File:The practice of surgery (1910) (14798710343).jpg

Identifier: practiceofsurger00mumf (find matches)
Title: The practice of surgery
Year: 1910 (1910s)
Authors: Mumford, James Gregory, 1863-1914
Subjects: Surgery
Publisher: Philadelphia and London, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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crotal swelling. We differentiate hernia frominguinal adenitis, which presents a hard, unvarying swelling; frominguinal sarcoma, which is hard and unvarying also; from psoas abscess,which fluctuates and may be confused with inguinal hernia; fromvarious hard and soft tumors of the testicle and cord, which tumorsare constant; and from hydrocele, which most closely resembles hernia. INGUINAL HERNIA 203 Hydrocele is fluctuant, dull on percussion, shows transmitted lightwhen examined by the hydroscope, and is invariable in size, except,of course, in cases of congenital hydrocele, but congenital hydroceleis commonly associated with and a part of congenital hernia. The operative treatment of both forms of inguinal hernia has nowbeen brought to such perfection that palliative measures are rarelyconsidered by surgeons. Yet palliative measures have their value,and by palliation I mean the use of the truss. One hesitates to advisea radical operation upon a feeble old person, and one shrinks from
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Fig. 108.—Deep dissection of inguinal and femoral canals (de Garmo). operating upon persons with advanced organic disease—cardiac, pul-monary, renal, diabetic. Moreover, in a Hmited class of cases trusseswill cure hernise—the hernia? of children under four years of age_ (thehome-made yarn-truss will often suffice); the small recent hernise ofyoung adults. In order to attain this result, however, you must enjomthe patient to wear the truss constantly that the hernia may not comedown, else a single violent exertion may undo the good work of months.The only hernise suitable for truss wearing are reducible hernise. Irre-ducible hernise are irritated and made worse by a truss. Large, irre- 204 THE ABDOMEN ducible scrotal hernisc, however, may be supported in a well-fitting bagshould the radical ()i)eration seem inadvisable. There is a great varietyof trusses made b) the instrument-makers, and the principle of them

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