On hernial and other tumours of the groin and its neighbourhood : with practical remarks on the radical cure of ruptures / by Carsten Holthouse.

  • Carsten Holthouse
Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: On hernial and other tumours of the groin and its neighbourhood : with practical remarks on the radical cure of ruptures / by Carsten Holthouse. Source: Wellcome Collection.

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    ]60 of inguinal hernia occurring in females, in whom there is not much fascia capable of beiug iuvaginated at this point. In some very small cases, both in male and female subjects, this last transfixion of the fascia or pillars by the needle may be altogether dispensed with; as any great amount of permanent invagination of the sac or fascia is not necessary to fill up a nar- row hernial canal when drawn together by the suture. In some small female cases, a simple incision over the superficial ring, without any separation of fascia, will suffice to apply the neces- sary sutures with accuracy, and to afford a free escape for the discharges. The next step in the operation is to straighten, stretch, and draw down both ends of the wire, until the loop above is close to the skin. Here it is held by the finger of an assistant while the surgeon twists the ends round each other, giving them three or four turns. This manoeuvre twists also the enclosed sac and fascia which are held between the ends of the wire. Next, the loop is drawn steadily upwards so as to invaginate the twisted sac and scrotal fascia firmly into the hernial canal, stretching them as far up as possible towards its deep opening. The loop is then, in its turn, twisted well down into the upper or groin puncture, giving it the same number of turns. The fore- finger of the operator should now be placed in the scrotal punc- ture to ascertain whether a satisfactory closure of the superficial ring has followed the tightening of the wire. The efiect of trac- tion on the wire upon the posterior wall can also be distinguished. Great care should also be taken that the skin of the scrotum is not drawn upwards between the pillars of the ring, so as to prevent their direct union. The projecting ends of the wire are then cut ofi by pliers about three inches from the surface; and both together bent into a hook, which is carried upwards to meet the loop curved down to receive it, till the two are locked together, and form an arch over the intervening skin. A pad of lint, rolled tightly up to a size sufficient to fill up the interval between the arch of wire and the skin, is then placed under it between the punctures. A broad spica bandage is then placed over all, so as to make firm compression upon the wire steadied by the pad of lint.