operatoreven after cocainization of the main sources of supply. In this par-ticular case, after cocainization of the ileo-inguinal alone, as it lay inthe canal (cf. Fig. 12), no further pain was experienced by the patient,except at the lower part of the scrotum, when the testicle, which wasremoved, was freed from the blood-supply at its lower pole, in which 16 HABVEY GUSHING. situation evidently unanaesthetized filaments of the internal pudic wereencountered. Castration and transplantation of the rectus were per-formed and the parietes closed. In this case simple division of onenerve-trunk, therefore, anaesthetized the entire deep operative field.That this trunk was a combined one is shown in Fig. 5, which givesthe area of subsequent cutaneous anaesthesia (ileo-inguin

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